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Clinical observations describing reduced protein intake, variability in lean mass trajectories, and micronutrient insufficiency during pharmacologically induced weight loss [40, 75, 94, 95] suggest that long-term metabolic stability may become sensitive to substrate availability even in the absence of overt deficiency

Patients with certain GLP1R or GIPR variants show 30-40% greater weight loss on tirzepatide, while others respond optimally to semaglutide monotherapyremoving trial-and-error from therapy selection