A 47-year-old woman with primary hypothyroidism and osteoarthritis of the right knee presented to the clinic for follow-up.  She is trying to lose weight in preparation for right knee surgery.  The weight loss has plateaued on a low-calorie meal plan.  Her exercise is limited by chronic knee pain.  She tracks her calories and daily steps.  After the discussion about the risks and benefits of weight loss medications, she was started on phentermine/topiramate extended-release daily.  She returns three months later and has lost 3% of her body weight since the last visit.  On physical examination, her BMI is 34 kg/m². She has decreased range of motion of right knee. Otherwise, the physical examination is unremarkable.