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and liver enlargement

Conclusion This case report demonstrates that the combination of prolonged water fasting and a GLP-1 receptor agonist is a safe and effective method for short-term substantial weight loss in patients with severe obesity for the purpose of pre-procedural optimization prior to bariatric surgery, and may result in the improvement of multiple chronic diseases including hypertension, insulin resistance, anemia, depression, and diastolic heart failure

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Substantial cell loss results in permanent endocrine deficiency and irreversible diabetes