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acts centrally to reduce appetite Setmelanotide : Reserved for specific genetic obesity syndromes (e.g., POMC/PCSK1/LEPR deficiency, Bardet-Biedl syndrome) under specialist supervision Non-pharmacological interventions form the cornerstone of weight management and may be particularly appropriate: Structured lifestyle programmes : NICE recommends multicomponent interventions including dietary modification, increased physical activity, and behavioural strategies

Additional downstream mediators include ErbB ligands such as epiregulin and vasoactive intestinal polypeptide (VIP) (68)