Dr Heather Ryan shares her weight-loss journey as a GP using GLP-1 medication as primary care prescribing of tirzepatide for obesity begins this week
Conflicts of interest declared: Dr Ryan co-owns a private GP clinic where her husband, but not herself, provides weight-loss services. She is also a member of the Nestle Nutrition Paediatric Advisory Board, although this role relates to infant, rather than adult, nutrition.
The rollout of dual GIP/GLP-1 receptor agonist tirzepatide in primary care begins today. As recommended by NICE, tirzepatide (brand name Mounjaro) will be made available to patients with a BMI of 35 or above with four weight-related comorbidities; though for the first year, only patients with a BMI of 40 or above will be eligible – as per NHS England’s patient cohort approach. The rollout for the total eligible population is expected to take 12 years, with around 220,000 people reached within the first three years.
There is little clarity on how tirzepatide will be delivered in primary care settings across ICBs, though the BMA has issued advice to GPs. Given the fact a report from the House of Lords declared obesity and diet-related issues a ‘public health emergency’ last year, it is frustrating to see the lack of progress in rolling out a treatment that we know works. And I would know.
I am one of the growing number of people using injectable weight-loss medication (obtained privately) and it has changed my life. Since May 2024, I’ve lost 50kg. Having started out in size 22 clothes, I am now a size 10. I’ve gone from being morbidly obese, with a BMI of 40.8, to a healthy weight (my BMI is currently 21.6).
As a medical student, I kept weight off effortlessly. I walked everywhere as I didn’t have a car, and I couldn’t afford to eat too much. My weight varied, but I was a size 12 with a BMI of 24 at my biggest. Unfortunately, the inevitable night shifts as a junior doctor wreaked havoc on my metabolism, and I lost the ability to regulate my appetite. Add in various stressful life events and two pregnancies, and my weight spiralled. I was good at short-term lifestyle change and on several occasions I drastically reduced my calorie intake and lost weight. I often kept it off for a while, but in the end I always regained it.
Until GLP-1 medication came onto the market, I didn’t fancy any of the treatment options available. I have a phobia of general anaesthetic, so was nervous about the prospect of bariatric surgery; and I knew a number of people who had surgery but regained the weight anyway. When the first injectable medication was launched a few years ago, I didn’t feel it was the right time for me, not least so as money was tight. But as the years passed, and I became bigger, it became increasingly apparent I was not going to be able to lose weight without medical help.
In 2023 my husband and I opened a private GP surgery. It was a success; but with private practice comes advertising, and I hated looking at photos of myself. I felt increasingly unfit and my weight was starting to limit my ability to follow my children up the sand dunes at our local beach. There is a lot of stigma associated with obesity, and I felt that as I grew in size, I was being judged by others.
I found an online private pharmacy which was prepared to prescribe for me. I took care to choose a service which was safe and reputable. The prescribers were GPs, and before they would issue the medication I had to supply full-length photographs, including one of me on the scales.
The medication worked almost instantly. Mere hours after my first injection, the ‘food noise’ in my brain disappeared. I had spent years feeling hungry, thinking about my next meal and craving certain foods. When those signals were turned off, it became easy to lose weight. My appetite dwindled – I was eating a fraction of what I had consumed before. In my first month on medication I lost 7.6kg, and in the second month another 5.4kg came off. Less than three months after starting, my BMI was below 35 and I started to look and feel noticeably better. I sometimes don’t recognise myself in the mirror as even my face has changed shape!
I am now in the maintenance phase, slowly reducing my medication dose with the aim of finding a dose at which I maintain my weight – rather than gaining or losing. I expect I may need to continue taking medication for the rest of my life; in the same way that patients with other chronic illnesses like hypertension and diabetes often need long-term drug treatment.
Now that I am a healthy weight, my experience of life is very different. I’ve developed an interest in fashion and style – I often post my ‘Outfit of the Day’ on Instagram. It’s easier to shop when you’re a size 10 than when you are confined to ‘plus size’ retailers. I find that strangers are kinder and more helpful now I am slimmer. And, rightly or wrongly, I feel like conversations with patients about their weight are easier now; when I was bigger, I felt like a hypocrite recommending that patients lose weight, when I demonstrably couldn’t do it myself.
I’m not a GLP-1 prescriber, so can only speak from a patient perspective. Medications for obesity are not a panacea – there are risks and contraindications. A couple of my friends have had to stop using them due to intolerable side-effects. GLP-1 support groups are full of tales of fatigue, mood swings, diarrhoea, and the dreaded ‘sulphur burps’. And, when accessed privately, medication is expensive (though I’ve found it almost pays for itself because I am spending far less on groceries, takeaways and alcohol).There are also good and bad slimming clinics – GP Facebook groups are awash with stories about clinics inappropriately dumping workload back onto NHS GPs. Some clinics are more rigorous than others when it comes to ensuring patients are good candidates for the drug and are reporting their weight accurately.
I was unsure whether to say yes when first asked to write this blog. Given the stigma around obesity, I realise I am potentially opening myself up to trolling. And given that I co-own a private GP service I know I may be perceived to have a conflict of interest. But I decided to write this because I think a lot of the current narrative about obesity is lacking the voices of people who are, or have been, obese.
I can’t help but roll my eyes at comments from fellow GPs about how patients just need to eat less and/or fewer processed foods. At home, we cook from scratch most nights, but I still ended up obese because of a huge appetite with no off switch. I overate supposedly healthy foods, or would eat a healthy dinner then want a snack afterwards. Now that I have a drug in my system that curbs my appetite, I don’t overeat – even if food is processed and hyper-palatable.
For many patients, obesity is a real, hormonal condition. GLP-1 medications help regulate appetite so patients feel less hungry and experience satiety. My weight-loss journey hasn’t been without challenge, but overall I’m so glad my chronic illness – obesity – is being treated.
These experiences as a patient have, inevitably, shaped how I practise as a GP. When I speak to a patient living with obesity, I approach their weight as I would any other chronic illness, and take great care to be non-judgemental. I know from personal experience that trite advice about cooking from scratch, eating less, and moving more rarely works. Exercise has many benefits, but it’s difficult to start being active with a very high BMI; I found it much easier to improve my lifestyle once I’d started to lose weight.
Although I am not a GLP-1 prescriber myself, I am not afraid to signpost patients towards exploring medication. And, in my experience the cost of private treatment is often not prohibitive once you factor in the cost savings from eating less. With that said, I find it tremendously frustrating that the NHS is not rolling out treatment more quickly. Surely it works out cheaper to bring a patient’s weight down with medication than it does to pay for the heart attack, hip replacement and type 2 diabetes that can result from untreated obesity?
If you take away one thing from reading this blog, please let it be that obesity is not a moral failing. It is a chronic illness – one for which now, thankfully, there is a very effective treatment.
Dr Heather Ryan is managing director of a private GP clinic in Merseyside
Clarification: An update was made at 10:55am on 24 June clarifying the difference between NICE recommendations and NHS England’s patient cohort approach to initial prescribing.
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The first paragraph states that eligibility for Tirzepatide from today in Primary Care is
BMI>35 plus one other risk factor.
This is incorrect, it’s BMI >40 plus 4 out of 5 specific co-morbidities.
Thanks for pointing that out, David
Millions would potentially benefit from GLPb1 drugs.
The NHS will offer them to a tiny fraction of that number.
It’s a Scandal, a National Disgrace.
Actually, Dr Ryan’s original statement was correct.
According TO NICE, Mounjaro IS recommended for pts with a BMI of 35 or greater, and at least 1 comorbidity….
It is the NHS that has approved it initially only for pts with a BMI of 40 or greater and 4 comorbidities….
And on private prescription, pts can get Mounjaro if they have a BMI of 30 or greater…..
Anyway thanks to Dr Ryan for sharing her story.
When this is rolled out, I wonder what would happen to the successful patients- like the author- who then end up with a lot of excess skin which the NHS won’t fund to remove? Are patients going to made to pay for skin removal? In which case could they privately fund Mounjaro for themselves. Not clear yet…..
And if eligible patients go into diabetes remission with all the weight loss, will they then lose the right to free prescriptions and have to pay for their NHS Mounjaro? Also unclear.
Congratulations. However, although you may look slimmer how much of that weight loss is sarcopenia & loss of bone mineral density?
Well done. My daughter has lost over 70 pounds on wegovy over the last year and it has been life changing. She cannot wait to get in the sea when we go to Cornwall this summer after several years of just trying to cover up on the beach.
She has described the lack of food noise as being fundamental – my husband has struggled with his weight and says he could just always keep on eating, is always hungry and I think she has inherited this – and the lack of that is a game changer.
People are very judgemental if they have never had a weight issue ( I’m even scared of saying my 23 year old daughter has had an issue – that all developed at uni – as I am worried about being judged) – so well done again for sharing your experience – it might just change some attitudes.
I would be fascinated to know how you get on in the weaning process. Please update us after a while. Best wishes..
Brilliant article. My views on obesity have changed. I have prescribed these meds and seen patients have huge benefits. I now view obesity as a disease-similar to T2DM.
Obesity is a killer. We should be prescribing more fat loss drugs and less opiates, sedatives and antibiotics.