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I'm also a sex counselor and a nutrition scientist

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Its generally prescribed if you meet one of these criteria: BMI 30 (classified as obese), or BMI 27 (overweight) with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia

Some preparations are stable at room temperature (up to 77F / 25C) for limited windows, but the safest default is to refrigerate