Weight management
Obesity is defined as a Body Mass Index above 30. The condition has become epidemic, with 75% of adults in the UK between 45-74 years being overweight/obese, and 25% of children.
The health implications are significant, with increased all-cause mortality, high blood pressure, cardiovascular disease, diabetes, osteoarthritis, sleep apnoea; as well as low self-esteem.
The main causes are poor diet and inadequate exercise. Genes have a role in a minority of people.
The major problem in management is breaking the cycle. Some people are successful in improving their diet and increasing their exercise, but it is for others an uphill struggle.
GLP-1 analogues (glucagon-like peptide-1 receptor agonists) have been available since 2009. They are used in the management of type 2 diabetes. They stimulate insulin release and suppress appetite by reducing hunger-signalling hormones (making you feel full sooner and reduce the desire for snacking).
The latest iteration is a drug called semaglutide. It is effective in increasing weight loss. It is available in either a weekly injectable form (Ozempic) or daily tablet (Rybelsus). My prescribing experience is that Ozempic is very significantly better tolerated, to the extent that I no longer use Rybelsus.
The starting dose is 0.25mg weekly for 1 month, then 0.5mg weekly for 1 month. 1mg weekly for 1 month for as long as is necessary. When target weight is achieved, gradual reduction of the dose regime commences.
Management includes full history and examination, including height, weight, BMI and body fat %. Blood tests will include general haematology, biochemistry, Vitamin D and, in men, where appropriate, testosterone.
Dietary information will be offered, including improving gut biome and Vitamin D supplementation. Exercise advice will be directed at reducing both BMI and body fat %: you will be encouraged to involve a Personal Trainer to achieve this. I should emphasise that medication alone is unlikely to resolve the problem. Review at 1 month, 2 months, 3 months, 6 months, then every 3 months. Blood tests as indicated.
The importance here is that gradual improvement is encouraged: your body is unlikely to accept sudden changes without the risk of “bounce-back”.
Weight Management Protocol
Initial consult
History, examination, general advice £160
Blood tests (full blood count, biochemistry
Cholesterol, thyroid function, HbA1c) £350
Prescription of ozempic/wegovy/mounjaro starting dose
2nd consult (3 -4weeks) £90-160
Review/prescription of next dose
3rd consult (3-4 weeks) £90-160
Review/prescription of next dose
4th consult (3 -4 weeks) £90-160
Review/prescription of next dose 1-3 months (1 month if concerns
about side effects*, 3 months if not).
*repeat prescriptions for 2 months as required (no charge for this)
By post
5th consult (3 months) £90-160
Review/repeat prescription 3 months
Onwards:
3 monthly review/ blood tests/prescription
renewal/dose reduction £90-160
I am happy to accept NHS blood tests done within last 6-12 months. Those not covered will be charged pro rata. It’s certainly worth asking your NHS GP to do the blood tests prior to your initial attendance. Have your results available on your NHS app or ask your surgery for a printout of your results. Ideally email to my secretary in advance of your appointment.
Please note that the cost of ozempic/wegovy/mounjaro varies with dose & availability. It is worthwhile contacting different pharmacies to secure a good deal.
Repeat prescriptions outside consultations incur a £30 charge (except * above).