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A clinical hierarchy: don’t stack until you’ve earned the right to stack Before we even talk combinations, an evidence-led clinic typically wants these foundations in place: Diagnosis clarity: Obesity phenotype, insulin resistance, prediabetes/T2D, dyslipidemia, sleep apnea risk, NAFLD risk Baseline labs: A1c, fasting glucose/insulin (or at least glucose), lipids, CMP, CBC

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Recombinant leptin for weight loss in obese and lean adults: a randomized, controlled, dose-escalation trial