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This function theoretically contributes to weight loss

The approved population is not a gut-health population: In the pivotal trial the average patient had 77 cm of remaining small intestine against a normal length of roughly 6 metres, had been dependent on intravenous nutrition for a mean of 6 years , and in 44% of cases had no colon in continuity [2]

The FDA isn't required to follow advisory committee recommendations but typically does

Some people may require 100mcg every three to four days for two to three weeks

The 2.5 mg starting dose is explicitly a tolerability dose in trials it was not intended to drive weight loss on its own, but to let the gut acclimate before therapeutic doses begin

While we usually think about low B12 causing anemia, a few case reports describe new or worsened polycythemia - an elevated red cell mass - after B12 administration