Resistance Exercise and Incretin Mimetic for Cardiometabolic Health in Survivors of ALL With Obesity

Inclusion Criteria: * ≥5 years from diagnosis of acute lymphoblastic leukemia (ALL) treated with chemotherapy only * ≥2 years from completion of therapy * Participant has a negative (urine or blood) pregnancy test (if female) Consistent with the FDA-approval for marketing of Tirzepatide for the treatment of obesity: * Age ≥18 years at the time of enrollment * Participant has obesity (BMI \> 30kg/m2) or overweight (BMI \> 27kg/m2) with ≥1 weight related co-morbidity (hypertension, dyslipidemia, obstructive sleep apnea, cardiovascular disease) * hypertension: treated or with systolic blood pressure (SBP) ≥130 mmHg or diastolic blood pressure (DBP) ≥80 mmHg * dyslipidemia: treated or with low-density lipoprotein (LDL) ≥160 mg/dL (4.1 mmol/L) or triglycerides ≥150 mg/dL (1.7 mmol/L), or high-density lipoprotein (HDL) \<40 mg/dL (1.0 mmol/L) for men or HDL\<50 mg/dL (1.3 mmol/L) for women * obstructive sleep apnea * cardiovascular disease (for example, ischemic cardiovascular disease, New York Heart Association (NYHA) Functional Class I-III heart failure) Exclusion Criteria: * Participant has known diabetes or is found at baseline to have laboratory evidence of diabetes including HbA1c ≥ 6.5% * Participant is using or has used weight management medication in the past 3 months or had recent significant weight loss \> 5kg in the last 3 months Severe renal dysfunction (eGFR \<30 mL/min/1.73 m²) * Saxenda® (liraglutide 3.0 mg) * Xenical®/Alli® (orlistat) * Meridia® (sibutramine) * Acutrim® (phenylpropanolamine) * Sanorex® (mazindol) * Adipex® (phentermine) * BELVIQ® (lorcaserin) * Qsymia® (phentermine/topiramate combination) * Contrave® (naltrexone/bupropion) * Compounded or generic incretin mimetic (GLP-1) medication Note: Use of metformin or any other glucose-lowering medication, whether prescribed for polycystic ovary syndrome or diabetes prevention is not permitted. * Participant has Multiple Endocrine Neoplasia Type 2 (MEN2) or family history of medullary thyroid cancer * Participant has severe renal dysfunction (renal-eGFR \<30 mL/min/1.73) * Participant has history of major cardiovascular event in past 3 months (e.g. acute myocardial infarction, cerebrovascular accident, unstable angina, hospitalization due to congestive heart failure or currently NYHA class IV heart failure symptoms) * Participant has uncontrolled hypertension during clinic assessment (SBP ≥160 mmHg or DBP ≥100 mmHg) ▪ Participant has known acute or chronic hepatitis or signs and symptoms of other liver disease determined by alanine aminotransferase test (ALT) \> 3 times the upper normal limit * Participant has known chronic pancreatitis or recent acute pancreatitis (in the past 1 year) * Participant is pregnant, or within 3 months post-partum, or nursing, or planning to become pregnant * Participant has clinically significant gastric emptying abnormality or chronically takes medications that affect GI motility (does not include Proton pump inhibitor (PPI) or histamine 2 blockade) * Participant has a transplanted organ or awaiting a transplant * Participant has current active cancer or undergoing treatment for active cancer * Participant has untreated hypothyroidism with thyroid-stimulating hormone (TSH) \> 10 uIU/mL or symptomatic * Participant has severe mental health disorder (e.g.major depressive disorder, schizophrenia, bipolar disorder, or other serious mood or anxiety disorder) or a history of suicide attempt * Participant has a patient health questionnaire-8 (PHQ-8) score of 15 or more at screening * Participant has a history of known drug or alcohol use disorder that in the opinion of the investigator may preclude the participant from following and completing the protocol * Participant has history of self-reported marijuana use in the past 3 months and unwilling to abstain during the trial. * Participant is unwilling or unable to perform self-injections of study drug (visually impaired or physically limited) and does not have assistance of a sighted individual/support person who is trained * Participant has cognitive impairment that, in the opinion of the investigator, would preclude the ability to participate in the intervention including self-injections and virtual study visits * Participant is Non-English speaking * Participant has no access WiFi availability for exercise sessions * Participant lives in a state that we cannot ship medication per current St. Jude Pharmacy restrictions