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Inadequate dose escalation is a common reason for disappointing results

"FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight"

Hyponatremia (low sodium) can develop through multiple mechanisms: excessive fluid intake relative to sodium (dilutional) or gastrointestinal sodium losses

Further Reading Obesity Drugs May Drop to as Little as $150 a Month (The New York Times) Lilly, Novo to Lower Obesity Drug Prices in Deal With Trump (Bloomberg) Trump administration announces deal to lower weight loss drug prices for many Americans (ABC)
People with ADHD often experience an internal dialogue running on a loop, taking up valuable mental bandwidth that could be used for other things

Bojkowski CJ, Arendt J, Shih MC, Markey SP
