# Obesity (primary care management) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: eMC SmPC, Wegovy 2.4 mg FlexTouch solution for injection (Novo Nordisk), sections 4.1 and 4.2 · Xenical US prescribing information, Dosage and Administration (DailyMed SetID 6240792b-9224-2d10-e053-2a91aa0a2c3e) · Chamarthi VS, Daley SF. Obesity Medications: Evidence-Based Management. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Sep 2. Bookshelf ID: NBK618375. - Verified date: 2026-08 ## Verified against - eMC SmPC, Wegovy 2.4 mg FlexTouch solution for injection (Novo Nordisk), sections 4.1 and 4.2 - Xenical US prescribing information, Dosage and Administration (DailyMed SetID 6240792b-9224-2d10-e053-2a91aa0a2c3e) - Chamarthi VS, Daley SF. Obesity Medications: Evidence-Based Management. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Sep 2. Bookshelf ID: NBK618375. ## Treatment metadata - Orlistat — 120 mg — oral.solid - Semaglutide — 2.4 mg — injection ## Complete treatment card ```text OBESITY (PRIMARY CARE MANAGEMENT) Sources: eMC SmPC, Wegovy 2.4 mg FlexTouch solution for injection (Novo Nordisk), sections 4.1 and 4.2 · Xenical US prescribing information, Dosage and Administration (DailyMed SetID 6240792b-9224-2d10-e053-2a91aa0a2c3e) · Chamarthi VS, Daley SF. Obesity Medications: Evidence-Based Management. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Sep 2. Bookshelf ID: NBK618375. Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Secondary causes account for about 5% to 10% of patients presenting with weight gain, and need treatment different from lifestyle change alone [weight gain] - Hypothyroidism presents with fatigue, cold intolerance, constipation and low mood, though it may be subtle when mild [cold intolerance · constipation · fatigue · low mood] - Male hypogonadism: reduced libido, erectile dysfunction, fatigue, low mood and loss of muscle mass [erectile dysfunction · fatigue · low mood] - Female hypogonadism: irregular periods, anovulation, reduced fertility and mood changes [abnormal uterine bleeding · irregular periods] - Hypothalamic obesity: rapid weight gain over 10 kg within a few months with constant hunger and poor satiety, after craniopharyngioma, brain surgery, head injury, CNS infection or radiotherapy [obesity · weight gain] SIGNS - what you find (5) - Cushing syndrome: central obesity with relatively spared limbs, purple stretch marks wider than 1 cm, easy bruising without trauma, proximal muscle weakness, hypertension and diabetes, facial plethora and supraclavicular fat pads [bruising · hypertension · muscle weakness · obesity · stretch marks] - Normal menopausal weight gain is 2 to 5 kg and gradual, with central fat redistribution [weight gain] - Lipoedema: bilateral symmetrical leg swelling from subcutaneous fat, with or without the arms, sparing the feet and hands so a cuff forms at the ankle and wrist [leg swelling] - Lipoedema also shows pain and tenderness out of proportion to the swelling, easy bruising, a nodular lumpy feel and minimal pitting oedema [bruising · leg swelling] - Dercum disease: multiple painful subcutaneous lipomas with chronic pain in fat, mostly in postmenopausal women TESTS (7) - TSH is the best initial screen; in obesity a TSH of 2.5 to 10 mIU/L may be an adaptive response rather than true hypothyroidism, so free T4 and anti-TPO antibodies separate the two - Screen adults over 35 every 5 years, annually if there are obesity-related metabolic complications or symptoms - Rapid weight gain over 10 kg, cold intolerance, easy bruising or purple striae are the red flags that prompt TSH, morning cortisol and a metabolic panel - Cushing screening: late-night salivary cortisol is preferred; the overnight dexamethasone suppression test has a high false-positive rate in obesity - Secondary hypogonadism gives low testosterone with low or inappropriately normal LH and FSH; primary testicular failure gives low testosterone with high LH and FSH. Morning testosterone below 300 ng/dL warrants further evaluation - Waist circumference above 102 cm in men and 88 cm in women marks raised risk; the Asian thresholds are 90 cm and 80 cm - BMI underestimates fat in older people and overestimates it in a muscular build; a normal BMI with a raised waist can carry more cardiovascular risk than metabolically healthy obesity IF NOT THIS - what else fits (6) - Lymphoedema rather than lipoedema if the swelling is one-sided, involves the feet or hands, has a positive Stemmer sign, or is painless and pitting - the Stemmer sign is negative in lipoedema - Venous insufficiency is one-sided with skin changes; simple obesity gives generalised, not symmetrical limb, fat distribution - Insulinoma: the Whipple triad of hypoglycaemic symptoms, a documented low glucose, and relief with glucose - weight gain comes from eating to prevent attacks - Lipodystrophy: visible loss of subcutaneous fat with prominent muscles, severe insulin resistance, triglycerides over 500 mg/dL and fatty liver - Madelung disease: symmetrical lipomatous masses of the neck and shoulders in a middle-aged man, with chronic alcohol use in over 80% - Sarcopenic obesity: normal or raised BMI with low muscle mass, weak grip and slow gait - higher mortality than either alone Source StatPearls "Secondary Causes of Obesity and Comprehensive Diagnostic Evaluation" (NBK541070) - it covers when obesity is not simply lifestyle, and how to measure it; it is not a general obesity-management chapter Status traced to the source above 1. ORLISTAT [1st line] Adult 120 mg three times a day with each main meal containing fat (during or up to 1 hour after the meal) Peds Not recommended for children under 12 years; specialist use only 12-16 years. Xenical US prescribing information section 8.4 says "Safety and effectiveness in pediatric patients below the age of 12 have not been established" and "The safety and efficacy of XENICAL have been evaluated in obese adolescent patients aged 12 to 16 years". Source Xenical US prescribing information, Dosage and Administration (DailyMed SetID 6240792b-9224-2d10-e053-2a91aa0a2c3e) Why Pancreatic and gastric lipase inhibitor that blocks absorption of dietary fat, used alongside a reduced-calorie diet for weight management. Caution CONTRAINDICATED in chronic malabsorption syndrome and cholestasis. Omit dose if a meal is missed or contains no fat. Common GI side effects include oily spotting, flatus with discharge, and fecal urgency. Take a multivitamin containing fat-soluble vitamins (A, D, E, K) at bedtime. Contraindicated during pregnancy. Egypt FATLOSE 120 MG 10 CAP. EL-OBOUR > RE... 20.00 EGP (2.00/unit) CUT DOWN 120 MG 20 CAPS. SABAA > NOVEL... 57.00 EGP (2.85/unit) EASY SLIM 120MG 10 CAPS. EUROPEAN EGYP... 30.00 EGP (3.00/unit) ORLISTYLE 120 MG 30 CAPS. COPAD PHARMA 105.00 EGP (3.50/unit) FINSHAPE 120MG 30 CAPS. MASH PREMIERE 240.00 EGP (8.00/unit) QUICK-SLIM 120 MG 30 CAPS. MARCYRL PHARM... 240.00 EGP (8.00/unit) ORLISMART 120 MG 30 CAPS. PHAROPHARMA 249.00 EGP (8.30/unit) ORLISTAT 120 MG 30 CAPS. SIGMA > OCTOB... 249.00 EGP (8.30/unit) 2. SEMAGLUTIDE [2nd line] Adult Subcutaneous once weekly, escalating over 16 weeks: 0.25 mg weekly for 4 weeks, 0.5 mg for 4 weeks, 1 mg for 4 weeks, 1.7 mg for 4 weeks, then a maintenance dose of 2.4 mg once weekly - Long-term alongside a reduced-calorie diet and increased physical activity; review benefit at 6 months Peds 12 years and over: Over 60 kg body weight: the same weekly escalation as an adult, to a maximum of 2.4 mg. Stop if BMI has not fallen by at least 5% after 12 weeks. (Adolescents 12 years and over with obesity and body weight above 60 kg use the same weekly escalation to a maximum of 2.4 mg. Stop if BMI has not fallen by at least 5% after 12 weeks. Not established below 12 years.) Source eMC SmPC, Wegovy 2.4 mg FlexTouch solution for injection (Novo Nordisk), sections 4.1 and 4.2 Why 14 live Egyptian products and the drug patients are asking for by name. The SmPC indication is weight management at BMI 30 or above, or BMI 27 to under 30 with at least one weight-related comorbidity - and this condition has three free slots with only orlistat in it. Caution The oral semaglutide tablets on the Egyptian market (3 mg, 7 mg, 14 mg) are licensed for type 2 diabetes, NOT for weight management - the two are not interchangeable, and the doses are unrelated. Stop immediately and investigate for pancreatitis if there is persistent severe abdominal pain. Nausea, vomiting and diarrhoea can cause dehydration and acute kidney injury - counsel on fluid intake and slow the escalation rather than pushing through. Gallstones in about 1.6% - the risk rises with rapid weight loss. Weight is regained after stopping unless diet and activity changes have been established. Cost is a genuine barrier in Egypt; discuss it before starting rather than after the first pen. Egypt WEGOVY 2.4 MG FLEXTOUCH PEN NOVO NORDISK ... 13612.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)