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And yet the one variable quietly undermining all of it often goes untested, unnoticed, and uncorrected

For some carefully selected patients, that opens the door to eventually reducing the drug burden rather than escalating it: a lower biologic frequency, a smaller methotrexate dose, or getting off chronic steroids

NICE recommended semaglutide 2.4 mg (TA875, 2023) for use within specialist Tier 3 weight management services in adults with a BMI of 35 kg/m (or 32.5 kg/m in people of South Asian, Chinese, other Asian, Middle Eastern, Black African, or African-Caribbean family background) with at least one weight-related comorbidity, or a BMI of 3034.9 kg/m in specific circumstances

Treatment decisions are based on more than one lab value

Seek out psychological support because it can be very difficult to turn around by yourself