For many people, losing weight is not as simple as being told to “eat less and move more”.
Diet and physical activity remain important, but weight is influenced by a far more complex combination of factors. These include genetics, appetite hormones, metabolism, sleep, stress, mental health, medication, social circumstances and our individual relationship with food.
At Evergreen Medical & Wellness Clinic in Morningside, Edinburgh, we believe that effective weight management should begin with understanding, not judgement.
Our medical weight-loss service is led by Dr Simon Smail, an experienced GP with a special interest in preventative medicine and metabolic health. Dr Smail has undertaken additional professional training through the National Medical Weight Loss Programme and provides individual assessment, prescribing and ongoing medical supervision.
Weight is a health issue, not a failure of willpower
Many patients seeking our help have already made repeated attempts to lose weight. They may have tried calorie-controlled diets, exercise programmes, commercial weight-loss plans or significant changes to their lifestyle.
Some will have initially lost weight before regaining it. Others describe persistent hunger, cravings or “food noise” that makes maintaining those changes extremely difficult.
This does not mean that they have failed.
Body weight is regulated by a complicated interaction between the brain, digestive system, hormones, metabolism and environment. When someone loses weight, the body can respond by increasing hunger and reducing energy expenditure, making it harder to sustain that loss.
Recognising this biology allows us to have a more helpful conversation about weight, one based on evidence, compassion and realistic long-term planning.
The role of GLP-1 and newer weight-loss medicines
Dr Smail believes that GLP-1-based and newer weight-management medicines can have an important role for appropriately selected patients.
These medicines influence the biological systems involved in appetite, fullness and blood-sugar regulation. For some people, they can reduce persistent hunger and cravings, making it easier to establish and maintain meaningful lifestyle changes.
However, medication is not suitable for everyone and should never be viewed as a casual or purely cosmetic treatment. Prescription weight-loss medicines require a proper clinical assessment, consideration of potential risks and contraindications, and ongoing monitoring.
Eligibility depends on several factors. These include:
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Your current and previous body mass index (BMI)
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Any weight-related medical conditions or health risks
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Your general health and current medication
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Previous attempts to manage weight through lifestyle changes
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Whether treatment can be used safely
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Your personal goals and expectations
We do not prescribe medication simply because it has been requested. The purpose of the initial consultation is to determine whether medical treatment is safe, appropriate and likely to be beneficial for you.
Why choose GP-led medical weight loss?
Some people feel comfortable accessing weight-loss treatment through a largely online service. Others would prefer to meet their prescribing clinician, discuss their concerns in detail and know exactly who is medically responsible for their care.
We particularly want to support patients who may have considered weight-loss medication but have felt apprehensive about starting treatment remotely.
At Evergreen, you will have a named, experienced GP overseeing your treatment. Consultations take place in our calm, discreet and thoughtfully designed clinic in Morningside, with time to discuss your health properly.
As a GP, Dr Smail considers more than the number on the scales. Weight can be connected to blood pressure, cholesterol, blood-sugar control, sleep apnoea, joint pain, reproductive health, emotional wellbeing and longer-term cardiovascular risk.
A GP-led assessment allows these wider health issues to be considered as part of the same conversation.
“The consultation should begin by understanding why someone’s weight has changed, what they have already tried and what support is most likely to improve their health. Medication may be part of that plan, but it should never be the whole plan.”
Dr Simon Smail
What happens at your first appointment?
Your initial medical weight-management consultation will usually include:
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A detailed discussion about your weight and health history
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Review of previous weight-loss approaches and what made them difficult to sustain
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Consideration of appetite, eating patterns, sleep, stress and psychological wellbeing
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Review of medical conditions, medication and family history
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Measurement of weight, BMI, blood pressure and other relevant clinical markers
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Discussion of your goals and what a realistic outcome might look like
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Blood tests or further investigation when clinically indicated
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A careful assessment of whether weight-loss medication may be appropriate
If medication is prescribed, we will explain how to use it, the expected benefits, common side-effects, important warning symptoms and when to seek medical advice.
More than a prescription
Weight-loss medication works best as part of a broader strategy.
Your individual plan may include advice about nutrition, protein intake, physical activity, sleep, alcohol and behaviour change. Preserving muscle is particularly important during weight loss, so we encourage appropriate resistance exercise and adequate nutrition wherever possible.
Follow-up appointments allow us to:
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Review your progress and general health
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Monitor for side-effects
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Adjust treatment safely when appropriate
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Discuss nutrition and activity
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Protect muscle and nutritional health
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Address difficulties before they become reasons to stop
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Develop a longer-term weight-maintenance plan
With your agreement, we can also communicate with your NHS GP so that your care remains safe and joined up.
A considered approach to long-term metabolic health
Medical weight management is not about chasing the lowest possible number on the scales. It is about helping people reduce health risks, feel better and develop an approach they can realistically sustain.
For some patients, lifestyle support will be the most appropriate starting point. For others who meet the relevant criteria, medication may provide an additional and valuable tool. In every case, the plan should be individual, medically responsible and free from blame.
If you are considering weight-loss treatment and would value face-to-face support from an experienced GP, you can arrange a medical weight-management consultation with Dr Simon Smail at Evergreen Medical & Wellness Clinic in Morningside, Edinburgh.
Call 0131 608 6800, email info@evergreenmedical.co.uk, or book a consultation online.
Prescription weight-management medication is not suitable for everyone. Any treatment is subject to an individual medical assessment, eligibility criteria and clinical judgement.