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When guiding patients, it can be helpful to frame the conversation around three questions: What fits best into your daily routine

Lifestyle Interventions: Diet, exercise, and behavioral changes remain foundational for diabetes and obesity management

Complementary approaches may include: Behavioral therapy or weight management counseling Sleep optimization (79 hours nightly) Stress management techniques Evaluation and treatment of coexisting conditions (insulin resistance, sleep apnea, depression) FDA-approved oral weight loss medications (orlistat, phentermine/topiramate ER, naltrexone/bupropion) as alternatives to injectables (note: phentermine monotherapy is approved for short-term use only) Patients should maintain realistic expectationsweight loss may be slower with hypothyroidism, even when well-controlled

It has been suggested that this effect is mediated by a reduction in endocannabinoid and arachidonic acid levels in the LSc and decreased synaptic dopamine levels (44)

SolaLeyva, A., Pathare, A