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Certainty of Evidence for ≥15% Weight Loss Since the ≥15% weight loss threshold is clinically meaningful for obesity management, we applied the GRADE approach to our NMA estimates, following the method described by Yepes-Nuñez et al
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However, over time clinicians also began observing several important challenges: Weight loss plateaus Metabolic adaptation Lean mass loss Reduced energy expenditure Long-term maintenance difficulty These observations helped shift the conversation toward broader metabolic regulation rather than appetite suppression alone
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