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If you are really stuck and have tried regular appetite suppressants, Semaglutide, Tirzepatide or other medical weight loss medications might be right for you

Am J Gastroenterol 105:13381345 Malaguarnera M, Vacante M, Giordano M, Pennisi G, Bella R, Rampello L, Malaguarnera M, LI Volti G, Galvano F (2011) Oral acetyl-L-carnitine therapy reduces fatigue in overt hepatic encephalopathy: a randomized, double-blind, placebo-controlled study

Large clinical trials such as LEADER and SUSTAIN-6 have not identified increased fracture risk with GLP-1 therapy compared to placebo

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Long-term data indicates that most patients maintain their weight loss improvements as long as they continue treatment

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