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Studies have shown that the gut microbiota not only directly affects the production of glucocorticoids and immune mediators, such as tumor necrosis factor- (TNF-), interleukin-1 (IL-1), and IL-6, but also further stimulates HPA axis activity through these mediators (112)

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Evidence-based alternatives include structured nutrition with adequate protein intake, progressive resistance training, appropriate cardiovascular exercise, and consultation with sports medicine professionals and registered dietitians

PubMed: 17204842

Conclusion This review has outlined the clinical rationale for combining pharmacological therapy, particularly GLP-1 RAs like semaglutide, with personalised dietary strategies in the treatment of obesity