Background: The prevalence of obesity is already a worldwide health concern. The development of straightforward guidelines regarding the whole available armamentarium (i.e., medical, endoscopic, and surgical interventions in conjunction with a guidance program) is paramount to offering the best multimodal approach to patients with obesity. Methods: The International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) identified a panel of experts to develop the present guidelines. The panel formulated a series of clinical questions (based on the patient, intervention, comparison, and outcome conceptual framework), which have been voted on and approved. A GRADE methodology will be applied to assess the quality of evidence and formulate recommendations employed to minimize selection and information biases. This approach aims to enhance the reliability and validity of recommendations, promoting greater adherence to the best available evidence. Results: These guidelines are intended for adult patients with a body mass index (BMI) ≥ 30 kg/m2 who are candidates for metabolic bariatric surgery (MBS). The expert panel responsible for developing these guidelines comprised 25 panelists (92% were bariatric surgeons) and 3 evidence reviewers, with an average age of 50.1 ± 10.2 years. The panel focused on 3 key questions regarding the combined use of structured lifestyle interventions, approved obesity management medications, and endoscopic weight loss procedures with MBS. Conclusions: The complexity of obesity as a chronic disease requires a comprehensive knowledge of all the available and feasible therapeutic options. The IFSO-EC society felt the urgent need to develop methodologically valid guidelines to give a full picture and awareness of the possible surgical and non-surgical therapeutic strategies employed with a multimodal approach.

Bariatric and Metabolic Surgery Unit Department of General and Laparoscopic Surgery Ospedale Evangelico Betania 80147 Naples Italy

Center for Obesity Northern Netherlands Department of Bariatric and Metabolic Surgery Medical Center 8934 Leeuwarden The Netherlands

Centro Multidisciplinar Do Tratamento da Obesidade Hospital Lusíadas Amadora e Lisboa 2724 002 Amadora Portugal

Delta CHIREC Hospital 1160 Brussels Belgium

Department of General Emergency and Metabolic Surgery Rovigo Hospital 45100 Rovigo Italy

Department of General Surgery Holy Family Hospital Nazareth 1601001 Israel

Department of Medical Surgical Sciences and Translational Medicine Sant'Andrea Hospital Sapienza University 00189 Rome Italy

Department of Surgery and Gastroenterology Catharina Hospital 5623 Eindhoven The Netherlands

Department of Surgery and Transplantation University Hospital Zurich University of Zurich 8006 Zurich Switzerland

Department of Surgery Bariatric Endoscopy Medical Faculty Mannheim Heidelberg University 69167 Heidelberg Germany

Department of Surgery Cerrahpasa Medical Faculty Istanbul University 34320 Istanbul Turkey

Department of Surgery Faculty of Medicine and Health Örebro University 70182 Örebro Sweden

Department of Surgery Ponderas Academic Hospital 014142 Bucharest Romania

Department of Surgery University of Turku 20014 Turku Finland

Department of Surgery Whittington Hospital University College London N19 5NF UK

Department of Surgical Sciences University of Tor Vergata 00133 Rome Italy

Diabetic Foot Unit University of Florence and AOU Careggi 50121 Florence Italy

Digestive Surgery and Liver Transplantation Unit Université Côte d'Azur 06103 Nice France

Division of Visceral Surgery Department of General Surgery Medical University of Vienna 1090 Vienna Austria

Endocrine Metabolic and Bariatric Surgery Unit Vall Hebron Barcelona Hospital Campus Universitat Autònoma de Barcelona 08035 Barcelona Spain

General and Digestive Surgery Department Fuenlabrada University Hospital Rey Juan Carlos University 28942 Madrid Spain

HM Delfos 08023 Barcelona Spain

OB Klinika Center for Treatment of Obesity and Metabolic Disorders 1300 Prague Czech Republic

Public Health Department School of Medicine University Federico 2 of Naples 80138 Naples Italy

San Marco Hospital GSD 24046 Zingonia Italy

The Azrieli Faculty of Medicine Bar Ilan University Ramat Gan 5290002 Israel

The Center for Obesity and Diabetes Hospital Alemao Oswaldo Cruz Sao Paulo 01323 20 Brazil

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