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The clinical and metabolic effects of rapid weight loss in obese pet cats and the influence of supplemental oral Lcarnitine. Journal of veterinary internal medicine 14.6 (2000): 598-608

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The additional marginal effect of the 1-star reduction is fairly minimal in the scope of ordinary year-on-year changes and is likely less than the one-time impact of other significant methodological changes in past years (most significantly the switch from latent variable modeling to explicit average measure group scoring and the introduction of peer grouping) (85 FR 86193)

Patients may notice reduced fatigue and improved wellbeing within two to four weeks, whilst macrocytic anaemia typically resolves over six to eight weeks