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constipation, reflux, or intermittent nausea may continue Persistent or progressive symptoms rather than gradual improvement After month 3 Symptoms may remain mild or infrequent at a tolerated regimen New severe symptoms should not automatically be blamed on the medication The most important pattern is not simply "week 1 is bad and month 3 is good." A more accurate pattern is initiation, adaptation, possible symptom flare during dose escalation, and reassessment based on tolerability

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The National Weight Control Registry indicates that members have lost an average of 33 kg and maintained the loss for more than 5 years

Instead, it usually develops because of a combination of genetic, autoimmune, and environmental factors