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Dietary recall data from a SURMOUNT-1 substudy showed a mean caloric reduction of approximately 550 kcal per day, accounting for the majority but not all of the weight loss [23]

The article says evidence suggests estrogen modulates GLP-1 receptor expression in hypothalamic appetite centres, so as estrogen falls, GLP-1 signalling efficiency may diminish and compound existing metabolic challenges

It was published twice in 2015 in the Journal of the International Society of Sports Nutrition and again in Human Psychopharmacology in 2016 with significant improvements

Additionally, lifestyle factors, including diet, physical activity, and stress levels, may impact the medications effectiveness