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Metabolism slows, muscle mass declines, hormonal shifts alter how the body stores fat, and the caloric deficit required to produce meaningful weight loss becomes more difficult to sustain through diet and exercise alone
Patients on Medicare who wanted Wegovy or Zepbound for chronic weight management typically paid full cash price, often $1,000 to $1,500 per month, putting these medications out of reach for most fixed-income beneficiaries
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Psychological framing matters enormously
A small subset of patients (approximately 10 to 15% based on clinical patterns) achieve moderate weight loss (10 to 15% of body weight), maintain that loss for 12+ months at a stable dose, build strong dietary and exercise habits, and express confidence in maintaining without medication
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