In short
- The medicine pathway. For people who have decided they want medical treatment and want it prescribed properly.
- Examination first, always. No forms, no video only prescriptions, no pens from unregulated sources.
- Which medicine is a decision. Semaglutide, tirzepatide or an alternative, chosen on your case and stated with a reason.
- A checkpoint at three months. Roughly 5 percent loss on a proper dose, or the plan changes.
- The dose is not the plan. Protein, training and a maintenance strategy are part of the prescription.
Treatment Overview
What this programme is
It is the medication pathway within medical weight loss, for adults whose weight is affecting their health and who have already made serious attempts without medicine.
The clinical problem it solves is narrow. Appetite regulation is biological, and for some patients no amount of discipline overrides it. Medicine can change that signal.
What medicine cannot do is choose itself, set its own dose, or notice a side effect.
Which medicine, and why
| Situation | Usual direction |
|---|---|
| Weight alone, no cardiovascular disease | Tirzepatide or semaglutide, the two most effective options |
| Cardiovascular disease without diabetes | Semaglutide, the only one with proven heart benefit in that group |
| Type 2 diabetes as well | An agent that treats both, coordinated with your diabetes care |
| GLP-1 not tolerated or not available | Phentermine with topiramate, naltrexone with bupropion, or orlistat, each with its own contraindications |
The reason for the choice is stated to you, not implied. If the honest answer is that no medicine is appropriate, that is what you hear.
Who qualifies
Generally a body mass index of 30 or above, or 27 and above with a weight related condition such as type 2 diabetes, high blood pressure, sleep apnoea or fatty liver, after lifestyle changes have failed to produce or hold a result.
Central weight with a weight related condition can also qualify even where the body mass index looks acceptable, because it underestimates risk in some people.
The three month rule
If you have not lost roughly 5 percent of your body weight after three months at a properly titrated dose, the medicine is not working for you.
At that point it is stopped and something else is tried, rather than the dose being pushed indefinitely. That rule exists to protect you from a year of cost and side effects for nothing.
What comes with the prescription
- A protein target in grams, set to your body weight.
- Resistance training at least twice a week.
- Body composition measured, not just weight.
- A maintenance strategy agreed before you reach your target, not after.
Who Is a Good Candidate?
- Your body mass index is 30 or above, or 27 and above with a weight related condition.
- You have made serious attempts without medication and they have not held.
- You want one doctor handling the prescription, the dose changes and the side effects.
- You accept blood work, an examination and a fixed review schedule.
- You want a prescription without being examined or tested.
- You or a close relative have had medullary thyroid cancer, or you have multiple endocrine neoplasia type 2.
- You are pregnant, trying to conceive or breastfeeding.
- You want medication to avoid changing how you eat and train. The licence assumes both, and results without them are poor.
- You are considering compounded semaglutide or tirzepatide from an unregulated source.
What Happens During the Consultation
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1
Eligibility and goals
Your weight history, what you have tried, any weight related conditions, and what you actually want from treatment. Pregnancy plans and contraception, because these medicines are not used in pregnancy.
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2
Examination and blood work
Weight, waist, body composition, blood pressure. HbA1c and glucose, lipids, liver, kidney and thyroid function. A full review of every medicine and supplement you take.
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3
Safety review
Personal and family history of medullary thyroid cancer and multiple endocrine neoplasia type 2, previous pancreatitis, gallbladder disease, inflammatory bowel disease, gastroparesis and diabetic eye disease.
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4
Prescription and plan
The medicine, the starting dose, the escalation steps, the three month checkpoint, what to do about side effects, the number to call and the review dates. You leave knowing exactly what the next twelve weeks look like.
Program Structure & Follow-Up
How dose changes are handled
Every step up is a decision made at a review, not a date in a calendar. If a step causes real nausea or vomiting, it is delayed or reversed.
The aim is the lowest dose that produces your result. Plenty of patients stay well below the maximum.
Review schedule
- Every four to six weeks while the dose climbs.
- Every two to three months once stable, with weight, body composition, blood pressure and repeat blood work.
- Between appointments. Direct access through the membership programmes, so a side effect does not wait for the next slot.
If you take other medication
Insulin and sulfonylureas often need reducing as weight comes down, otherwise blood sugar can drop too low. Blood pressure medicines frequently need adjusting too.
That is planned at the start, and reviewed at every appointment.
Protecting muscle
Across studies of this class close to a third of the weight lost came from muscle related measures. Protein, resistance training and body composition measurement are part of the prescription, not optional extras.
Before you finish
The maintenance plan is agreed before you reach your target, including what happens to the medicine. Without one, regain averages around 0.4 kg a month after stopping.
Benefits, Limits & Safety
What the medicines achieve
Average weight loss in trials runs from roughly 15 percent with semaglutide 2.4 mg to about 21 percent with tirzepatide 15 mg over 15 to 18 months, against about 3 percent on placebo with the same lifestyle programme.
Individual results vary widely, and no number is promised to you here.
Side effects
- Common. Nausea in roughly a quarter to 40 in 100 patients. Vomiting, diarrhoea or constipation in 10 to 20 in 100. Worst after a dose increase, usually settling.
- Uncommon but serious. Gallbladder disease, pancreatitis, bowel obstruction.
What helps
- Smaller meals, more often, stopping at the first sign of fullness.
- Low fat and low spice in the days after an injection.
- Enough fluid.
- Delaying a dose step rather than pushing through.
When to call
- Severe stomach pain going through to the back, especially with vomiting.
- Vomiting you cannot stop.
- Pain under the right ribs, or yellow skin or eyes.
- Any change in vision if you have diabetes.
What is not prescribed here
- Compounded semaglutide or tirzepatide. Mixed outside a regulated manufacturer, without the safety, quality and effectiveness review the licensed products go through.
- Deliberate microdosing. Not studied, unpredictable, and a route to dosing errors.
- Anything without an examination. Including repeat prescriptions for patients who are never seen.
Before surgery
Tell the anaesthetist you take a GLP-1 medicine. Slower stomach emptying raises risk during anaesthesia and a dose may need holding.
What the evidence shows
Roughly 15 to 21 percent average weight loss in trials over 15 to 18 months depending on the medicine and dose, against about 3 percent on placebo. Individual results vary widely.
How you are followed
Review every four to six weeks while the dose climbs, then every two to three months. A defined three month checkpoint decides whether the medicine continues.
When it is not prescribed
Pregnancy, breastfeeding, personal or family history of medullary thyroid cancer, multiple endocrine neoplasia type 2. Caution or refusal after pancreatitis, and in severe inflammatory bowel disease or gastroparesis.
Cost & Program Investment
Cost depends on which medicine, which dose and how long you stay on treatment, so a single number on a website would be misleading. You get the full figure in the consultation before anything is prescribed, and there are no charges you have not been told about. The assessment, the blood work, the escalation plan, the reviews and access between appointments are what you are paying for.
Frequently Asked Questions
No. Every prescription here follows an examination and blood work. That is not a formality: the contraindications, the interactions and the dose decisions all depend on information a form cannot give.
It depends on your case. Tirzepatide and semaglutide are the most effective. Semaglutide is preferred if you have cardiovascular disease without diabetes. Where a GLP-1 is not suitable, other licensed options exist. The reason for the choice is explained.
Generally with a body mass index of 30 or above, or 27 and above with a weight related condition, after serious attempts without medication. Central weight with a related condition can also qualify.
About three months on a properly titrated dose. If you have not lost roughly 5 percent by then, the medicine is stopped and something else is tried rather than the dose climbing indefinitely.
Every four to six weeks while the dose is going up, then every two to three months. Dose increases are decisions made at a review, not automatic.
You contact the practice. Delaying or reversing a dose step is normal and is not treated as failure. Waiting weeks with vomiting is what should not happen.
Not from unregulated sources. Where a pen came from decides whether the contents are what the label says, and compounded versions have caused harm. Supply through a licensed pharmacy is part of the treatment.
Often yes, because obesity behaves like a long term condition and stopping usually means regain. That question is answered honestly before you start, not once you have lost the weight.
Insulin, sulfonylureas and blood pressure medicines frequently need reducing as weight comes down. That is planned at the start and checked at every review.
Some of it will be, across studies close to a third. That is why a protein target, resistance training and body composition measurement come with the prescription rather than as advice.
No. These medicines are not used in pregnancy or while breastfeeding and are stopped well before a planned pregnancy. Contraception is discussed before you start.
It depends on the medicine, the dose and the duration, so a single figure would be misleading. You get the full cost in the consultation before anything is prescribed.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- Obesity and overweight
- Obesity: identification, assessment and management
- Semaglutide for managing overweight and obesity
- Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1)
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.