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NICE guidance on obesity management (CG189 and recent technology appraisals) recommends a stepwise approach: First-line: Lifestyle interventions including dietary modification, increased physical activity, and behavioural support Pharmacotherapy: Consider when BMI 35 kg/m (or 30 kg/m with comorbidities) and lifestyle measures have been insufficient Licensed options: Orlistat remains a primary pharmacological option in NHS formularies, with GLP-1 receptor agonists like semaglutide (Wegovy) now available through specialist services for those with BMI 35 kg/m (or 30 kg/m with comorbidities) and at least one weight-related comorbidity Bariatric surgery: Considered for those with BMI 40 kg/m (or 35 kg/m with comorbidities) when other measures have failed NICE guidance emphasises using licensed medications with established safety profiles and does not recommend combining weight loss drugs without robust evidence