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Metformin contains no GLP-1 activity whatsoever, making it fundamentally different from modern peptide-based therapies that directly target appetite centers in the hypothalamus

Severe cases may cause fainting (syncope), which requires immediate medical evaluation

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Future or secondary analyses might subdivide participants into multiple tiers, such as low, moderate, or high engagement based on the frequency of each component (eg, attended 5 coaching sessions or logged weight 3 times per week)

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