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however, indirect factors such as rapid weight loss, postural changes, gastrointestinal side effects, and rare complications like gallbladder disease or pancreatitis may contribute to back discomfort

If denied for "no documented failure of alternative therapy," submit a letter stating the patient tried phentermine 37.5 mg for 12 weeks without achieving 5% weight loss, or tried a commercial program like Noom or Weight Watchers for 6 months

Rather than stopping treatment, patients should consult their healthcare provider or a dermatologist to identify possible causes, such as telogen effluvium or nutritional deficiencies , and receive appropriate treatment

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