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Furthermore, such a retrospective design inherently limits the identification of causal relationships, and unmeasured residual confounding variablessuch as glycemic control, hypoglycemic episodes, familial suicide history, and socioeconomic statusmay persist

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The rapid weight loss associated with these medications can include significant lean mass loss if protein intake is inadequate

These reductions in fat mass, lean body mass, and muscle mass correlate with the degree of body weight reduction and are similar to those documented with other obesity therapies that achieve large weight reductions, such as bariatric surgery and very low-calorie restricted diets [61]