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4 The peak risk window is during active weight loss

Belly fat, particularly visceral fat surrounding internal organs, responds differently to weight loss efforts compared to subcutaneous fat in other body areas

The goal is sustainable weight loss that preserves lean muscle mass and supports overall health, rather than rapid weight reduction that may be difficult to maintain

There is no need to pinch the skin excessively in most patients, though individuals with minimal subcutaneous fat may benefit from a gentle skin fold to ensure subcutaneous rather than intramuscular injection

However, if serum cobalamin concentration is within the normal range, treatment should be continued at least monthly (for parenteral supplementation) and the owner should be forewarned that clinical signs may recur sometime in the future