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Rather than simply putting every patient on the same protocol, the better approach is first to determine whether you are an appropriate candidate for an aggressive calorie-restricted plan, whether you have underlying medical concerns, and whether a safer or more sustainable option may be better for you

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Vascular: Ultrasound (Doppler) to evaluate blood flow

Maintenance and discontinuation SURMOUNT-4, continue vs placebo switch after lead-in to about 20.9% loss: stopping regained about +14% over 52 weeks while continuing lost a further -5.5%

If your energy is off, other factors deserve equal attention iron status, sleep quality and duration, training load and recovery, testosterone levels, thyroid function, and how your GLP-1 protocol is affecting your overall nutrient intake

Additionally, the regulatory mechanisms between other pathways or protein receptors mediating mitophagy and mitochondrial biogenesis require further investigation