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What guidelines and real-world practice say Despite the lack of direct trials, major guidelines support: Using the lowest effective dose Shared decision-making Individualised plans In real-world practice, many clinicians: Use a maintenance phase Reduce dose gradually Monitor appetite, weight stability, and wellbeing Adjust based on how the person feels, not just the scales This approach is not because we have perfect data, but because it aligns with physiology, patient experience, and common sense

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