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But here is the honest clinical ceiling: Average total body weight loss with phentermine monotherapy: 5-8% at 12 weeks With Qsymia (phentermine + topiramate): 8-11% at 1 year With lifestyle intervention alone: 3-5% at 1 year With GLP-1 medications (semaglutide/tirzepatide): 10-22% at 1 year With bariatric surgery: 25-40% at 1 year and maintained long-term For patients who need to lose 15-25 lbs and have no cardiovascular contraindications, phentermine is a legitimate first-line tool