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Step requirements can be waived with documented intolerance or prior failure

If you are losing weight consistently at the starting dose, there is no urgent reason to increase

Moreover, cytokines produced in innate immune responses, such as TNF, IL-6 and IL-1 are found at comparable levels in rheumatoid arthritis joint tissues, early OA and end-stage disease synovium [18]

The magnitude and progress of lean body mass, fatfree mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and metaanalysis - PMC Preserving Healthy Muscle during Weight Loss a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up Preserving Healthy Muscle during Weight Loss - PMC Long-Term Efficacy and Safety of Anti-Obesity Treatment: Where Do We Stand