Management of Obesity in Special Populations and Limited-Resource Settings: An Egyptian Medical Position Statement.
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BACKGROUND: Obesity/adiposity-based chronic disease is a chronic progressive relapsing disease linked to several comorbidities, with rising prevalence in Egypt. Limited local guidelines and healthcare challenges necessitate evidence-based, culturally adapted strategies. METHODS: The Egyptian Medical Association for the Study of Obesity convened a clinical multidisciplinary panel to develop consensus recommendations. Evidence was synthesized from literature, prioritizing resource-limited settings and special situations. RESULT: Assessment: Move beyond Body Mass Index to include waist circumference, waist/height ratio, body composition, and screening for obesity-related complications and diseases. Lifestyle Interventions: a-Nutrition: Mediterranean/dietary approach to stop hypertension diets, slow eating, and supervised fasting (eg Ramadan and Christian). b-Activity: Culturally tailored approaches (eg prayer-time movement and Arabic apps). c-Behavior: Cognitive-behavioral therapy and family-inclusive support. Pharmacotherapy: Use of approved agents (orlistat, naltrexone/bupropion, liraglutide, semaglutide, and tirzepatide) according to obesity-related complications and diseases and age group. Avoid GLP-1, GLP-1/GIP analogues in patients with medullary thyroid cancer, and all agents during pregnancy. Bariatric Surgery: Indicated for body mass index ≥40 kg/m2 (or ≥35 with obesity-related complications and diseases), with lifelong micronutrient supplementation. Special Populations: a-Adolescents: Focus on growth, not only weight-loss; consider pharmacotherapy in different age groups. b-Elderly: Prioritize muscle preservation; avoid weight loss unless obesity-related complications and diseases exist. c-Pregnancy: No weight loss; delay postpartum interventions until lactation is established. Policy Actions: Mandate food labeling, tax sugar-sweetened beverages, and integrate obesity services into primary healthcare. CONCLUSION: These recommendations provide a pragmatic framework for obesity/adiposity-based chronic disease management in Egypt, emphasizing affordable, patient-centered care, and clinical multidisciplinary collaboration and policy support.