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27 Inflammation Obesity associated with overnutrition induces macrophage infiltration and chronic hypoxia, causing low-grade inflammation in the adipose tissue 28 and the release of proinflammatory factors such as interleukin (IL)-1 and tumor necrosis factor (TNF-), 29,30 thus impairing insulin signaling pathway in a number of ways

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Topiramate acts primarily by modulating neurotransmitters such as GABA and glutamate, which play significant roles in regulating appetite and reward-driven eating

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