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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

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Complications Complications were infrequent and distributed similarly between groups

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