Key principles for better conversations are included in the 'Language Matters' guidance document via the Healthy Weight Resources page here. In summary: Use person-first language Say: “person living with obesity” Avoid: “obese person” Ask permission before raising the topic For example: “Would it be okay if we talked about your weight today?” Avoid blame or assumptions Recognise that obesity is complex and influenced by biological, psychological, and environmental factors — not simply lifestyle choices. Be empathetic and encouraging Use phrases like: “It sounds like this has been tough for you” or “You’ve made real progress — keep going.” Focus on positive outcomes Emphasise benefits such as improved energy, mobility, or wellbeing, rather than just weight loss. Ask: “What changes would help you feel better in yourself?” Avoid stigmatising or judgmental language Don’t use terms like “fat”, “lazy”, or “just eat less”. Use respectful, neutral language and avoid assumptions. Collaborate on realistic, personalised goals Ask: “What would success look like for you?” Encourage shared decision-making and acknowledge individual progress. Create an inclusive clinical environment Ensure appropriate seating, weighing areas, and equipment are available. Aim to make the setting comfortable, private, and welcoming.

The expected weight loss typically consists of approximately 75% fat and 25% muscle. There have been noted mental health effects, particularly with Ozempic, and weight regain is common after stopping treatment. This is generally considered a long-term or lifelong medication.

At present, NICE guidelines do not specify a maximum duration for therapy, so in theory, the medication could be taken long-term. However, this may be reviewed following the upcoming 3-year evaluation. If the treatment was initially accessed privately and the patient no longer meets NHS eligibility criteria at the time of presentation, then they would not be eligible to continue it on the NHS.

Yes, current evidence indicates that around 90% of patients regain weight once treatment is stopped, which supports the view that this medication is not a short-term solution but part of long-term disease management. Obesity is increasingly being treated as a chronic, relapsing condition — much like type 2 diabetes or hypertension — where ongoing pharmacological support may be required to maintain benefits. As more patients begin treatment and remain on it long-term, the overall cost burden will likely grow. That said, this isn’t necessarily a sign of failure; rather, it reflects the reality that sustained weight loss often requires sustained intervention. This drug is not a “cure-all” for obesity — it’s a tool, and one that works best alongside dietary, behavioural, and lifestyle support. Over time, as patents expire and generic versions become available, the cost per patient may decrease. But the broader question is whether the healthcare system is prepared to treat obesity as a long-term condition, rather than expecting a short course of medication to deliver permanent results.

No, blood glucose monitors are not required. Patients will be advised to monitor for symptoms of hypoglycaemia, but routine self-monitoring of blood glucose isn’t necessary when GLP-1 receptor agonists or Tirzepatide are used as monotherapy.

Hairloss can be a side-effect. It could also indicate their diet is low in protein and so it is important they attend the wraparound service that provides education on this.

Wear off is possible, thus wraparound care vital to support diet, lifestyle, portions, timing and food choices.

No, that wouldn’t be considered appropriate.

In most cases, faulty pens are due to incorrect dialing of the medication — we’ve come across this a couple of times.

You’ll need to refer the patient to the accompanying wraparound support service.

Not routinely, but it may be appropriate in cases of rapid weight loss or if there are signs of underlying nutritional deficiencies, such as low iron, MCV, or haemoglobin. These issues could also be identified during the 1:1 remote weight loss support sessions as part of the wraparound care.

There is currently no evidence on this.

Not if a fine needle aspiration (FNA) has been done and the result is Thy 2. However, if the patient is currently undergoing investigation for possible thyroid cancer, it may be necessary to wait until that assessment is complete.

At present, NICE guidelines do not specify a maximum duration for therapy, so in theory, the medication could be taken long-term. However, this may be reviewed following the upcoming 3-year evaluation. If the treatment was initially accessed privately and the patient no longer meets NHS eligibility criteria at the time of presentation, then they would not be eligible to continue it on the NHS.

Cannot enforce, upsell though as will help with the overall goals.

Light clothing and no shoes.

This is generally considered a lifelong medication. Just as with hypertension—where treatment is continued even after blood pressure normalises—the same principle applies here. The goal is to maintain the benefits, not just to achieve them temporarily.

Yes, the eligibility criteria are different because this is a separate clinical indication.

GP practices must develop and implement a protocol for the identification and support of patients living with obesity which seeks to: normalise conversations about weight and weight management in all consultations, not just those for long-term condition management recognise that these conversations need to be handled sensitively, using shared decision-making principles, etc.

A new Local Enhanced Service (LES) was sent to all SWL practices week commencing 16 June 2025. Practices signing up to the LES will also have access to training, resources and support from the SWL ICB.

The ICB are working with provider colleagues to avoid inappropriate signposting of patients back to their GPs to request treatment. If you receive an inappropriate redirection from secondary care we suggest advising secondary care colleagues to sign-post patients to the SWL ICB dedicated public-facing Tirzepatide web-page here.

The LES specifies that you hold a monthly review for at least the first 6 months to check compliance, tolerance and titrate dose and use this as an opportunity to reinforce counselling discussions and confirm engagement with the national wraparound service. At seven months or at the point the patient has been on the highest tolerated dose for 6 months, the review should include a weight check to assess benefit of continuing treatment.

After the initial onboarding, a monthly review which could be by telephone, then at key points e.g., 6 months.

Yes.

Yes, normal prescription charges apply.

GLP1s can affect the absorption of oral progesterone, so patients on oral progesterone as part of their HRT protocol will need a review. For patients using contraception, it is advised that patients double up on contraception (eg use barrier method in addition). Similarly, for patients using oral contraceptive progesterone, it is advised that patients have a Mirena coil fitted, or use barrier method. Tirzepatide can help regulate cycles, can help with PCOS. Resource link: 23-BMS-TfC-Use-of-incretin-based-therapies-APRIL2025-E.pdf

Eligible cohort is very small and therefore, no supply issues foreseen.

Self-harm is not a contra-indication; more likely to be harmful for patients with binge/ purge approaches, but this will become clearer overtime.

It may be more appropriate to reduce the dose rather than switch to fortnightly injections, as the medication's half-life makes dose reduction a more effective approach. This also ensures the treatment remains within the licensed guidelines. There’s no significant difference in cost between the two approaches.

Yes in the UK. No in the US.

Dose escalation should be considered when the patient is no longer losing weight and is tolerating the medication well. It's important to assess their weight loss over the past four weeks before making any changes. It's also helpful to review the support in place, including their education, nutrition knowledge, and overall lifestyle interventions.

A pack of 100 needles will cover 100 weeks of use — so it should last around 2 years. Considering this is a long term medication, this should be OK.

Yes this will be needed.

Yes

Yes, begin with a 2.5mg dose and evaluate progress based on the patient’s reported outcomes and response to treatment.

Yes, there is Public Health training available which can be accessed via the Healthy Weight Resources page here. We also recommend reading the Language Matters document available here. https://www.e-lfh.org.uk/programmes/healthy-weight-coach/ https://www.personalisedcareinstitute.org.uk/your-learning-options/ https://learninghub.kingshealthpartners.org/course/addressing-obesity-in-a-consultation

You can contact Vikash Patel at patel_vikash_d@lilly.com and Andy Rankine at rankinea@lilly.com.

Yes, 23-BMS-TfC-Use-of-incretin-based-therapies-APRIL2025-E.pdf

The reps have visited us to provide training and brought along demo pens, which has been really helpful. For further support, you can contact Vikash Patel at patel_vikash_d@lilly.com or Andy Rankine at rankinea@lilly.com.

Awaiting contact information.