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Healthcare providers should evaluate and manage factors that may impede progress, including: Medications that promote weight gain (certain antidepressants, antipsychotics, corticosteroids, insulin, beta-blockers) Undiagnosed or suboptimally treated hypothyroidism Sleep disorders, particularly obstructive sleep apnoea Psychological factors including depression, anxiety, and eating disorders Social and environmental barriers to lifestyle change Patients who have not achieved expected weight loss with single-agent therapy should undergo comprehensive reassessment before considering any treatment changes

Nutrient Deficiencies Long-term metformin use can reduce vitamin B12 levels, leading to fatigue

Analysis of the redox metabolites from a single blood sample has been a challenge because of the different pH stability requirements of their reduced and oxidized forms, and the high protein concentration of the blood