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And you often don't even realize what you changed, at least at first, and sometimes you don't realize it at all until a subsequent play-through where something you changed has turned out slightly or even massively different. Some of the changes are specific to one or two of the four basic paths you can take through the game, so you may never even encounter what you changed, which incidentally is also frustratingly accurate to real life. Sometimes this feels forced and/or stupid, and sometimes it actually forced and stupid, and there are plenty of aspects where they didn't take full advantage of the opportunity to really change things like they maybe could have. But there's also quite a few aspects where it works really well or even brilliantly, much more so than other games where they only claim that choices matter.
So, it can depend a lot on what you do, and your mileage may vary by quite a bit. It's not some huge revolution in how "choices matter" can or should be done, but it is an outline of, or a few steps in the right direction toward, or a lesson in, what a major overhaul to the "choices matter" concept could look like.
Act 1 choices determine which main quest path you end up on (Disfavored, Scarlet Chorus, Rebel, Anarchist)
A lot of options are gain favor/neutral/be rude and gain wrath, or gain favor with one faction and gain wrath with their enemy.
Some options/talents are gated behind having enough rep with a certain faction.
You can end up killing/chasing off all the other party members.
Honestly as far as 'choices matter' it isn't that much different from other RPGs (aside from 4 different main quest lines instead of 1).
You're leaving a few things out. Quite a lot of things, actually, depending on how specific you want to get, but just speaking generally, only a few things.