Tesamorelin in An Giang: Why HIV-Associated Lipodystrophy Research Cannot Be Generalized to Everyone
Featured Answer: Why Can’t HIV-Associated Lipodystrophy Research Be Generalized to Everyone?
Tesamorelin is a growth hormone-releasing hormone (GHRH) analogue that stimulates the body’s production of growth hormone. In the United States, the prescription product EGRIFTA WR is indicated to reduce excess abdominal fat in adults with HIV-associated lipodystrophy. It is explicitly not indicated for weight-loss management.
The pivotal trials enrolled a specific population: adults living with HIV, receiving antiretroviral therapy, and experiencing excess abdominal fat associated with lipodystrophy. Researchers measured visceral adipose tissue (VAT), body composition, and selected metabolic outcomes. Those findings do not automatically apply to people with general obesity, people without HIV, or individuals seeking cosmetic abdominal-fat reduction.
The distinction matters because visceral fat, subcutaneous fat, total body weight, and the fat-distribution changes associated with HIV and its treatment are not interchangeable. Participants’ underlying conditions, medication histories, eligibility criteria, and baseline metabolic health also influence the interpretation of results.
Bottom line: Evidence that tesamorelin reduces excess visceral abdominal fat in a defined HIV-associated lipodystrophy population is not proof that it is a general weight-loss medicine or a universally appropriate fat-loss treatment.
Key Takeaways
- The studied condition is specific. The pivotal tesamorelin trials focused on adults with HIV-associated lipodystrophy and excess abdominal fat, not the entire population with overweight or obesity.
- Visceral fat is not the same as total body weight. Tesamorelin can reduce visceral adipose tissue without producing the kind of overall weight loss expected from a conventional weight-management intervention.
- HIV, antiretroviral therapy, and fat distribution matter. The participants’ clinical context differs from that of people seeking general weight loss or cosmetic body shaping.
- Trial eligibility limits generalization. The original studies used specific age, waist, waist-to-hip ratio, glucose, and medical-history criteria. People outside those criteria were not represented in the same way.
- A change in VAT does not prove improvement in every health outcome. Changes in abdominal fat, glucose regulation, cardiovascular events, and long-term health are distinct endpoints.
- Safety requires particular attention. Tesamorelin can increase IGF-1 and may affect glucose regulation; fluid retention and hypersensitivity reactions have also been reported.
- Regulatory approval is indication-specific. The U.S. indication for EGRIFTA WR is reduction of excess abdominal fat in adults with HIV-associated lipodystrophy, not general weight-loss management.
- Commercial availability does not establish suitability. A product listing cannot prove that a product is authentic, sterile, approved, or appropriate for a particular person.
1. Introduction: One Peptide, Different Clinical Questions
Tesamorelin is often discussed online in the context of abdominal fat, body composition, and growth hormone signaling. However, discussions sometimes move too quickly from a clinical trial involving people with HIV-associated lipodystrophy to broad claims about fat loss in everyone.
That leap overlooks a fundamental principle of clinical research: a treatment’s observed effects must be interpreted in relation to the population, condition, comparator, and endpoints studied.
HIV-associated lipodystrophy is a specific clinical context involving abnormal fat distribution in some people living with HIV. Excess abdominal visceral fat may occur alongside changes in subcutaneous fat and other metabolic features. Historical and current antiretroviral treatment regimens, the person’s underlying health, and other clinical factors can influence this presentation.
General obesity is a broader condition with multiple biological, environmental, behavioral, and medical contributors. A person with general obesity may have excess visceral fat, subcutaneous fat, or both, but this does not mean the person has HIV-associated lipodystrophy.
This article explains what tesamorelin studies actually evaluated, why their results are population-specific, and how to distinguish a supported clinical finding from an extrapolation that the evidence does not establish.
2. What Is Tesamorelin?
Tesamorelin is a synthetic analogue of growth hormone-releasing hormone (GHRH). It stimulates the pituitary gland to release endogenous growth hormone, which in turn influences the production of insulin-like growth factor 1 (IGF-1) and other physiological processes.
Its pharmacology differs from that of medicines that primarily act on appetite-related pathways. Tesamorelin’s approved U.S. use is directed at reducing excess abdominal fat in adults with HIV-associated lipodystrophy rather than managing total body weight.
2.1 Growth hormone signaling and body composition
Growth hormone participates in several physiological processes, including the regulation of lipid and carbohydrate metabolism. Because tesamorelin stimulates endogenous growth hormone release, researchers investigated whether it could reduce visceral abdominal fat in people with HIV-associated fat accumulation.
However, a plausible biological mechanism is not sufficient to establish that the same treatment will produce the same outcome in every population. The effect depends on the condition being treated, the characteristics of the participants, the treatment studied, and the outcome measured.
2.2 What the mechanism does not prove
Growth hormone signaling is not a universal shortcut to a particular body shape. An increase in growth hormone or IGF-1 does not by itself prove that a person will experience clinically meaningful fat loss, improved health, or a favorable long-term benefit-risk balance.
For this reason, the relevant question is not simply whether tesamorelin affects growth hormone signaling. It is whether clinical evidence supports its use for a specific condition and population.
3. What Is HIV-Associated Lipodystrophy?
Lipodystrophy refers to abnormalities in the distribution or storage of body fat. In people living with HIV, altered fat distribution can include excess visceral abdominal fat, loss of subcutaneous fat in some areas, or a combination of changes.
These patterns are not identical in every person. Some individuals may have central fat accumulation without substantial peripheral fat loss, while others may have more complex changes in body composition.
3.1 Visceral adipose tissue
Visceral adipose tissue is fat stored within the abdominal cavity around internal organs. It is distinct from subcutaneous fat, which lies beneath the skin.
Visceral fat is relevant to metabolic research because it is associated with several cardiometabolic risk factors. However, the amount of visceral fat is only one component of health, and a change in VAT does not automatically establish a reduction in cardiovascular events or improvement in every metabolic outcome.
3.2 Subcutaneous abdominal fat
Subcutaneous abdominal fat lies beneath the skin of the abdomen. It is anatomically and metabolically different from visceral fat.
A treatment that reduces visceral fat without a comparable change in subcutaneous fat may produce a different body-composition pattern from a treatment that reduces total fat mass more broadly. This distinction is central to understanding tesamorelin research.
3.3 Why the HIV context matters
HIV-associated lipodystrophy develops in a specific clinical setting. HIV infection, antiretroviral treatment history, baseline body composition, and other health factors may affect the phenotype being studied.
It would be inaccurate to assume that every person with a large waist has the same underlying condition or that every type of abdominal fat accumulation will respond identically to tesamorelin.
4. What the Pivotal Tesamorelin Trials Actually Studied
The U.S. prescribing information for EGRIFTA describes randomized, double-blind, placebo-controlled trials in adults with HIV-associated lipodystrophy and excess abdominal fat. The primary efficacy focus was visceral adipose tissue rather than conventional weight loss.
The original trials included adults aged 18 to 65 years with specified waist circumference and waist-to-hip ratio criteria. Participants were required to be on a stable antiretroviral regimen before randomization. The studies also used medical and metabolic exclusion criteria that limited which individuals could participate.
For example, the prescribing information describes exclusions involving type 1 diabetes, type 2 diabetes under specified criteria, previous treatment with insulin or certain glucose-lowering medicines, hypopituitarism, and a history of malignancy. The exact eligibility criteria differed by protocol and should be checked in the relevant trial record or product labeling.
These details matter because a clinical trial does not study every person who might encounter the treatment in online discussions. It studies people who meet its inclusion criteria and remain within the study’s follow-up and analysis framework.
4.1 A representative randomized study
A randomized placebo-controlled study published in 2010 enrolled 404 HIV-infected patients with excess abdominal fat in the context of antiretroviral therapy. Participants were randomized to tesamorelin or placebo for the initial six-month efficacy phase, followed by a safety and extension phase.
The primary endpoint was VAT. Secondary outcomes included body image, IGF-1, safety measures, glucose-related measures, and other body-composition variables.
During the six-month efficacy phase, VAT decreased by 10.9% in the tesamorelin group, compared with 0.6% in the placebo group. Waist circumference and several other body-composition measures also changed. The study did not demonstrate a significant change in the glucose parameters measured during that phase.
These findings support a specific conclusion: tesamorelin reduced VAT in the studied population under the trial’s conditions. They do not prove that it is a universal weight-loss treatment or that every person with abdominal fat will experience the same result.
5. Why the Trial Population Limits Generalization
Clinical findings are most directly applicable to people whose characteristics resemble those of the study population. When researchers move from a narrowly defined population to a broader one, uncertainty increases.
| Research factor | Pivotal tesamorelin context | Why it matters for generalization |
|---|---|---|
| Underlying condition | HIV-associated lipodystrophy with excess abdominal fat. | General obesity is not the same clinical condition. |
| Treatment context | Participants were receiving antiretroviral therapy and had a stable treatment history. | People without HIV or with different medication histories may differ biologically and clinically. |
| Primary endpoint | Change in visceral adipose tissue. | VAT reduction is not equivalent to total weight loss or a demonstrated improvement in every health outcome. |
| Eligibility criteria | Specific waist measurements, age range, glucose criteria, and medical exclusions. | People outside the eligibility criteria were not represented equally in the trial evidence. |
| Follow-up | Controlled efficacy phases and extension follow-up. | Short-term changes do not establish long-term safety or durability in every population. |
| Regulatory indication | Reduction of excess abdominal fat in adults with HIV-associated lipodystrophy under the U.S. label. | Approval for a specific indication does not establish approval for general weight management or cosmetic use. |
6. Visceral Fat Reduction Is Not the Same as General Weight Loss
One of the most important distinctions in tesamorelin research is the difference between VAT reduction and total body-weight reduction.
Body weight reflects fat mass, lean tissue, water, and other components. VAT is one compartment within body fat. A change in VAT may occur without a proportionate change in total body weight.
The U.S. prescribing information explicitly states that EGRIFTA WR is not indicated for weight-loss management because it has a weight-neutral effect. This statement is important when evaluating online descriptions that present tesamorelin as a general fat-loss or weight-loss product.
6.1 Why body-composition endpoints matter
Researchers may use imaging methods to quantify VAT, while waist circumference provides a simpler measure of abdominal size. These measures are related but not interchangeable.
Waist circumference does not directly quantify visceral fat. Similarly, a lower VAT measurement does not necessarily indicate that total fat mass or body weight has decreased by a corresponding amount.
6.2 Why a cosmetic outcome is a different claim
A claim that a treatment improves a particular clinical endpoint is different from a claim that it produces a desired cosmetic appearance. Body shape depends on multiple fat compartments, skeletal structure, muscle mass, skin, and other factors.
The pivotal tesamorelin trials were designed to evaluate excess abdominal fat in a defined clinical population. They were not designed to establish a universal cosmetic body-shaping effect for people without HIV-associated lipodystrophy.
7. Baseline Metabolic Health and Glucose Regulation
Tesamorelin stimulates growth hormone release and increases IGF-1. Growth hormone signaling can influence glucose metabolism, making glycemic outcomes important when assessing both effectiveness and safety.
The early HIV-associated lipodystrophy trials enrolled a selected population. The prescribing information describes specific glucose-related eligibility criteria and exclusions involving diabetes and glucose-lowering treatment. This limits how directly their results can be applied to people with different baseline metabolic profiles.
7.1 Why glucose results cannot be assumed to generalize
A finding that glucose parameters did not change significantly in one study does not establish that tesamorelin has no effect on glucose regulation in every population. The result applies to the participants, measures, follow-up period, and statistical power of that study.
People with pre-existing glucose intolerance or diabetes may have a different baseline risk profile. The FDA-approved prescribing information warns that glucose intolerance or diabetes mellitus may develop during treatment and recommends evaluation of glucose before and during therapy.
7.2 IGF-1 is a biomarker, not a universal measure of benefit
IGF-1 levels typically increase with tesamorelin because the treatment stimulates growth hormone signaling. This is a pharmacodynamic effect, but a higher IGF-1 value should not automatically be interpreted as a desirable outcome.
The prescribing information warns about elevated IGF-1 and notes that the effects of prolonged elevations are unknown. It recommends monitoring and consideration of discontinuation in patients with persistent elevations, as specified in the label.
This illustrates a broader principle: a biomarker can help explain a treatment’s biological activity, but its clinical meaning depends on the context and on evidence linking it to outcomes that matter to patients.
8. What Happens When Treatment Stops?
Duration and treatment discontinuation are important when interpreting tesamorelin research. In the 2010 randomized study, participants who continued tesamorelin for 12 months maintained a reduction in VAT. Participants switched from tesamorelin to placebo after the initial six-month phase experienced relatively rapid loss of the earlier VAT improvement.
This finding indicates that the observed body-composition effect was not necessarily durable after treatment withdrawal in that study population.
It does not establish that every person will have the same response after stopping treatment, nor does it answer every question about long-term clinical outcomes. However, it cautions against interpreting an on-treatment change as permanent remodeling of body fat.
For generalization, the relevant questions include how long the treatment was continued, whether outcomes were measured after discontinuation, and whether the study was designed to evaluate the durability of the effect.
9. Safety: Why Population-Specific Evidence Matters
Evidence of efficacy in a defined population does not remove the need to assess safety in that population or in others. Tesamorelin’s growth hormone and IGF-1 effects are relevant to its benefit-risk profile.
9.1 Malignancy-related precautions
The EGRIFTA WR prescribing information lists active malignancy as a contraindication and warns about the risk of neoplasms. It states that a pre-existing malignancy should be inactive and treatment completed before therapy is started, and that treatment should be discontinued if there is evidence of recurrent malignancy.
These precautions are particularly important when considering a drug that influences growth hormone and IGF-1 signaling. The risks and benefits must be evaluated using the current prescribing information and the person’s clinical circumstances.
9.2 Fluid retention and musculoskeletal symptoms
Fluid retention can occur with tesamorelin and may be associated with peripheral edema, joint pain, or carpal tunnel syndrome. Arthralgia and other musculoskeletal symptoms are among the reported adverse reactions.
Such effects are distinct from changes in fat mass. A change in body weight or limb appearance should not automatically be attributed to fat loss or fat gain without considering fluid-related effects and other causes.
9.3 Glucose intolerance and diabetes
The prescribing information warns that glucose intolerance or diabetes mellitus may develop. This is relevant to interpretation because the original efficacy trials used specific eligibility criteria and did not represent all people with diabetes or all levels of metabolic dysfunction.
9.4 Other contraindications and warnings
The U.S. label also lists disruption of the hypothalamic-pituitary axis, known hypersensitivity to the product or its excipients, and pregnancy among contraindications. Hypersensitivity reactions have been reported, and the label includes a warning concerning increased mortality in patients with acute critical illness.
These details reinforce why evidence from a clinical trial cannot be reduced to a single claim about abdominal-fat reduction. Treatment suitability requires a separate assessment of contraindications, warnings, and the individual’s medical context.
A randomized trial can show that tesamorelin reduces VAT in a defined HIV-associated lipodystrophy population. That is evidence for the studied endpoint and population. It does not establish that the same benefit-risk balance applies to someone without HIV, someone with a different fat-distribution pattern, or someone with different glucose regulation or medical history. Efficacy and suitability are related, but they are not the same question.
10. Regulatory Indication: What the U.S. Label Actually Says
The current U.S. prescribing information for EGRIFTA WR identifies the product as a GHRH analogue indicated for reducing excess abdominal fat in adults with HIV-associated lipodystrophy.
The label includes important limitations:
- Long-term cardiovascular safety has not been established.
- The product is not indicated for weight-loss management because it has a weight-neutral effect.
- There are no data supporting improved adherence to antiretroviral therapy as a result of taking EGRIFTA WR.
These statements are not minor qualifications. They define what the approved product is intended to do and identify important questions that remain unresolved.
Regulatory status is jurisdiction-specific. The U.S. indication should not be presented as a complete statement of Vietnamese law, and online availability does not establish local authorization or suitability for a particular use.
11. What the Evidence Does—and Does Not—Support
| Claim | Evidence-based interpretation |
|---|---|
| “Tesamorelin reduces visceral abdominal fat in adults with HIV-associated lipodystrophy.” | Supported by randomized placebo-controlled trials and the U.S. prescribing information for the indicated population. |
| “Tesamorelin is a general weight-loss medicine.” | Not supported by the U.S. indication; EGRIFTA WR is explicitly not indicated for weight-loss management. |
| “Results in people with HIV-associated lipodystrophy prove the same effect in people without HIV.” | Not established. The populations and clinical contexts differ. |
| “A reduction in VAT proves total body fat and body weight will decrease.” | Not established. VAT, total fat mass, and total body weight are different measurements. |
| “An increase in IGF-1 proves the treatment is beneficial.” | Incorrect. IGF-1 is a pharmacodynamic marker that requires clinical interpretation and monitoring. |
| “Tesamorelin has been shown to prevent cardiovascular events in the indicated population.” | Not established; the U.S. label states that long-term cardiovascular safety has not been established. |
| “An online product with tesamorelin in its name has the same evidence as EGRIFTA WR.” | Not established. Product identity, formulation, quality, sterility, regulatory status, and clinical evidence must be assessed separately. |
12. Statistics and Evidence Snapshot
| Evidence source | Reported finding or design detail | Interpretation |
|---|---|---|
| Randomized study published in 2010 | 404 adults with HIV-associated excess abdominal fat were enrolled; VAT was the primary endpoint. | The evidence concerns a defined HIV-associated clinical population, not general obesity. |
| VAT at six months | VAT decreased by 10.9% with tesamorelin versus 0.6% with placebo in the reported efficacy phase. | Supports VAT reduction under the study conditions, not universal weight loss. |
| Twelve-month extension | VAT reduction was approximately 18% among participants continuing tesamorelin in the reported study. | Provides longer on-treatment evidence in the studied population, not proof of permanent effects after stopping. |
| Treatment withdrawal | Participants switched from tesamorelin to placebo experienced relatively rapid loss of the earlier VAT improvement. | Suggests that the body-composition effect may not persist after discontinuation. |
| EGRIFTA WR U.S. label | Indicated for reducing excess abdominal fat in adults with HIV-associated lipodystrophy; not indicated for weight-loss management. | Defines the approved U.S. indication and a key limit on extrapolation. |
| Safety monitoring | Label warnings include elevated IGF-1, glucose intolerance or diabetes, fluid retention, hypersensitivity, and malignancy-related precautions. | Efficacy should be interpreted alongside safety and clinical suitability. |
13. Frequently Asked Questions
No. The U.S. prescribing information for EGRIFTA WR states that it is not indicated for weight-loss management and has a weight-neutral effect. Its indicated use is reduction of excess abdominal fat in adults with HIV-associated lipodystrophy.
The trials were designed to address excess visceral abdominal fat in a specific clinical population. Their results answer that research question and should not automatically be transferred to people with unrelated causes of abdominal fat accumulation.
Visceral fat is stored within the abdominal cavity around internal organs. Subcutaneous fat lies beneath the skin. These compartments are anatomically and metabolically distinct, so a change in one does not automatically establish a comparable change in the other.
Not necessarily. VAT is one component of body fat, while body weight includes fat, lean tissue, water, and other components. The relationship between VAT change and total weight change depends on the treatment and the population studied.
The findings may inform biological understanding, but the clinical benefit-risk balance cannot be assumed to be the same. People without HIV may have different underlying conditions, fat-distribution patterns, treatment histories, and baseline risks.
An increase in IGF-1 is a pharmacodynamic effect of growth hormone signaling, not a universal measure of clinical benefit. The U.S. label warns about elevated IGF-1 and describes monitoring considerations.
No such universal conclusion is established. Glucose outcomes depend on the population, baseline metabolic health, study design, and treatment context. The prescribing information warns that glucose intolerance or diabetes may develop.
In a randomized study, participants switched from tesamorelin to placebo after the initial treatment phase experienced relatively rapid loss of the earlier VAT improvement. This cautions against assuming that the effect is permanent.
The label includes warnings about neoplasms, elevated IGF-1, fluid retention, glucose intolerance or diabetes, hypersensitivity reactions, and increased mortality in patients with acute critical illness. Contraindications include active malignancy, pregnancy, and disruption of the hypothalamic-pituitary axis, among others.
No. Regulatory indications are jurisdiction-specific, and the U.S. indication does not establish the regulatory status of a product or use in Vietnam. Local status must be checked through the relevant official authorities.
No. A product name or listing does not independently verify active ingredient identity, formulation, concentration, sterility, quality, regulatory authorization, or clinical equivalence.
14. Related Articles and Educational Resources
- Knowledge Hub — explore research-oriented articles on peptide science, body composition, and metabolic health.
- Peptide FAQ — review general questions about research peptides, product claims, and research limitations.
- Peptide Products and Research Information — examine product listings while distinguishing commercial descriptions from independently established clinical evidence.
15. Related Research Products
Tesamorelin 10mg — Research Product Listing
This listing relates to tesamorelin, the molecule discussed in this article. It should not be treated as equivalent to an approved prescription formulation or as evidence that a product is appropriate for general weight loss. Product identity, formulation, quality, sterility, regulatory status, and clinical suitability require independent verification.
HGH Somatropin 100 IU — Related Growth-Hormone Research Listing
Somatropin is growth hormone, whereas tesamorelin stimulates the body’s endogenous growth hormone release. These are pharmacologically different interventions. Findings from tesamorelin trials should not be transferred to somatropin products, and neither a product listing nor a shared connection to growth hormone signaling establishes clinical equivalence.
Related Educational Resource: Fat Loss Peptide Plan
The Fat Loss Peptide Plan is a related educational resource for readers exploring weight-management research. It should not be interpreted as a validated treatment protocol, a recommendation to use tesamorelin for general fat loss, or a substitute for evidence-based clinical care.
16. Scientific References
- Falutz J, Allas S, Blot K, et al. Effects of tesamorelin, a growth hormone-releasing factor, in HIV-infected patients with abdominal fat accumulation: a randomized placebo-controlled trial with a safety extension. Journal of Acquired Immune Deficiency Syndromes. 2010. PubMed record.
- U.S. Food and Drug Administration. EGRIFTA WR (tesamorelin) Prescribing Information. Revised March 2025. Indication, limitations of use, contraindications, warnings, adverse reactions, and clinical studies. Official FDA label.
- DailyMed. EGRIFTA WR — tesamorelin kit, full prescribing information. Current product labeling and clinical study details. DailyMed label.
- DailyMed. EGRIFTA SV — tesamorelin for injection, prescribing information. Clinical study populations, eligibility criteria, safety, and efficacy context. DailyMed label.
- U.S. Department of Health and Human Services, ClinicalInfo HIV.gov. Weight Gain in People With Treated HIV. Discussion of pharmacotherapy targeting adipose tissue, tesamorelin evidence, and limitations in people with HIV. Guideline resource.
- Falutz J, Potvin D, Mamputu JC, et al. Effects of tesamorelin, a growth hormone-releasing factor, in HIV-infected patients with abdominal fat accumulation: a randomized placebo-controlled trial with a safety extension. PubMed-indexed clinical study. PubMed.
- Stanley TL, Fourman LT, Feldpausch MN, et al. Efficacy and safety of tesamorelin in people with HIV on integrase inhibitors. Clinical research examining tesamorelin in a population receiving integrase inhibitor-based antiretroviral regimens. PubMed record.
- U.S. Food and Drug Administration. Investigational New Drug (IND) Application. General regulatory context for investigational medicines and clinical development. FDA resource.
Conclusion: A Specific Clinical Result Is Not a Universal Fat-Loss Claim
Tesamorelin has clinical evidence supporting reduction of visceral abdominal fat in adults with HIV-associated lipodystrophy. That finding is meaningful, but it is tied to a defined condition, a selected trial population, and specific endpoints.
The pivotal studies did not establish tesamorelin as a general weight-loss medicine for everyone with overweight, obesity, or abdominal fat. The U.S. prescribing information explicitly states that EGRIFTA WR is not indicated for weight-loss management and notes that its effect is weight-neutral.
The distinction between visceral fat, subcutaneous fat, total body weight, and other measures of health is central to interpreting the research. Baseline metabolic status, antiretroviral treatment context, trial eligibility, and treatment duration also affect how confidently results can be generalized.
Safety is equally important. Tesamorelin influences growth hormone and IGF-1 signaling, and its labeling includes important warnings and contraindications involving malignancy, glucose regulation, fluid retention, hypersensitivity, and other clinical considerations.
For readers in An Giang and elsewhere, the most reliable approach is to ask exactly which condition was studied, which outcome improved, who participated, and what the current regulatory indication permits. A product marketed for abdominal fat reduction should not be assumed to reproduce the outcomes of a prescription product studied in a defined HIV-associated lipodystrophy population.
The central conclusion: Tesamorelin’s evidence in HIV-associated lipodystrophy cannot be generalized automatically to everyone because the condition, trial population, endpoints, and benefit-risk profile are specific. Research findings should inform careful interpretation—not turn an indication-specific treatment into a universal weight-loss or cosmetic-fat-loss claim.