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At 593 Days/~20 Months (N=40): Total 25.4 kg reduction from baseline (99.5 kg to 74.1 kg), BMI improved by 9.3 kg/m (from 36.5 to 27.2 kg/m), achieving 25.5% 2.4% total weight loss maintained entirely on generic AOMs without GLP-1 RA therapy