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If you do have decreased kidney function and your doctor recommends methylcobalamin, you may need a much higher dose because its less stable, so be sure to ask them about whats best given your condition

The main risk is hypoglycemia (dangerously low blood sugar), which can become a medical emergency

doi: 10.1016/j.ajpath.2011.08.039 133

Gastric bypass typically achieves higher percentage loss (30 to 35%) but carries surgical risks, permanent anatomical changes, and significant recovery time

The results are amazing, said Arslanian, who is also director of the Pediatric Clinical and Translational Research Center and scientific director of the Center for Pediatric Research in Obesity and Metabolism at Pitt and UPMC Childrens Hospital of Pittsburgh