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A quality program includes structured dietary guidance, access to prescribers for dose adjustment requests between scheduled follow-ups, and explicit protocols for managing the three most common treatment obstacles: early-phase nausea severe enough to disrupt daily function, weight loss plateaus at 812 weeks despite medication adherence, and the transition period when patients approach goal weight and begin considering maintenance dosing or discontinuation

For patients with mild deficiency, smaller weekly or bi-weekly doses may be used