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Regardless, it is important that appropriate precautions are taken in these patients and that antibiotics are selected that account for antimicrobial resistance

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These patients may display subtle metabolic abnormalities insulin resistance, dyslipidemia, or visceral adiposity despite appearing lean. Clinical markers such as waist circumference, hepatic imaging findings, and elevated liver enzymes (ALT/AST) should prompt further evaluation even when BMI is below 25 kg/m

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However, NHS access criteria are more restrictive, typically requiring referral to specialist weight management services and higher BMI thresholds (generally 35 kg/m with comorbidities, with lower thresholds for some ethnic groups)