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The options, he added, range from behavioral approaches like cognitive behavioral therapy and stress management to other medications such as naltrexone or bupropion

R01DK132427 (M.D.G.) and K01DK120742 (D.A.D.) from the National Institute of Diabetes and Digestive and Kidney Diseases are also acknowledged

Combination therapy would be off-label and requires specialist supervision, informed consent, enhanced monitoring, and is not routinely NHS-funded

At the starting dose, realistic first-month losses typically fall between 2 and 6 pounds total, depending on starting weight, dietary changes, and individual metabolism