I don’t believe those alleged before and after pictures.
Anyone losing that much weight is going to have saggy skin. Skin gets stretched out with that much fat and takes time (if young enough I suppose) and/or surgery to deal with it.
You can always tell when someone has lost a lot of weight. And they do NOT look like that *after* picture.
Yeah, I don’t have much faith in before and after photos. Just suggesting a possible answer to the mystery of why the patients are getting pregnant. It reminds of the wave of heart attacks in older men after Viagra. Not really a big mystery at all.