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These physiologic changes are normal, but they can lead to slowed weight loss, plateaus, or gradual regain years after surgery

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Many women experience gradual weight gain during the perimenopausal transition, with changes in body composition even when weight remains stable

Genetic variants in GLP-1 receptor signaling, incretin metabolism, and appetite regulation pathwayscombined with fasting glucose, insulin sensitivity, and inflammatory markerscreate a more nuanced picture of who may benefit from microdose initiation versus standard protocols

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