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NICE guidance (CG189) recommends considering surgery for adults with BMI 40 kg/m or BMI 35 kg/m with significant comorbidities who have not achieved adequate weight loss with non-surgical methods

This approach recognizes that health risk varies by person, not just absolute weight

Berberine is not suitable for infants because it has been linked to a harmful build-up of the waste product, bilirubin, for this reason it may be unsafe during pregnancy and when breastfeeding

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This creates a need for nutritional guidance when using these drugs

Authorizations and step therapy programs make access difficult where coverage exists at all