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Moreover, adipose tissue macrophages in obesity adopt a pro-inflammatory M1 phenotype, further amplifying systemic immune activation, whereas weight reduction favors a switch toward an anti-inflammatory M2 phenotype [39]

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A second point that trips people up: the induction dose is explicitly sub-therapeutic by design

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The mitigation is clear and evidence-based: personalized protein targets (minimum 1.21.6g per kg body weight daily) and resistance exercise throughout treatment