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The Weight Management Medication Programme

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
wegovy medication The Weight Management Medication Programme

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%
mounjaro medication The Weight Management Medication Programme

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.

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    Orla Mulligan
    Administration and Social Media Manager
    Administration, LBSM

    Orla Mulligan is the administration and social media manager for LBSM. She has a strong background in sport having herself played netball at an elite standard for the U21s Northern Ireland team in the European Championships as well as the U21s competition for Saracen Mavericks.

    She understands youth sport pathways having herself played and training in the netball Kent regional pathway. She has a keen interest in most sports and a good understanding of how injury and illness can impact on the mind and body, as well as rehabilitation pathways.

    She looks forward to speaking and assisting LBSM patients and gives her best support to them during their treatment pathway.

    A day in the life of Orla involves communicating with patients via phone and email, managing and organising clinics, operations and media management.

    Outside of work, Orla is a gym enthusiast, enjoys tennis and still finds the time for an occasional game of netball.

    Maddie Tait
    BSc, MSc
    Associate, LBSM
    Musculoskeletal and Sports Podiatrist

    Maddie treats and manages complex foot and ankle injuries in London and Surrey.

    She is particularly interested in helping her patients improve their quality of life and achieve their personal goals, working closely with Foot and Ankle Consultants, Sports Medicine Doctors and Physiotherapists.

    Maddie has a sporting background herself having previously represented England in Hockey. She understands the demands of elite sport and the importance of physical and mental health. In her spare time, Maddie continues to enjoy an active lifestyle by running, cycling and attending a Pilates class.

    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

    Outside of work, Maddie still finds time to play hockey and enjoys running and skiing.

    Mr Prakash Saha
    MBBS, PhD, FRCS
    Consultant Partner, LBSM
    Consultant in Vascular Surgery

    Mr Prakash Saha is a Consultant Vascular Surgeon at LBSM. He takes pride in providing the best possible results for his patients by using the most appropriate non-surgical and surgical methods based on clinical evidence, patient results and satisfaction.

    He treats fit and active people suffering with a range of cardiovascular issues, from painful leg swelling associated with exercise to venous insufficiency, post-thrombotic syndrome and leg ulcers. He also treats people with arterial system problems including poor circulation, compression syndromes and aneurysms. He carries out both endovascular and open aortic repair and has some of the best outcomes in the country.

    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

    Mr Saha regularly lectures and runs workshops across the globe on the latest surgical techniques to treat vascular disease. He has also been awarded a number of research grants from the Royal College of Surgeons, the Circulation Foundation, the Wellcome Trust, the Academy of Medical Sciences, and the British Heart Foundation, which has led to over 80 publications and the development of innovative technologies to help treat patients. For this work, Prakash has received a number of prizes, including the Venous Forum prize from the Vascular Society of Great Britain and Ireland, an International Young Investigator Award, and an Early Career Investigator Award from the American Heart Association.

    A day in the life of Mr Saha involves seeing patients in clinic, operating in surgical theatre or lecturing at his university. He also regularly teaches and presents at vascular and sports medicine conferences.

    Mr Saha is an avid cyclist and tennis player (although yet to get a set of Dr Seth!). Outside of work, he spends time with his family who consists of 3 children and enjoys travelling.

    Dr Gajan Rajeswaran
    MBBS, FRCR
    Consultant Partner, LBSM
    Consultant in Sports and Musculoskeletal Radiology

    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

    A day in the life of Dr Rajeswaran involves giving his expert opinion on investigations such as MRI and CT scans, x-rays and ultrasound. He also performs injection lists under ultrasound, CT and X-ray including spinal injections. He also regularly teaches and presents at sports medicine conferences.

    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    MBBS, BSc, MSc, MRCS, MRCGP, FFSEM
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.