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Although lifestyle interventions (low-calorie diets and exercise) are still the cornerstone of weight management, weight loss achieved through this approach is extremely difficult to sustain in the long term, particularly due to physiological adaptations that reduce the energy expended or increase appetite to compensate for the missing calories

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44 An open-label, uncontrolled trial in 51 patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) found improvements in 34 patients after 3 months of supplementation with hydroxo-B12, 10 000 mcg twice per week as nasal drops