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Tier 3 (BMI 35-39.9 with comorbidities or BMI 40+): Aggressive pharmacotherapy with GLP-1 agonists or dual agonists, potentially combined with very low-calorie dietary interventions and consideration of bariatric surgery referral if medical management is insufficient

primarily focus on other alleged side effects, such as gastrointestinal injuries, including gastroparesis and intestinal obstruction

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