The access path varies a lot - some people go through telehealth for the script, others source directly when insurance won't cover or the script isn't happening. The 18lbs already is solid early momentum.
The combination of active baseline plus intake reduction without calorie tracking is actually optimal for body composition on Mounjaro - the workout stimulus is preserved while the overeating that was previously offsetting it gets removed. The 22kg without changing exercise is the clean version of that outcome.