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Period III- High Dose Treatment Participants randomly assigned to tirzepatide at visit 3 who have not discontinued study intervention will be randomly assigned to a tirzepatide maintenance dose at visit 9 (15mg, 20mg, or 25mg.) Higher doses of tirzepatide (above 15mg/week) will have additional escalation every four weeks at 5 mg increments until the randomization dose of 20 mg or 25 mg is reached

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