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One possible explanation is that low serum vitamin B12 levels would trap folate as 5-methyltetrahydrofolate, prevent the generation of methionine from homocysteine, and therefore reduce protein synthesis and lean tissue deposition

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Bupropion/Naltrexone Sustained Release (SR) The combined bupropion/naltrexone (NB) therapy induced significantly greater weight loss on a diet and exercise program over 56 weeks compared to monotherapy and placebo (61)

By month 6, the gains had further accumulated

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doi: 10.1007/s11596-018-1862-9