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This might involve: Optimising the current medication dose to the maximum tolerated level Intensifying lifestyle interventions with specialist dietetic or psychological support Switching to an alternative single agent if the first medication is poorly tolerated or ineffective Considering bariatric surgery referral for patients meeting eligibility criteria who have not achieved adequate weight loss with medical management The consensus among UK specialists is that combination pharmacotherapy for weight loss should only be considered within clinical trials or highly specialised settings where close monitoring is possible