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Participants were required to have continuous enrolment in a commercial, Medicare, or Medicaid plan for at least 12 months before and 17 months after starting treatment

General warning signs that may indicate electrolyte disturbance include: Muscle-related symptoms : Cramps, spasms, twitching, or persistent weakness, particularly in the legs, may suggest potassium, magnesium, or calcium deficiency Cardiovascular symptoms : Palpitations, irregular heartbeat, or chest discomfort warrant urgent medical attention, as these may indicate significant potassium or magnesium depletion affecting cardiac rhythm Neurological symptoms : Confusion, difficulty concentrating, headache, dizziness, or altered consciousness can indicate sodium imbalance or severe dehydration Gastrointestinal symptoms : Persistent nausea, vomiting (especially if unable to keep fluids down), or severe diarrhoea lasting more than 24 hours Fatigue and lethargy : Whilst common during weight loss, severe or sudden-onset fatigue may indicate electrolyte depletion Reduced urine output : Dark-coloured urine or significantly decreased urination suggests dehydration Numbness or tingling : Paraesthesia, particularly around the mouth or in the extremities, can indicate calcium or magnesium disturbance Patients should contact their GP or healthcare provider promptly if they experience: Persistent vomiting or diarrhoea lasting more than 24 hours Inability to maintain adequate fluid intake Severe muscle weakness or cramps Palpitations or irregular heartbeat Confusion or significant dizziness Signs of severe dehydration (very dark urine, no urination for 8+ hours, extreme thirst) Severe abdominal pain (especially if radiating to the back) with vomiting, which could indicate pancreatitis Immediate medical attention (999 or A&E) is required for: Chest pain or severe palpitations Seizures or loss of consciousness Severe confusion or inability to stay awake Collapse or severe symptoms of dehydration If unable to keep fluids down for more than 24 hours or experiencing worsening dehydration, contact NHS 111 or seek an urgent GP appointment or visit an urgent treatment centre

Questions about the study can be directed to Jennifer Paff ([email protected]).