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A wide range of factors may contribute to suboptimal clinical response, including psychological factors, such as depression, anxiety, alcohol and substance abuse, personality disorder, and low self-esteem 11,25,26 , eating behaviors including binge eating, loss of control eating, and emotional eating 11,27,28 , low socio-economic status, low social support, low education, physical inactivity, hormonal factors, genetic factors, anatomical and surgical factors 11,26 , biochemical factors such as low albumin levels and elevated HbA1c 29 , and older age 30
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