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Patients are presenting with increasingly complex patterns of dysfunction

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Subsequently, the gut microbiota produces short-chain fatty acids (SCFAs), such as butyrate, acetate, and propionate, which affect intestinal homeostasis (147, 153)

NICE-recommended weight management strategies include: Dietary intervention aiming for a 600 kcal/day deficit through reduced portion sizes, limiting energy-dense foods, and increasing fruit and vegetable consumption Physical activity building up to 150300 minutes of moderate-intensity aerobic activity weekly, plus muscle-strengthening activities on at least two days weekly, in line with UK Chief Medical Officers' guidelines [10] Behavioural approaches including self-monitoring, goal-setting, and addressing emotional eating patterns Commercial weight management programmes such as those meeting NICE quality standards (QS127) Very-low-calorie diets in specific circumstances, under clinical supervision and for limited periods For patients with a BMI 30 kg/m (or 27.5 kg/m in those of South Asian, Chinese, or other Asian family origin) who have not achieved adequate weight loss through lifestyle measures alone, pharmacological interventions may be considered