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Ethics statement The study is considered exempt research by the United States Department of Health and Human Services under 45 CFR 46.104(d)(4) as it involved only the secondary use of data that were de-identified in compliance with the Health Insurance Portability and Accountability Act (HIPAA), specifically, 45 CFR 164.514

Clinical trials consistently show average weight losses of 1521% of baseline body weight over 72 weeks, making weight gain an unexpected response that warrants investigation

Escalation pauses or steps back if side effects become troublesome

The predictability and standardization reduce variables that could complicate treatment

For patients searching for Qsymia for weight loss in Houston, surrounding Texas cities or the DFW metro, the prescribing clinician needs to be involved long-term, which is why most patients prefer a local team they can follow up with regularly

Because this study used only de-identified data compliant with the requirements of the Health Insurance Portability and Accountability Act, Institutional Review Board review and approval was not needed