Weight Loss- A guide to How I would work up a patient

We live in an age, where everyone has access to information at their finger tips. Everyone can google or now even look up their symptoms on chat gpt and many will be lead to believe that starting the injection is straight forward.

I am mindful there has been a craze over Ozempic and Mounjaro for weight loss. What is important to understand is when I first see a patient , I will always assess them holistically before we choose the route of using an injection.

Assessing the patient generally is key- weight, height and BMI. It is also key to rule out underlying mental health conditions and medical conditions that would contribute to increased weight- such as hypothyroidism. If a patient does not have recent bloods done - Looking at your tfts- thyroid function , hba1c- assesses your risk for pre diabetes and diabetes/insulin resistance and fasting cholesterol will give me an idea , where does a patient stand. For example a patient with increased weight /BMI , pre-diabetic or having elements of metabolic syndrome - with raised cholestrol and abdominal circumference as well- will benefit a lot from Tirzepatide (dual GIP/GLP‑1 receptor agonist)- not only for weight loss nut also to improve insulin resistance and pre diabetes.

Diet becomes another important factor to look at - if you know you consume higher fat and carbohydrate foods, processed foods, alcohol and sodas- this will also need to be drastically adjusted while a patient is on the injection. There is a misconception patients stay lean on the injection- not realising maintaining a form of discipline and strict diet changes with increased protein to maintain the lean muscle mass is critical. Many patients start a Tirzepatide for example, shed the weight, stop the injection - only to regain all of it a few months later.

Exercise - aiming for 150 minutes of exercise a week is standard. Strength training will also be necessary when starting an injection as it can reduce lean muscle mass.

Side effects of nausea, vomiting, gastritis can occur , pancreatitis and decreased bone density have also been noted. Taking these into account- it also is important to assess patient risk profile. E.g a patient known with a prior perforated ulcer or osteoporosis would be considered a high risk for this injection and hence I would not recommend it unless a specialist has assessed these patients- I would always weight benefits and risks before considering a patient for this option . Higher risk patients looking to opt for the injection route need to consult with their specialists before starting such treatments.

Overall these injections can serve as a great way for cardio metabolic protection and improving the risks in patients with established diabetes and metabolic syndrome. It is always great to have a balanced diet, with the ample exercise as your baseline before considering this route as an adjunct .

Feel free to contact me for more information and we can consult and start your weight loss journey :)

Dr Tewari