Let’s talk about something that makes many people uncomfortable: weight.
I’ve had plenty of conversations with patients who quietly tell me, “I know I need to lose weight.”
Sometimes they have tried every diet imaginable. Low-carb. No-carb. Fasting. Meal replacements. Calorie counting. You name it.
They lose some weight, feel fantastic, then six months later the weight is back.
And then comes the inevitable feeling of failure.
But here is something I wish more people understood.
Obesity isn’t simply a failure of willpower.
If losing weight were as easy as “eat less and move more”, we wouldn’t have an obesity problem.
Why does it matter?
Carrying excess weight isn’t just about appearance.
It increases the risk of type 2 diabetes, high blood pressure, heart disease, stroke, fatty liver disease, sleep apnoea, joint problems and certain cancers.
And for some ethnic groups, particularly South Asians, metabolic problems such as type 2 diabetes can occur at a lower BMI than people might expect.
So this isn’t about trying to fit into a particular trouser size.
It’s about what excess body fat is doing to your health.
So what can actually help?
This is where medicine has changed dramatically.
We now have medicines such as semaglutide (Wegovy) and tirzepatide (Mounjaro).
You may have heard people talking about them as “weight-loss injections”.
That description is technically correct, but it doesn’t really explain how they work.
They act on hormone pathways involved in appetite and satiety. In simple terms, they can make you less hungry, help you feel full sooner and reduce the constant thoughts about food that some people experience.
And the clinical trials have shown substantial weight loss in many people when these medicines are combined with lifestyle changes.
That is a very different situation from some of the questionable slimming products that have been sold over the years.
But—and this is a big but—they aren’t magic.
There is no injection that cancels out an unhealthy lifestyle
The medicines work best alongside changes to food, activity and behaviour.
And they aren’t suitable for everybody.
Nausea, vomiting, diarrhoea, constipation and abdominal discomfort are common problems, particularly when treatment is started or the dose is increased.
There are also less common but more serious risks, including gallbladder problems and pancreatitis.
And there is another question people should ask before starting treatment:
“What happens when I stop?”
For many people, appetite increases again after stopping and some weight can return.
That doesn’t necessarily mean the medicine didn’t work.
It means obesity can behave like a long-term condition.
We shouldn’t expect someone to take a medicine for a few months, lose weight and then magically be protected from regaining it.
And then there is orlistat
This is an older treatment and works in a completely different way.
It reduces the absorption of dietary fat.
It can work, but there is a rather memorable downside.
If you eat a high-fat meal while taking it, you may experience oily stools, urgency and diarrhoea.
I’ve seen patients learn very quickly that the medicine isn’t particularly forgiving of a greasy takeaway!
What about diet?
This is where I think we sometimes make things unnecessarily complicated.
You don’t need a diet that makes you miserable.
You need an eating pattern you can live with.
More vegetables.
Enough protein.
More fibre.
Smaller portions.
Less processed food.
Less sugary drinks.
Be sensible with alcohol.
And watch the little extras.
The handful of biscuits while making a cup of tea.
The sugary coffee.
The evening snacks.
The sauces.
The weekend takeaway that somehow becomes three meals.
None of these things are evil.
But they add up.
Exercise still matters
You don’t have to become a marathon runner.
Start with walking.
Walk more often. Walk a little faster. Take the stairs. Cycle. Swim. Jog if your joints allow it.
And don’t forget strength training.
When people lose weight, they can lose muscle as well as fat. Resistance exercise, together with adequate protein, can help preserve muscle.
You don’t need an expensive gym.
A pair of dumbbells, resistance bands and a bit of determination can do a surprising amount.
But here’s the real challenge
Losing the weight is only half the job. Keeping it off is where the real work begins.
I’ve seen people lose considerable amounts of weight and then gradually put it back on.
Not because they are weak.
Simply because the old habits slowly creep back.
That is why I don’t particularly like the word “diet”.
A diet sounds temporary.
What you really need is a way of eating and living that you can maintain.
If you lose 20 kilograms but return to exactly the same lifestyle that produced the weight gain, your body isn’t going to politely forget what happened.
So where does that leave us?
If someone needs medication, there should be no shame in using it.
We don’t tell someone with high blood pressure that taking tablets means they have failed.
We don’t tell someone with diabetes that medication means they haven’t tried hard enough.
So why should we treat obesity differently?
But equally, I wouldn’t encourage anybody to think of weight-loss injections as a shortcut.
They are proper medicines with proper risks and side effects.
They should be used for the right person, at the right dose, with appropriate monitoring and alongside lifestyle changes.
For some people, medication may be the thing that finally makes losing weight achievable.
For others, improving food choices, increasing activity and changing daily habits may be enough.
And for many, it will be a combination of the two.
The target shouldn’t simply be a smaller number on the bathroom scales.
The real target is better health, better fitness, better mobility and a lower risk of serious disease.
That, in my view, is a much better reason to lose weight than simply trying to look thinner.
Until next time take good care of yourself
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