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Starting BMI and weight loss goal Metabolic health, including prediabetes, diabetes, insulin resistance, fatty liver, or PCOS Blood pressure, heart rhythm history, anxiety, and sleep issues Reflux or GERD history Preference for pills versus injections Side effect tolerance, including nausea, constipation, insomnia, or jitteriness Insurance coverage, self-pay cost, and pharmacy access History of bariatric surgery or weight regain after surgery Bottom line The right plan is the one you can tolerate, afford, and follow while your progress and safety are monitored over time

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