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At-risk groups include vegans, older adults, those with pernicious anaemia, gastrointestinal conditions, or taking long-term metformin or proton pump inhibitors

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In the case, the sisters modest weight improvement may benefit from female-specific hormonal environments (e.g., estrogen) that enhance GLP-1 receptor signaling, while the brothers limited response could be related to male-specific factors that blunt semaglutide-induced appetite suppression and energy expenditure regulation