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As a result, lifestyle interventions alone, such as diet and exercise, are often insufficient, and effective management typically requires a combination of strategies to address the underlying biology of obesity. The group explored data from more than 60,000 patients who originally participated in one of 56 randomized controlled trials (RCTs)

Although superoxide anion and hydrogen peroxide are not particularly reactive they may synergize with specific factors, eg iron, generating potent free radicals such as hydroxyl radical, which may cause direct injury through alteration of vital cellular macromolecules (DNA, protein or lipids)