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FDA-approved pharmacotherapy alternatives include several options with established safety profiles: Semaglutide (Wegovy): A GLP-1 receptor agonist producing 12-15% weight loss, with cardiovascular benefits demonstrated in the SELECT trial and FDA-approved indication for reducing cardiovascular risk Liraglutide (Saxenda): A GLP-1 receptor agonist producing 5-8% weight loss [4] Phentermine-topiramate (Qsymia): FDA-approved combination producing 7-10% weight loss with established safety data Naltrexone-bupropion (Contrave): Combination targeting reward pathways and appetite, producing 5-9% weight loss [4] Orlistat (Xenical, Alli): Lipase inhibitor producing 3-5% weight loss with gastrointestinal side effects [4] Setmelanotide (Imcivree): For rare genetic obesity disorders (POMC, PCSK1, LEPR deficiency) [4] Metabolic and bariatric surgery should be considered for patients with BMI 40 kg/m or 35 kg/m with obesity-related comorbidities who have not achieved adequate weight loss with nonsurgical interventions

Congenital causes are rare and are the result of genetic mutations in genes encoding proteins involved in B12 absorption, transport, and intracellular processing

Physicians usually prescribe B12 for fatigue, as the vitamin converts nutrients from food into glucose, which makes an individual experience a boosted energy level needed for intensive activities

Vadillo, and L

2026 J Cosmet Dermatol