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Target Population Obese adults without diabetes No prior diagnosis of obesity-associated cancers Mean age: 47.2 years (SD 14.8) Study period: December 2014 to June 2025 Study Design Design: Target trial emulation using retrospective cohort data Database: TriNetX nationwide database of 113 million US patients Total cohort: 229,467 patients Matched cohort: 161,798 patients after 1:1 propensity score matching 80,899 GLP-1RA users 80,899 diet/exercise counseling controls Validation: Inverse probability of treatment weighting analysis Endpoints Primary endpoint: Cumulative incidence of 13 obesity-associated cancers between treatment groups Secondary endpoints: Cancer incidence stratified by: Sex (female vs

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