Adherence

Greater weight loss in the first year (≥5%) is a consistent independent predictor of long-term weight loss maintenance across all intervention groups (metformin, ILS, and placebo).

Focus on getting that first 5% weight loss. It is the single best predictor of whether you will keep it off for years, regardless of whether you use medication, diet, or exercise. Don't get discouraged if you don't lose a huge amount immediately; consistency in that first year matters most.