Weight Management Programme

A programme, not a prescription

This is a structured, clinician-led weight management programme delivered by a GMC-registered GP over video. It consists of an initial assessment, baseline blood tests where indicated, a treatment decision made with you, and a planned schedule of reviews for as long as treatment continues.

Medication is one component, and it is not the component that determines whether this works. What determines that is the assessment beforehand and the review afterwards — whether an untreated condition is driving the weight, whether an existing medicine is contributing, whether the dose is being escalated at a pace you can tolerate, and whether other prescriptions need adjusting as the weight comes off.

What it covers

• Assessment — weight history, medical background, current medication, previous attempts and what happened to them
• Investigation where indicated — thyroid, HbA1c, liver and kidney function, so a treatable cause is not missed
• An honest treatment decision, which sometimes concludes that medication is not the right next step
• Structured review — dose, tolerance, side effects, muscle preservation, and adjustment of your other medicines
• A planned exit, discussed at the start rather than when the prescription runs out

What it is not

It is not a subscription, a package bought upfront, or a prescription issued against a questionnaire. We do not dispense, we do not deliver, and we earn nothing from the medication itself — so there is no financial reason for us to prescribe rather than to advise.

It is also not the most supported route available to most people. NHS tier 3 services bring a dietitian, a psychologist and exercise support that private prescribing does not, and that support measurably improves results. If you are likely to qualify, we will tell you so at the assessment — and the fee still applies, because you are paying for the assessment rather than for a prescription.

You may be suitable if

• Your BMI is 30 or above, or 27 or above alongside a weight-related condition
• You have made genuine attempts at diet and activity change
• You are able to attend follow-up reviews

You are probably not suitable if

• You are pregnant, breastfeeding or trying to conceive
• You have a history of an eating disorder — this needs specialist input first
• You are looking for a prescription without ongoing review

What we will not do

Prescribe on the basis of a questionnaire, issue medication without follow-up, or treat someone whose BMI does not meet the licensed threshold. If that is what you are looking for, we are not the right service.

Your first consultation covers your weight history, medical background, current medication and what you have already tried. Where appropriate, baseline blood tests are arranged before anything is prescribed.

If treatment is suitable, you are reviewed regularly to check tolerance, progress and any side effects, and the plan is adjusted as needed.

Review is the programme

Anyone can issue a prescription. What changes outcomes is what happens in the months afterwards — and the commonest failure in private weight management is medication issued against a questionnaire and then left alone.

The pattern of reviews

• Around four weeks after starting — tolerance, side effects, technique, and the first decision about increasing the dose
• Every four to eight weeks while the dose is being titrated
• Every three months once stable, and longer-term after that
• At twelve weeks on orlistat, which has its own decision point

Dose increases are made at reviews rather than on request. That is not gatekeeping — going up too fast is the commonest reason people abandon treatment altogether.

What gets measured

• Weight and waist. Waist is often the better guide, particularly early on
• Blood pressure, which frequently falls as weight comes off — and existing blood pressure medication often needs reducing
• HbA1c where relevant. Insulin and sulfonylurea doses usually need lowering, or hypoglycaemia follows
• Kidney and liver function where indicated
• What you are actually eating — and specifically whether protein has collapsed along with appetite
• Mood and eating patterns. Any new low mood, or thoughts of self-harm, matters and should be raised

The bit most programmes skip

Protecting muscle. A meaningful share of weight lost on appetite-suppressing medication is lean tissue, which affects how you feel now and how much you regain later.

• Protein at every meal, roughly 1.2–1.6g per kg of body weight daily
• Resistance training twice a week — more important here than cardio
• Adequate fluid, since dehydration is the commonest avoidable complication

When to contact us between reviews

• Severe or persistent abdominal pain, particularly radiating to the back — urgent, same day
• Vomiting that stops you keeping fluids down
• Jaundice, pale stools, or severe right upper abdominal pain
• Symptoms of low blood sugar if you take insulin or a sulfonylurea
• New low mood, or any thoughts of harming yourself

Planning the end from the beginning

What happens when treatment stops is discussed at the start, not when the prescription runs out. Appetite returns, and regain is common and well documented — so the habits, the strength work and the eating patterns built during treatment are what carry the result afterwards.

Check the free routes first — we would rather you did

• NHS weight management services. Tier 2 and tier 3 programmes exist in most areas, and tier 3 brings a dietitian, psychologist and exercise support that private prescribing simply does not. That multidisciplinary support meaningfully changes outcomes
• NHS GLP-1 prescribing, on criteria that have been widening. Ask your own GP before paying privately
• Bariatric surgery, still the most effective long-term treatment for severe obesity. It has not been superseded by injections, whatever the current noise suggests

Things that matter as much as the drug

• A medication review. Several common medicines drive weight gain — some antidepressants, antipsychotics, older antihistamines, insulin, sulfonylureas and steroids. Sometimes an alternative exists
• An untreated condition. Underactive thyroid, sleep apnoea, PCOS and depression all make weight loss harder, and each is treatable in its own right. Sleep apnoea in particular is badly under-diagnosed, especially in women
• Binge eating disorder, which is common, under-recognised and responds to psychological treatment. Suppressing appetite can mask it rather than treat it
• Sleep and shift work, both of which affect appetite regulation directly

The medication options

• Tirzepatide — weekly injection, greatest average weight loss
• Semaglutide — weekly injection, longer track record, stronger cardiovascular outcome data
• Oral semaglutide — daily tablet, no needles, strict empty-stomach routine
• Orlistat — far cheaper, non-hormonal, modest effect, and available at a lower dose without prescription

The comparison page weighs these against each other properly.

Where medication is not the answer

Below the licensed BMI thresholds we will not prescribe, and any service that will is selling rather than assessing. With a current or past eating disorder, specialist input comes first.

And if you are looking for a prescription without follow-up, we are not the right service — that is said plainly rather than discovered at the end of an appointment.

What you pay us

• Initial assessment — £40, charged whether or not medication is prescribed. You are paying for the assessment, and "no" is a legitimate outcome of one
• Each review — £40. Reviews are where dose decisions are made, so they are part of the treatment rather than an extra
• Blood tests where indicated, quoted before they are arranged

What you pay elsewhere

The medication, paid to your pharmacy. We do not dispense, we do not deliver, and we earn nothing from what is prescribed — which is deliberate, because it removes any financial reason to prescribe rather than to advise.

• Prices vary considerably between pharmacies. Ring two or three before handing the prescription over
• Injectable costs rise with the dose. Budget on the maintenance dose, not the starting one
• Orlistat costs a fraction of the injectables, and a lower dose is available over the counter
• NHS exemptions and prepayment certificates do not apply to private prescriptions

The honest sum

Work out the yearly cost, not the monthly one — medication at the maintenance dose, plus roughly four to six reviews, plus occasional bloods.

This is long-term treatment and stopping is generally followed by regain, so the real question is whether it is sustainable for a year or more. It is better to conclude that before starting than four months in.

What we will tell you

• If you may qualify for NHS treatment, we will say so — the referral through your own GP costs nothing and usually comes with more support than we can offer
• If a cheaper medicine is reasonable for you, we will say that
• If medication is not appropriate, we will say so, and the fee still applies

Two things to be wary of anywhere

Upfront multi-month packages give the seller a commercial interest in keeping you on treatment and escalating the dose, and leave you out of pocket if it does not suit you.

Anywhere that prescribes from a questionnaire alone. Counterfeit pens circulate in the UK, the MHRA has warned repeatedly, and people have been hospitalised — some after injecting insulin sold as a weight-loss pen.

What actually happens at the first appointment?

Twenty minutes on your weight history, medical background, current medication, what you have already tried and what happened, and an honest view on whether medication is appropriate at all. Baseline bloods are arranged where indicated.

It is a consultation, not an order form. Sometimes the answer is that medication is not the right next step.

Will I definitely get a prescription?

No, and the fee applies either way, because it paid for the assessment.

We will not prescribe below the licensed BMI thresholds, without follow-up, or where there is something that needs addressing first. If a guaranteed prescription is what you are looking for, we are not the right service.

Do I qualify?

The licensed criteria are a BMI of 30 or above, or 27 or above alongside a weight-related condition such as type 2 diabetes, high blood pressure, sleep apnoea or raised cholesterol.

Meeting the criteria does not automatically mean it will be prescribed — that follows the clinical assessment.

Should I try the NHS first?

Yes, and we will tell you if we think you would qualify. NHS weight management services usually include dietetic and psychological support that private prescribing does not, and that support measurably improves results.

Which medicine is best?

It depends on cost, tolerance, needles, other medicines and what you will realistically keep doing. On average tirzepatide produces the most weight loss; semaglutide has the longer record; orlistat is far cheaper and non-hormonal.

The best treatment is the one you will still be taking in a year.

Why do I have to come back for reviews?

Because doses change, side effects cluster around those changes, and other medicines frequently need adjusting as you lose weight — blood pressure tablets and diabetes medication in particular.

Issuing a prescription and disappearing is how private weight management goes wrong, and it is what this programme is built to avoid.

How much weight will I lose?

Trial averages are around 15% on semaglutide and around 20% on tirzepatide, with wide individual variation. Orlistat is far more modest.

Trial participants received structured dietary and behavioural support throughout — that is part of the number, not a footnote to it.

Do I have to change my diet as well?

Yes. None of these medicines work properly without it, and anyone telling you otherwise is selling rather than treating.

Protein and resistance training matter more than most people expect, because they determine how much of the loss is fat rather than muscle.

What if it does not work?

We review dose, technique, what you are eating, sleep, activity and other medicines before concluding a drug has failed — more often than not something in that list is the explanation.

If it genuinely is not working, switching or stopping is discussed openly. Nobody should be paying for a treatment that is not helping.

What happens when I stop?

Appetite returns and regain is common. That is the published evidence, not a comment on anyone's discipline — which is exactly why the exit is planned at the start.

I have had an eating disorder. Can I be treated?

Not without specialist input first, and we would say so at the assessment. Appetite-suppressing medication in that setting carries real risk and can conceal a relapse rather than treat a weight problem.