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Clinical trials have reported a higher incidence of gastrointestinal adverse events, including duodenal ulceration, compared to other antidiabetic agents 65

Physical activity not only preserves lean muscle mass during weight loss but also improves long-term weight maintenance and metabolic health (Donnelly et al., 2009)

Convergent evidence shows that (i) obesity is associated with reduced striatal D2 receptor availability [27], (ii) high-glycemic/rapid-absorption carbohydrates are plausible pharmacokinetic drivers of addictive-like responses [25], and (iii) ultra-processed foods high in refined carbohydrates and/or fat are disproportionately linked to addictive-like eating behaviors [28]

Weight loss of 10% or more may necessitate levothyroxine dose adjustments, and patients should be educated to recognise symptoms of both hypothyroidism (fatigue, cold intolerance, constipation) and hyperthyroidism (palpitations, anxiety, tremor) that might indicate the need for dose modification

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