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Vitamin B12 deficiency may manifest as: Hyperchromic macrocytic megaloblastic anaemia (pernicious anaemia, Biermer's anaemia, Addison anaemia

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The shelf life varies by specific product, and all medications should be used before the expiration date printed on the packaging when stored according to the manufacturer's instructions: Semaglutide (Ozempic, Wegovy) : Unopened pens may be stored in the refrigerator until the expiration date on the label Dulaglutide (Trulicity) : Remains stable when refrigerated until the printed expiration date Liraglutide (Victoza, Saxenda) : Maintains potency when refrigerated continuously until expiration Tirzepatide (Mounjaro, Zepbound) : Stable under refrigeration until the manufacturer's expiration date Exenatide (Byetta, Bydureon BCise) : Requires refrigeration and remains effective until expiration when stored properly It is important to note that permitted room-temperature storage periods as specified in the prescribing information do not invalidate the expiration date

Key evidence-based strategies include: Calorie-controlled diets tailored to individual needs, with a focus on whole foods, vegetables, lean proteins, and reduced ultra-processed food intake Regular physical activity the NHS recommends at least 150 minutes of moderate-intensity exercise per week for adults, alongside strength training on two or more days [15] Behavioural interventions , including cognitive behavioural therapy (CBT) approaches, which address eating habits and psychological relationships with food NHS weight management programmes , such as referral to Tier 2 or Tier 3 services depending on BMI and comorbidities

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