Anecdotal reports of stomach paralysis after long term use. I do know that in my circle of acquaintances those who have been using it soon show signs of the drug being the method of loss...their body composition changes along with getting smaller. I'd assume that concentrated exercise would help with that. I'm not personally aware of many men on the plan, but every woman I know who's using it has definitely lost a lot of weight, but they've also lost any feminine shape that they had initially...every angle has gone flat.  One friend who has lost probably 30-40 lbs looks very much like a caricature of a clown. She's always had a beautiful prominent, toothy smile, but the significant weight loss has pulled and thinned her face and sunken her large eyes to the point of being startling.