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doi: 10.1097/00007611-195208000-00029 178

Their safety is not established for this use, and unregulated products add risks of contamination and inaccurate dosing

Real-world persistence is low: about half discontinue within a year and roughly three-quarters within two years , often due to cost or side effectsraising the risk of rebound weight and lost health gains (Scientific American on discontinuation rates)