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Stress, toxins, poor diet, and other lifestyle factors can deplete levels

Requirements usually include: (1) BMI 30 , or BMI 27 with at least one weight-related health condition (type 2 diabetes, high blood pressure, or high cholesterol per FDA labeling), (2) participation in a 6-month weight management program (diet, exercise, and lifestyle changes), (3) chart notes documenting BMI and health conditions, and (4) no contraindications such as personal/family history of medullary thyroid cancer or MEN2 syndrome (a rare genetic condition)

The STEP 1 trial, for example, found that the average weight loss over 68 weeks was 14.9%

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They must never be frozen and need to be kept out of direct sunlight