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Wu et al., 2019), suggesting a feedback relationship in which transcription promotes eccDNA formation, and gene amplification, which in turn can further elevate transcription

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Chronic stress elevates cortisol, which promotes fat storage, particularly in the abdominal area, and increases cravings for comfort foods

Key factors contributing to a plateau include: Metabolic adaptationthe body's natural response to sustained calorie restriction Changes in body composition, with initial fluid loss giving way to slower fat loss Variable response to the medication's appetite-suppressing effects over time Unconscious increases in caloric intake or reductions in physical activity Understanding that plateaus are a common and expected part of the weight loss journey is essential for maintaining motivation and realistic expectations