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L-carnitine deficiency severely impairs the mitochondrial import of long-chain acyl-CoAs, directly limiting the acetyl-CoA pool required for ketogenesis ( -oxidation activity ( Figure 2 The preterm brain exhibits extraordinarily high energy demands to fuel rapid growth and development, demands which can surpass the capacity of glucose supply alone

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Bastian SE, Walton PE, Wallace JC, Ballard FJ. Plasma clearance and tissue distribution of labelled insulin-like growth factor-I (IGF-I) and an analogue LR3IGF-I in pregnant rats. J Endocrinol. 1993 Aug;138(2):327-36.doi: 10.1677/joe.0.1380327. PMID: 7693845

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If you've just started treatment or recently increased your dose, you may not be experiencing the medication's full appetite-suppressing benefits yet