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Comparison of surgical versus diet-induced weight loss on appetite regulation and metabolic health outcomes

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The aggressive answer is "if it didn't freeze and wasn't above 86°F for more than a few hours, you're fine." Most clinicians land somewhere in between: if the pen was above 86°F for less than 4 hours and you're early in the 21-day window, continue use but monitor for reduced efficacy (less appetite suppression, smaller weight-loss trend)