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Its a combination of all three of these factors. Since the study was retrospective, it is not enough to change practice, so large randomized clinical trials addressing this question are needed, Sheth said

Research and clinical experience suggest that IV NAD+ produces a sharp but short-lived spike in plasma levels that does not reliably translate to intracellular increases, which is where the therapeutic effect actually happens

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The COR-I trial, involving 1,742 participants over 56 weeks, demonstrated 6.1% average weight loss with Contrave versus 1.3% with placebo (Greenway et al., Obesity, 2010)