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MC4R activation promotes increased energy expenditure through stimulation of sympathetic nervous system activity, brown adipose tissue thermogenesis, and enhanced fatty acid oxidation

Check meds that mask hypoglycemia (-blockers) and adjust sulfonylurea/insulin doses to avoid lows

Microflora such as Bilophila , Lactobacillus , Marvinbryantia , Alistipes , Lachnospiraceae_NK4A136_group , Oscillibacter , and [Eubacterium]_xylanophilum_group were decreased and Anaerostipes , Parasutterella , [Clostridium]_innocuum_group , Hungatella , Bacteroides , Lachnoclostridium , Akkermansia , Blautia , and Flavonifractor were increased in the mice transplanted with faecal microbiota from growth hormone-secreting pituitary adenoma patients compared to the controls [185]

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These include conducting additional randomized clinical trials in patients with or at risk for AD dementia, determining optimal dosage and timing, and further determining potential side effects, particularly of long-term use

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