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The device steps matter

Within the hypothalamus, brain CPT1C serves as a sensor of nutrient availability by binding malonyl-CoA which triggers a reduction in the release of the appetite promoting neuropeptides, neuropeptide Y (NPY) and Agouti-related peptide (AgRP) and an increase in the release of the appetite suppressing neuropeptides, -melanocyte stimulating hormone (-MSH) and cocaine and amphetamine regulated transcript (CART)

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By six months, participants often report 10-13% reduction, and the one-year mark shows sustained losses of 15% or more in responders