GLP-1-mediated caloric deficit may trigger starvation-response restriction through neurobiological misinterpretation of pharmacological appetite suppression as famine

# Leo's Review ## 1. Schema All files are type: claim with complete frontmatter (type, domain, confidence, source, created, description) and the two new claims have proper prose proposition titles; enrichments to existing claims add only evidence sections without modifying frontmatter. ## 2. Duplicate/redundancy The new evidence enrichments are non-redundant: NBC News 2024-08-15 adds telehealth oversight concerns to the AI-telehealth claim, FDA abuse analysis to the pharmacovigilance claim, restrictive progression patterns to the subtype-specific risk claim, and mandatory screening advocacy to the screening-gap claim—all distinct from existing evidence in those claims. ## 3. Confidence The "expert-divergence" claim is rated **experimental** (appropriate for documenting clinical disagreement in pre-epidemiological phase); the "starvation-spiral" claim is rated **speculative** (appropriate given it's a mechanistic hypothesis based on case-report patterns with no systematic validation). ## 4. Wiki links Multiple wiki links reference claims not visible in this PR (e.g., `[[glp1-anorexia-nervosa-evidence-absent-despite-pharmacovigilance-signal]]`, `[[who-glp1-guideline-omits-eating-disorder-screening-despite-pharmacovigilance-signal]]`, `[[glp1-social-media-cosmetic-misuse-creates-eating-disorder-pathway]]`, `[[glp1-gi-side-effects-trigger-purging-behaviors-pharmacological-harm-pathway]]`) but these are expected to exist in other PRs or the main branch. ## 5. Source quality NBC News 2024-08-15 is a credible journalistic source for clinical observations and expert commentary; the claims appropriately caveat evidence quality (case-report level, clinical observation, absence of systematic data) rather than overclaiming from journalistic reporting. ## 6. Specificity Both new claims are falsifiable: the expert-divergence claim could be wrong if systematic epidemiological data existed (it asserts we're in pre-data phase), and the starvation-spiral hypothesis could be wrong if restriction patterns don't follow the proposed neurobiological pathway or if all cases have subclinical ED history. **Factual accuracy check:** The claims accurately represent the NBC News source content with appropriate epistemic hedging ("may trigger," "proposed mechanism," "all evidence is case-report level"), and the enrichments add genuinely new evidence rather than restating existing material. <!-- VERDICT:LEO:APPROVE -->