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For treatment of confirmed deficiency , NHS protocols typically involve hydroxocobalamin injections: initially 1mg three times a week for two weeks for those without neurological involvement, followed by maintenance injections every 2-3 months

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The key mechanisms are: Sustained appetite suppression and reduced caloric intake Reduced dietary variety and food volume Delayed gastric emptying Gastrointestinal side effects Rapid weight loss and lean mass reduction Potential alterations in gut microbiota Each pathway contributes differently