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Bariatric surgery remains an option for patients with severe obesity who meet specific NICE criteria generally a BMI of 40 or above, or 35 or above with significant comorbidities, with lower thresholds applicable in some groups, such as those with recent-onset type 2 diabetes

Interestingly, greater benefits were seen in those with high compared to low homocysteine concentrations at baseline, suggesting the importance of lowering homocysteine levels in prevention of brain atrophy and cognitive decline (91-93)

The practice may stem from bodybuilding peptide protocols rather than neurological considerations