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When Combination Might Be Considered: In select cases, clinicians might discuss combination therapy for patients who: Have achieved partial but insufficient response to maximally tolerated tirzepatide Have specific dietary patterns with high fat intake Have previously responded well to orlistat but need additional intervention Understand and accept the increased side effect burden For patients with BMI 40 kg/m or 35 kg/m with obesity-related comorbidities, referral for bariatric surgery evaluation should be considered per American Society for Metabolic and Bariatric Surgery guidelines, rather than pursuing multiple pharmacotherapies