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NICE guidelines emphasise a multicomponent approach incorporating dietary changes, increased physical activity, and behavioural strategies, ideally delivered through structured weight management programmes

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Patients often notice reflux symptom reduction within 2 to 4 weeks of starting treatment, before substantial weight loss occurs

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420 However, KD may contribute to decreased sensitivity to peripheral insulin and impaired glucose tolerance by upregulating insulin receptors, as determined by previous studies, which contradicts clinical findings