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The strongest case for early intervention exists in adults who meet all of the following: BMI of 30 or greater (or 27 or greater with cardiometabolic risk factors), fasting insulin or HOMA-IR in the insulin-resistant range, family history of type 2 diabetes, and a pattern of progressive weight gain despite lifestyle efforts

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heat disrupts hydrogen bonds and disulfide bridges, permanently altering the peptide's shape

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