LBSM Weight Management Medication Program
Congratulations on joining the LBSM weight management medication programme! The information below takes you through the step by step process of the programme and information around the possible medications and delivery. If you haven’t already, please read the LBSM guide on Achieving a Healthy Weight (hyperlink). It is important to remember that any weight loss medication needs to be taken in conjunction with dietary and exercise advice.
Step 1. Pre Assessment
- Questionnaire & Consent
- Health & Lifestyle
Step 2. Initial Weight Loss Consultation
- Setting Weight Loss Goals
- Personalised management plan
Step 3. Programme Delivery
- Saxenda
- Wegovy
- Mounjera
Step 4. Follow up
- Initiation phase
- Maintenance phase
Step 1: Pre Assessment
This is the first step in your LBSM Weight Management Program. This phase ensures that you meet the program’s criteria and helps us tailor our approach to your specific health needs.
Eligibility Criteria:
- Age Requirement: 18 to 75 years old.
- BMI Requirement:
- BMI ≥ 30, or
- BMI between 27-30 with any of the following associated health conditions:
- Pre-diabetes
- High blood pressure
- High cholesterol
- Heart problems
- Individuals who have not yet achieved their desired weight loss through lifestyle changes alone.
Questionnaire Assessment:
- Dietary Review : Which includes your food preferences, any previous dietary changes and understanding of your nutritional habits to tailor dietary advice that fits your lifestyle.
- Physical Activity Evaluation : Your current levels of cardiovascular and resistance activities, to develop a personalised physical activity plan.
- Psychological Wellbeing : We conduct mood assessments, evaluate current stress levels, to address your overall mental health as it relates to weight management.
Review:
- Blood Tests : A full blood count, kidney function test and metabolic panel including bone profile, thyroid function test, cholesterol and blood sugar levels.
- DEXA scan : will be conducted to assess your body composition including muscle mass
Consent Form:
Before beginning the program, you’ll review and sign a consent form that outlines the benefits and risks of the programme. This ensures you are fully informed and agree to the treatment plan.
Step 2: Initial Weight Loss Consultation
In this consultation with one of our doctors, we’ll help you tailor a weight management strategy that suits your specific needs. We will consider your health profile, weight loss goals, and personal preferences. If appropriate we will discuss how to integrate medications into your broader weight management strategy
Below is more detailed information about the expected weight loss with different doses for each medication:
Liraglutide (Saxenda):
Mechanism: Acts as a GLP-1 receptor agonist that regulates appetite and calorie intake.
Expected Weight Loss: From the SCALE Obesity and Prediabetes Study utilising a 3.0 mg dose:
- Individuals typically start seeing weight loss within the first few months of treatment. By around 17 weeks, a significant percentage of users will have lost at least 5% of their starting weight.
- About one in three participants can expect to achieve weight loss of 10% or more, with some individuals experiencing as much as 20% weight loss.
Semaglutide (Wegovy):
Mechanism: Functions similarly to GLP-1, enhancing appetite regulation.
Expected Weight Loss: In the STEP trials, the average weight loss was as follows:
- 0.25 mg dose: Early treatment phase, with minimal weight loss expected.
- Up to 1 mg dose: Gradual increase in weight loss
- Maintenance dose (2.4 mg): Greater than 80% of individuals lost at least 5% of their body weight by the end of the study and almost half of individuals in the study lost 15% or more of their initial body weight
Tirzepatide (Mounjaro):
Mechanism: Enhances the body’s insulin response and reduces appetite by acting on incretin hormones.
Expected Weight Loss: In the SURMOUNT-1 trial, 85% of participants lost at least 5% of their initial body weight when taking tirzepatide once a week for 72 weeks. The observed weight loss outcomes for different doses were:
- 5 mg dose: Average weight reduction of 16.0%.
- 10 mg dose: Average weight reduction of 21.4%.
- 15 mg dose: Average weight reduction of 22.5%
Step 3: Programme Delivery
For each medication, the dosing regimen is carefully structured to optimise efficacy while minimising potential side effects. Here’s an example dosing schedule for each of the medications discussed:
Liraglutide (Saxenda)Example Treatment Algorithm
Week 1: Start with 0.6 mg of Saxenda daily.
Week 2: Increase to 1.2 mg daily as tolerated.
Week 3: Increase to 1.8 mg daily as tolerated.
Week 4: Increase to 2.4 mg daily as tolerated.
- Week 4 Review: In-person or telehealth visit to review side effects and assess treatment efficacy.
- Action : Evaluate patient’s response to medication; adjust dose if necessary based on side effects and efficacy.
Week 5 and Onwards: Increase to the maintenance dose of 3.0 mg daily.
- 3-Month Review: Assess the patient’s adherence to medication, lifestyle changes, and overall satisfaction with the treatment. Evaluate the initial weight loss results and side effects.
- Adjust Treatment Plan: Based on the weight loss achieved and side effects experienced, consider maintaining the current dose or providing additional support strategies.
- Health Education: Reinforce dietary guidelines and physical activity recommendations.
- Psychological Support: Check in on the patient’s mental well-being and make referrals for behavioural support if necessary.
- 6-Month Review:
- In-depth Evaluation: Conduct a thorough review including a repeat DEXA scan and laboratory tests to measure the impact of the treatment on body composition and metabolic health.
- Treatment Adjustment: Decide on the continuation, escalation, or tapering off based on long-term effectiveness and patient health status.
- Collect Feedback: Gather feedback on the patient’s experience to further personalise support and management strategies.
Semaglutide (Wegovy) Example Treatment Algorithm
Weeks 1-4: Start treatment 0.25 mg once a week.
- Week 4 Review: Assessment to review side effects and patient tolerability.
- Action : Increase dose to 0.5 mg/week if tolerable.
Weeks 5-8: Increase to 0.5 mg once a week.
- Week 8 Review: Evaluate side effect tolerance and weight loss progress.
- Action: If weight loss targets are not met and side effects are tolerable, increase dose to 1 mg/week.
Weeks 9-12: Increase dose to 1 mg once a week.
- Week 12 Review: Assess side effect tolerance and weight loss progress.
- Action : If weight loss targets are not met and side effects are tolerable, increase dose to 1.7 mg/week.
Weeks 13-16: Increase dose to 1.7 mg once a week.
- Week 16 Review: Assess the patient’s adherence to medication, lifestyle changes, and overall satisfaction with the treatment. Evaluate the initial weight loss results and side effects..
- Action : If weight loss targets are not met and side effects are tolerable, increase dose to 2.4 mg/week.
- Health Education: Reinforce dietary guidelines and physical activity recommendations.
- Psychological Support: Check in on the patient’s mental well-being and make referrals for behavioural support if necessary.
Week 17 Onwards: Increase dose to 2.4 mg once a week and continue as maintenance dose.
- Week 24 Review:
- Assessments: Conduct a comprehensive review of medication effectiveness, including a repeat DEXA scan and laboratory tests.
- Long-Term Planning: Evaluate the necessity of continuing treatment, potential dose adjustments, or possible cessation of medication based on efficacy and patient tolerance.
- Collect Feedback: Gather feedback on the patient’s experience to further personalise support and management strategies.
Tirzepatide (Mounjaro) Example Treatment Algorithm
Weeks 1-4: Start with a dose of 2.5 mg once per week.
- Week 4 Review : Assessment to review side effects and patient tolerability.
- Action : Evaluate patient’s response to medication; adjust dose if necessary based on side effects and efficacy.
Weeks 5-8: Increase to 5 mg once per week if indicated.
- Week 8 Review: Assess side effect tolerance and weight loss progress.
- Action: Evaluate patient’s response to the medication; adjust dose if necessary based on side effects and efficacy.
Weeks 9-12: Increase to 7.5 mg once per week if indicated.
- Week 12 Review : Assess side effect tolerance and weight loss progress.
- Action : Based on the weight loss achieved and side effects experienced, consider maintaining the current dose or adjusting the treatment plan.
Weeks 13-16: Increase to 10 mg once per week if indicated.
- Week 16 Review : Assess the patient’s adherence to medication, lifestyle changes, and overall satisfaction with the treatment. Evaluate the weight loss results to date and side effects.
- Adjust Treatment Plan: Based on the weight loss achieved and side effects experienced, consider maintaining the current dose or providing additional support strategies.
- Health Education: Reinforce dietary guidelines and physical activity recommendations.
- Psychological Support: Check in on the patient’s mental well-being and make referrals for behavioural support if necessary.
Weeks 17-20: Increase to 12.5 mg once per week if indicated
- Week 21 Review : Assess the patient’s adherence to medication, lifestyle changes, and overall satisfaction with the treatment.
- Action : Based on the weight loss achieved and side effects experienced, consider maintaining the current dose or adjusting the treatment plan.
Week 21 Onwards : Increase to the maximum dose of 15 mg once per week if required.
- Week 24 Review:
- Assessments: Conduct a comprehensive review of medication effectiveness, including a repeat DEXA scan and laboratory tests.
- Long-Term Planning: Evaluate the necessity of continuing treatment, potential dose adjustments, or possible cessation of medication based on efficacy and patient tolerance.
Maintenance and Monitoring
Follow-Up Appointments to monitor weight loss progress, discuss any side effects, and make necessary adjustments based on your response to the medication.
Managing Side Effects
Gastrointestinal Issues: Nausea, diarrhoea, and constipation are common. Manage these by adjusting your diet (smaller, frequent meals) and staying hydrated.
Injection Site Rotation: To avoid tissue damage or bruising, rotate injection sites between the abdomen, thigh, and upper arm.
If side effects persist, worsen, or are a serious nature seek immediate medical attention.
Safety and Compliance
Sharps Disposal: Use a sharps container to dispose of needles safely.
Long-Term Use and Lifestyle Integration
Aim to take the medication at a regular time to maintain consistent blood levels. Consider using reminders to achieve this and to track injection site and any side effects.
Patient Experience: Your feedback is vital to improving treatment protocols and support.
Step 4: Follow up
Initial Phase
- Check-In:
- Purpose: Monitor initial response to the medication and manage early side effects and determine frequency of ongoing reviews.
- Reinforce injection techniques, discuss dietary and activity changes, and address any concerns about side effects or efficacy.
- Method: Telehealth check-ins to ensure you are managing well with the new medication and dosing schedule.
- Maintenance Phase
- Once you have reached a stable dose, transition to less frequent evaluations.
- Assessments: Check weight progress, dietary adherence, side effects, and overall satisfaction with the treatment. Adjust medication dosage as necessary.
6 Month Review
- Review of medication effectiveness which may include laboratory tests and repeat DEXA.
- Long-Term Planning: Evaluate the need for ongoing treatment with the medication, potential dose adjustments, or cessation of medication.
For more information about the LBSM weight management programme or to consult with one of our doctors feel free to contact us.
