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Skinny fat occurs as a consequence of conscious health decisions, but may be exacerbated if youre on a GLP-1 like tirzepatide

le Roux CW, Astrup A, Fujioka K, et al

Metformin acts systemically as a pharmaceutical agent with well-established pharmacokinetics and clinical endpoints, while inositol works at the cellular level as a nutrient-like compound supporting physiological processes

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Kendall DM et al (2009): Clinical Application of Incretin-Based Therapy: Therapeutic Potential, Patient Selection and Clinical Use