Your complete reference for obesity and its treatment.
From lifestyle to injections, endoscopy, surgery and life after it, without blame and without promises.
Everything a person treating their weight needs in one place: what obesity is and how it is measured, what losing 5–10% changes, food and movement, weight-loss injections with their schedules and what follows stopping, endoscopic options, bariatric surgery with its stages and supplements, weight regain, and Ramadan and pregnancy. Then the Qawam tools to follow your weight, injection, supplements and tests.
- Understand13 reference sections
- Know your medicines10 medicines with schedules
- DecideWhen to contact your team
- FollowQawam tools
Do not wait if: Severe, persistent abdominal pain, especially if it spreads to the back: seek urgent care., Persistent vomiting or inability to keep fluids down, with dizziness or little urine: seek urgent assessment., Sudden loss of vision or rapid worsening of vision while using semaglutide: seek urgent care., After surgery: repeated vomiting or persistent difficulty drinking needs an urgent call to your team., After surgery: breathlessness or chest pain, bleeding or black stools, fainting, confusion or fever with worsening.. Seek the appropriate assessment. Do not wait for a message from the site; nothing you enter is clinically monitored.
Medical supervisor of SADA: د. الفضل عبدالفتاح، استشاري الجهاز الهضمي والقولون والمستقيم. Scope of medical review
Obesity is a chronic disease governed by hormones, not weak willpower.
What is obesity? A chronic disease, not weak willpower →One fact a day from the centre. Come back tomorrow for a new card.Understand obesity and its treatment
Open any section for the explanation and its sources. Each one is written to be the last thing you need to read on its topic.
What is obesity? A chronic disease, not weak willpowerObesity is an accumulation of fat that harms health, governed by hormones, genes, environment, sleep and medicines, not willpower alone. It is therefore treated as a chronic disease with a long plan, not a short campaign.
The WHO defines obesity as abnormal or excessive fat accumulation that presents a risk to health, and classifies it as a complex chronic disease.
The body regulates its weight with appetite, fullness and energy-burning signals that work against weight loss: when you lose weight, hunger hormones rise and energy expenditure falls, which is why weight returns for many people, not a lack of commitment.
The NICE guideline notes that blame and stigma harm treatment, that weight is discussed respectfully and at the person's request, and that the goal is health and quality of life, not the scale number alone.
Start with one change you can repeat, such as arranging a meal or a time to move. The injection path and the surgery path are parts of the same program.
Limits: A general description; assessing the causes of weight (medicines, thyroid, sleep, mental health) is done with the doctor.
Sources: WHO (2025) · NICE NG246 (2025) · NIDDK (2023)
How it is measured: BMI and the waistBody mass index (BMI) is weight in kilograms divided by height in metres squared. 25–29.9 is overweight, 30 and above is obesity, with classes rising with the number.
Body mass index (kg/m²)
- 18.5–24.9Healthy weight
- 25–29.9Overweight
- 30–34.9Obesity class 1
- 35–39.9Obesity class 2
- 40+Obesity class 3
Waist circumference adds what BMI cannot see: fat around the abdomen is more dangerous for the heart and diabetes. NICE notes a waist-to-height ratio under 0.5 as a practical target (your waist less than half your height).
For people of South Asian, East Asian and Middle Eastern origin, risks may begin at lower numbers; NICE suggests lower BMI thresholds (23 instead of 25, and 27.5 instead of 30) for these groups.
BMI does not distinguish muscle from fat and is not enough on its own for athletes, older people or pregnant women; the doctor combines it with the waist, history and tests.
Limits: The numbers are a classification, not a diagnosis; your risk depends on the whole picture.
Sources: WHO (2025) · NICE NG246 (2025) · NIDDK (2023)
What does losing 5–10% of your weight change?You do not have to reach an "ideal" weight to benefit. Losing 5–10% of body weight improves blood pressure, blood sugar, lipids, fatty liver, sleep and joints for many people.
Obesity raises the risk of type 2 diabetes, high blood pressure, metabolic fatty liver disease, sleep apnoea, knee osteoarthritis, some cancers and fertility problems.
Larger loss (10–15% or more, as achieved by newer medicines or surgery) can put diabetes into remission and improve sleep apnoea and fatty liver more clearly.
Success is not measured by weight alone: waist circumference, blood pressure, tests, sleep, mobility and mood.
Limits: Benefits differ from person to person; your doctor sets targets that fit your case.
Sources: NIDDK (2023) · NICE NG246 (2025) · WHO (2025)
Food: no single diet for everyoneNo particular diet is proven superior in the long term; what is proven is consistency. Choose a pattern you can live with, not one you wait to end.
NICE suggests a moderate calorie deficit (about 600 kcal below your daily need) achieved through regular smaller meals, enough protein at each meal, vegetables, and fewer sweetened drinks and fast food.
A small appetite does not mean giving up on nutrition. Include a protein source that suits you, vary your food, and discuss activity that keeps your strength.
With weight-loss injections fullness increases and meals shrink; the risk here is too little protein and fluid and muscle loss, not overeating. Start your meal with protein and drink through the day.
Very low-calorie diets (under 800 kcal) have a limited place under medical supervision only, and do not suit pregnant women, teenagers or people with an eating disorder.
Limits: No personal calorie numbers from this page; the dietitian calculates them for you.
Sources: NICE NG246 (2025) · Guy's and St Thomas' NHS (2025) · WHO (2025)
Movement: to keep muscle and keep weight offMovement alone loses little weight, but it is the strongest tool against regain and for keeping muscle, heart and mood.
The WHO recommends adults do 150–300 minutes a week of moderate activity (brisk walking) or 75–150 minutes of vigorous activity, with muscle-strengthening exercise on at least two days a week.
During weight loss with medicine or surgery, muscle is lost along with fat; resistance exercise (weights, bands, body weight) with enough protein reduces this loss.
Start where you are: ten minutes of walking after two meals beats an hour-long plan that never starts. Add five minutes each week.
Limits: People with heart disease or severe joint disease check with their doctor before a new program.
Sources: WHO (2020) · Guy's and St Thomas' NHS (2025) · NICE NG246 (2025)
Weight-loss injections and obesity medicines: for whom, how much, and what after stopping?AGA guidance recommends adding medicine to lifestyle change for people with a BMI of 30 or more, or 27 or more with a weight-related disease, when lifestyle alone is not enough.
GLP-1 analogues (weekly semaglutide, daily liraglutide) and tirzepatide (weekly GLP-1/GIP) slow stomach emptying and increase fullness. In trials: semaglutide 2.4 mg about 15% of body weight over 68 weeks, tirzepatide up to about 20%, liraglutide about 8%, orlistat about 3% beyond lifestyle.
Common side effects: nausea, vomiting, constipation or diarrhoea, bloating, reflux; they usually ease with gradual dose increases and small meals. Rare but important: pancreatitis, gallstones, dehydration, and rare reports of optic neuropathy with semaglutide.
The medicine works while it continues; after stopping, a large part of the weight returns within a year for most people unless eating and activity habits are established. Stopping or tapering is therefore discussed with the doctor as a plan, not a sudden decision.
Gather the name of your medicine, the date of the last dose and what you noticed, and take them to your appointment. The program does not choose the medicine or calculate the next dose.
MHRA warnings: these medicines are not used in pregnancy and are stopped before trying to conceive (semaglutide: two months); tell the anaesthetist before any operation or endoscopy because the stomach may remain full; and do not buy injections from unlicensed sources.
The medicine and supplement map: for whom, how taken, and the usual pattern ↓
Limits: No starting a medicine and no dose change from this page; medicines are by prescription and follow-up.
Sources: AGA (2022) · NICE NG246 (2025) · MHRA (2026) · FDA labels (DailyMed) (2025)
Nausea, fullness and constipation: what to do at homeMost side effects settle within weeks of each dose step. A small, slow meal and enough water solve most of them.
Try a small amount, eat slowly, and cut down on fatty meals and smells that bother you. Being unable to keep fluids down needs medical help.
Watch your drinking and your stool form. Too little food and fluid can go with constipation, and diarrhoea can cause fluid loss.
Stop eating at the first feeling of fullness; eating beyond it causes nausea and reflux. Stay upright for two hours after a meal.
If nausea or vomiting persists or you stop eating for days, do not take the next dose increase on schedule before speaking to your doctor; the step may be delayed or the dose reduced.
Limits: Severe abdominal pain spreading to the back or persistent vomiting is a warning sign, not a side effect.
Sources: Guy's and St Thomas' NHS (2025) · MHRA (2026) · NICE NG246 (2025)
Endoscopic options: the balloon and endoscopic sleeveBetween medicine and surgery sit endoscopic procedures without an incision: the temporary gastric balloon, and endoscopic sleeve gastroplasty (stitching from inside).
- Lifestylethe base at every stage: food, movement, sleep
- Obesity medicinesBMI 30+ or 27+ with a comorbidity
- Endoscopic proceduresballoon or endoscopic sleeve, BMI 30–40
- Bariatric surgeryBMI 35+ or 30+ with metabolic disease
- After surgerysupplements, tests and lifelong follow-up
The balloon is usually placed for 6 months and then removed; it helps some people lose about 10% of body weight with a dietary program, and weight returns if habits do not change.
Endoscopic sleeve gastroplasty reduces stomach volume by internal stitching without removing part of it; weight loss is less than surgery but recovery is faster and complications fewer.
These procedures suit people with a BMI of 30–40 who do not want or are not suited to surgery, and are not done without a dietary program and follow-up.
Limits: Availability and approval differ between centres; discuss the option with a specialist team.
Sources: NIDDK (2024) · NICE NG246 (2025)
Bariatric surgery: for whom, which operation, and what to expectUnder the 2022 ASMBS/IFSO guidance, surgery is recommended for people with a BMI of 35 or more regardless of comorbidities, for a BMI of 30–34.9 with metabolic disease (such as diabetes), and at lower thresholds for people of Asian origin.
- Sleeve gastrectomyRemoves about 80% of the stomach and leaves a narrow tubeSimpler, fewer deficiencies; may worsen reflux
- Gastric bypassA small pouch joined to the small intestine, bypassing part of itStronger for diabetes and reflux; more deficiencies and dumping
Sleeve gastrectomy removes about 80% of the stomach and leaves a narrow tube; gastric bypass creates a small pouch and joins it to the small intestine, bypassing part of it. Bypass is stronger for diabetes and reflux; the sleeve is simpler with fewer deficiencies.
Expected loss is about 25–30% of total body weight over 12–18 months, with major improvement in diabetes, blood pressure and sleep apnoea. Part of the weight (about 5–10%) may return after years for many people.
Early risks: leak, bleeding, clots, stricture; late: vitamin deficiencies, gallstones, reflux after sleeve, low blood sugar and dumping after bypass.
Preparation: stopping smoking, a liver-shrinking diet usually for two weeks before the operation, heart, breathing and psychological assessment, and telling the anaesthetic team about any weight-loss injections you use.
Limits: The choice of operation is the surgeon's decision with you according to your case; this page explains and does not choose.
Sources: ASMBS / IFSO (2022) · NIDDK (2024) · NHS (2024)
After surgery: food stages, supplements and testsThe surgeon's and dietitian's plan is the reference for food texture and moving between stages. Do not apply general meal examples to the post-surgery stage automatically.
Usual stages: liquids in the first two weeks, then puree for 2–4 weeks, then soft food, then regular food in small portions after about 6–8 weeks; your team sets the date of each transition.
Permanent rules: small meals, slow chewing, protein first (about 60–80 g a day as set by your team), drinking between meals not with them, and avoiding fizzy drinks and sugars.
Lifelong supplements according to the operation: a daily multivitamin, vitamin B12, iron, calcium citrate, vitamin D; and periodic tests (usually at 3, 6 and 12 months then yearly) to catch deficiencies before symptoms.
After bypass: dumping syndrome (palpitations, sweating, diarrhoea after sugars) and low blood sugar after meals are managed by adjusting meals and reviewing with the team. Pregnancy is advised to be delayed 12–18 months after the operation.
Limits: The schedules here are usual examples; your team's plan and your tests are the reference.
Sources: ASMBS (2024) · BOMSS (2023) · NHS (2024) · NIDDK (2024)
Weight regain: why it happens and what to doRegaining part of the weight after any treatment is biologically expected, not a failure. What matters is catching it early and treating it with a plan, not blame.
Its causes: the body's adaptation (more hunger, less energy burned), stopping medicine, pouch widening after surgery, changed circumstances (work, pregnancy, a new medicine such as steroids or some antidepressants and diabetes medicines).
What is proven to help maintenance: regular weekly weighing, breakfast and protein, 60 minutes of moderate movement most days, enough sleep, and follow-up with the team instead of dropping out.
After surgery a GLP-1 medicine may be added for people who regain; after medicine, returning to it or switching may be discussed; options are listed after the causes are reviewed.
Limits: A gain of 5% or more above your lowest weight is a reason to review with the team, not to wait.
Sources: NICE NG246 (2025) · AGA (2022) · ASMBS (2024)
When to wait and when to goNausea after a dose increase or fullness after a large meal are usual symptoms managed with what you know. Severe pain, inability to drink or a change in vision are symptoms that do not wait.
For a usual symptom: smaller, slower meals, fluids between meals, postponing fatty food, and a light walk.
Contact your team this week if nausea lasts more than two weeks after a dose step, you have not passed stool for 4 days, your weight has regained 5% above its lowest, or swallowing becomes painful after a sleeve.
Do not wait for the appointment with any of the warning signs listed at the bottom of the page.
Limits: The signal is a descriptive aid for your decision, not a diagnosis.
Sources: MHRA (2026) · NHS (2024) · ASMBS (2024)
Ramadan, pregnancy and travel with treatmentTreatment does not stop when circumstances change; it is adjusted. Discuss every change before it happens, not after.
In Ramadan: fasting usually does not change the weekly injection; a daily one is taken after breaking the fast as your doctor advises. The biggest risk is dehydration and skipping the pre-dawn meal; after surgery the team may advise not fasting in the first year.
In pregnancy: obesity medicines are not used, and semaglutide is stopped at least two months before trying to conceive; after surgery, pregnancy is delayed 12–18 months and supplements and tests are followed carefully during it.
When travelling: carry the medicine in hand luggage with a prescription, and keep pens refrigerated before first use; after surgery carry your operation card and supplement list.
Other medicines can add weight (some antidepressants, anti-epileptics, diabetes medicines and steroids); do not stop them yourself, and mention them to your doctor to look for alternatives.
Limits: Every medicine adjustment is arranged with your doctor.
Sources: MHRA (2026) · BOMSS (2023) · NICE NG246 (2025)
The medicine and supplement map: for whom, how taken, and the usual pattern
The schedule shown is the usual licensed adult pattern. Your prescription is the reference and may differ for reasons specific to you. The "My treatment" tool reminds you of the dose your own doctor wrote.
Semaglutide 2.4 mg (weekly injection)Weight-loss injections (GLP-1 and GLP-1/GIP)
- Brand names
- Wegovy
- Usual schedule
- Subcutaneous injection once a week: 0.25 mg for 4 weeks, then 0.5, then 1, then 1.7, each for 4 weeks, then 2.4 mg maintenance
- Before and during
- A lower dose can be kept longer if nauseated; not used in pregnancy; tell the anaesthetist before any procedure
- Tell your team about
- Severe abdominal pain, persistent vomiting, change in vision, pain in the upper right abdomen
Tirzepatide (weekly injection)Weight-loss injections (GLP-1 and GLP-1/GIP)
- Brand names
- Mounjaro, Zepbound
- Usual schedule
- Subcutaneous injection once a week: 2.5 mg for 4 weeks, then increased by 2.5 mg at least every 4 weeks to 5, 7.5, 10, 12.5 or 15 mg by response and tolerance
- Before and during
- The right dose is not always the highest; not used in pregnancy
- Tell your team about
- Severe abdominal pain, persistent vomiting, dehydration, pain in the upper right abdomen
Liraglutide 3 mg (daily injection)Weight-loss injections (GLP-1 and GLP-1/GIP)
- Brand names
- Saxenda
- Usual schedule
- Subcutaneous injection once a day: 0.6 mg for a week, then increased by 0.6 mg each week to 3 mg
- Before and during
- At any time of day, consistently; not used in pregnancy
- Tell your team about
- Severe abdominal pain, persistent vomiting, palpitations
OrlistatOther obesity medicines
- Brand names
- Xenical, Alli
- Usual schedule
- One 120 mg capsule with each main meal (up to 3 times a day); omitted if the meal has no fat
- Before and during
- Oily stools and wind if the meal is fatty; may need a multivitamin taken well apart from it
- Tell your team about
- Jaundice, dark urine, severe abdominal pain
Naltrexone/bupropionOther obesity medicines
- Brand names
- Mysimba, Contrave
- Usual schedule
- Tablets: one in the morning in week 1, then increased weekly to two in the morning and two in the evening from week 4; effect reviewed after 16 weeks
- Before and during
- Not used with epilepsy, opioids or uncontrolled high blood pressure; stopped if 5% is not lost after 16 weeks
- Tell your team about
- Mood change or troubling thoughts, a seizure, raised blood pressure
Post-bariatric multivitaminPost-surgery supplements
- Brand names
- Forceval, bariatric-specific brands
- Usual schedule
- One or two tablets a day for life according to the operation and your team (usually double the standard dose after bypass)
- Before and during
- Chewable or liquid in the first weeks
- Tell your team about
- Severe tiredness, sudden hair loss, tingling
Vitamin B12Post-surgery supplements
- Usual schedule
- Tablets 1000 micrograms a day under the tongue or by mouth, or an intramuscular 1000 microgram injection every 1–3 months at the team's decision
- Before and during
- Monitored by blood test; deficiency causes tingling and anaemia
- Tell your team about
- Tingling in hands or feet, poor balance
IronPost-surgery supplements
- Brand names
- ferrous sulfate / fumarate
- Usual schedule
- One iron tablet (about 45–60 mg elemental iron) daily or on alternate days, doubled for menstruating women as the team advises; taken two hours apart from calcium
- Before and during
- Better absorbed with vitamin C; causes constipation and dark stools
- Tell your team about
- Severe tiredness, palpitations, pallor
Calcium citratePost-surgery supplements
- Usual schedule
- 1200–1500 mg a day divided into 2–3 doses (500–600 mg each), apart from iron
- Before and during
- Citrate is absorbed without stomach acid; carbonate is less suitable after surgery
- Tell your team about
- Muscle cramps, bone pain
Vitamin D3Post-surgery supplements
- Usual schedule
- 3000 IU a day (or the weekly equivalent), adjusted according to the vitamin D level
- Before and during
- Monitored by blood test once or twice a year
- Tell your team about
- Bone pain, muscle weakness
Sources: FDA labels (DailyMed) (2025) · BNF (NICE) (2026) · BOMSS (2023) · ASMBS (2024)
When not to wait for the appointment
- Severe, persistent abdominal pain, especially if it spreads to the back: seek urgent care.
- Persistent vomiting or inability to keep fluids down, with dizziness or little urine: seek urgent assessment.
- Sudden loss of vision or rapid worsening of vision while using semaglutide: seek urgent care.
- After surgery: repeated vomiting or persistent difficulty drinking needs an urgent call to your team.
- After surgery: breathlessness or chest pain, bleeding or black stools, fainting, confusion or fever with worsening.
Seek the appropriate assessment. Do not wait for a message from the site; nothing you enter is clinically monitored. Sources: MHRA (2026) · NHS (2024) · ASMBS (2024)
Questions to take to your appointment
Qawam tools and programs: your weight, injection, supplements and tests in your pocket
Everything above is open to everyone. The tools turn knowledge into daily follow-up, and your data stays on your device.
- "Today": one minute to log movement, protein, nausea and fluids, with a weekly strip that shows your pattern.
- "My treatment": your weekly or daily injection with its dose-step schedule, and post-surgery supplements, with calendar reminders and a "Taken" button.
- "My results": weight and waist on a curve, and vitamin B12, iron, vitamin D and HbA1c with their bands and each result compared with the last.
- "My tests": post-surgery blood panels, the pre-operative endoscopy, liver and sleep studies with their dates, and the next test if your team set one.
- "Doctor summary": one page with your weight, medicines, results and days, to show at your appointment.
- The obesity and injections program (12 weeks) and the bariatric surgery pathway for those who bought them: both open the Qawam tools automatically (Arabic).
Try the tools now with sample numbers
Bought it before? Open the Qawam tools · Obesity programs · Restore my purchases
Educational content from published sources; it does not diagnose and does not replace your doctor. Scope of medical review · Content version 1.0.0.