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These effects result directly from the medication's mechanism of actionspecifically, delayed gastric emptying and effects on gastrointestinal motility

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Diabetes Care 32:375380 Fukase N, Igarashi M, Takahashi H et al (1993) Hypersecretion of truncated glucagon-like peptide-1 and gastric inhibitory polypeptide in obese patients

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This creates a bidirectional relationship where fatigue limits motivation and activity, which worsens mood, which deepens fatigue

Gastric bypass increases circulating bile acids and activates hepatic farnesoid X receptor (FXR) but requires intact peroxisome proliferator activator receptor alpha (PPAR) signaling to significantly reduce liver fat content