Making the Effort
13 October 2014

It was a routine clinic appointment and as my next patient entered my office I realised he was new to me. He had been seeing a colleague, and had been receiving medical treatment for weight management. In my colleague’s absence, he had made an appointment to see me. His request was simple. “Can I have some more weight loss tablets please?” After asking a few details, checking through his medical records, and checking his weight on my scales, I asked him how long he’d been having drug treatment for weight loss. “About a year, maybe a year and a half” was his thoughtful reply. But in fact, according to his records, he started taking treatment over three years ago. He had done well to begin with, losing a respectable amount of weight, and had stopped treatment for a few months, but had rapidly started to regain, so started taking the tablets once again. And here we were, three years later, and still needing to take them. “I’ll start putting weight back on as soon as I stop taking them if you don’t prescribe me some more” His eyes were sorrowful; he meant it. And all that effort would have been wasted. But, what effort?

We continued our chat by going back to basics. How regular was his eating pattern? Answer, chaotic. Did he eat a low fat diet? Answer, sometimes. Did he watch his portion sizes? Answer, nope. Did he regularly exercise? Answer, yes, once a week. Five-a-side football with his mates. But what really struck me was just how little his lifestyle had changed in the three years. He’d used the tablets as his main route to weight loss. And that’s the most disappointing thing about it. No lessons had been learned, no habits changed.

It took a while to persuade my new patient that medication alone would never lead to long term weight loss. In fact in most clinical studies drug treatment can only help with a few pounds of weight loss over and above that achieved by good old-fashioned diet and exercise. And given that no-one would want to be on medication for any longer than necessary, they have to be used short term, and if nothing else changes, any weight lost will be short term too.

Now, prescription medication is a valid aid to weight loss, in some circumstances, and I continue to use it selectively in a few of my patients. But in my experience, the people who lose most weight, and keep it off, are always those who make significant changes to their lifestyle, at the beginning, in the middle, and after their weight loss programme. Good health takes effort. It has to be worked at. There’s no quick fix. But like most things that have to be earned, it can be very rewarding indeed. I think we parted on good terms. I’ll know if he returns as agreed next month for a further chat. Then again, he might prefer to see someone less challenging!