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For adults with a BMI of 40 kg/m2 or higher or those with a BMI of 35 kg/m2 or higher with obstructive sleep apnea or prediabetes, Apovian recommends strongly considering bariatric surgery as a first-line therapy due to very low complication rates and robust and durable weight loss

Stage 4: Macrocytic anemia (abnormally large red blood cells) seen on laboratory testing

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Glutathione mediated reductive activation and mitochondrial dysfunction play key roles in lithium induced oxidative stress and cytotoxicity in liver