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Medical Evaluation Investigate potential medical contributors to weight loss resistance: Thyroid function: Check TSH if not recently assessed, as hypothyroidism impairs weight loss Medications: Review for weight-promoting drugs (antipsychotics, certain antidepressants, corticosteroids) Sleep disorders: Screen for sleep apnea and insufficient sleep, both associated with weight loss resistance Stress and cortisol: Chronic stress elevates cortisol, promoting central adiposity and metabolic dysfunction Dose Optimization If patients have not reached the maximum tolerated dose, consider further titration according to FDA labeling

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Most reputable pharmacies will replace heat-compromised shipments, especially during summer

Symptoms can include constipation, cramps, bloating, and painless bleeding from the rectum

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Extended delivery windows of 3-5 days push beyond the design limits of standard cold chain packaging