What a prescriber assesses before treatment

BMI is the start of the assessment, not the whole of it

Most people arrive at this question with one number in mind. Body mass index is genuinely part of the assessment — it is how national guidance defines who these medicines are licensed for — but it is a screening measure, not a diagnosis, and a prescriber treats it as one input among several.

BMI does not distinguish muscle from fat, does not describe where weight is carried, and behaves differently across ethnic groups and body types. A number that clears a threshold tells a prescriber that a conversation is worth having. It does not tell them the answer.

What the thresholds are for

Licensed weight management medicines are authorised for use above defined BMI thresholds, and those thresholds are lower where somebody also has a weight-related health condition — raised blood pressure, type 2 diabetes, obstructive sleep apnoea, and others. National guidance also sets a lower threshold for several ethnic groups, because the health risk associated with a given BMI appears at a lower number in those populations than in white European populations. That is an adjustment made so the measure is accurate for more people, not a different bar.

[TO BE CONFIRMED] — the exact thresholds this pharmacy applies, and the list of conditions that count as weight-related, are set by our superintendent pharmacist and are not yet published here. They are confirmed to you during your consultation. We would rather this page said nothing than said a number nobody has signed off.

What else is weighed up

Meeting a threshold is a necessary condition and not a sufficient one. A prescriber is also assessing:

• Conditions that make a medicine unsafe for you. Some are absolute; some depend on how well controlled they are.
• Your family history, because certain conditions in a close relative rule out certain medicines regardless of anything else about you.
• Everything else you take. Interactions matter, and so do medicines that change how these ones behave — insulin and some diabetes tablets are the clearest example, because the combination affects blood sugar.
• Pregnancy, planning a pregnancy, and breastfeeding. These medicines are not for use in pregnancy, and a prescriber will ask about contraception where it is relevant.
• Your history with weight and with weight management, including what you have tried and what happened.
• Eating disorders, past or present. This matters and it is asked about directly.
• Your age. There is a minimum, and there is an upper limit above which a different assessment applies. [TO BE CONFIRMED] — the upper age this pharmacy works to is pending confirmation and is not published here yet.

Why the answer is sometimes no

Treatment is declined for reasons that have nothing to do with how much anyone wants it: a condition that makes it unsafe, a medicine that interacts, an answer that does not fit together, a BMI below the licensed range, or a clinical picture that needs a doctor who can examine you rather than a prescriber reading a form.

A decline comes with the reason. It is not an invitation to resubmit with different answers, and a consultation completed dishonestly is dangerous rather than clever — the prescriber is making a safety judgement on exactly the information given.

Being turned down is not the end of it

Medicine is one route and it is not the first one for everybody. Free NHS advice is at nhs.uk, NHS weight management services exist in many areas and your GP can tell you what is available locally. Nothing on this site is meant to suggest that a private prescription is the expected answer to weight, or the best one.

If your circumstances change — a new diagnosis, a change in weight, a medicine stopped — a later consultation is assessed on the facts as they are then.

Moving from another provider

If you are already taking one of these medicines and want to continue here, say so at the start. You will be asked what you take, at what strength, how long you have been at it, when your last dose was, who prescribed it, and for evidence such as a photograph of the pen or box.

Two rules apply, and they exist for safety rather than for paperwork. The strength you declare is a ceiling — a prescriber may start you lower, and will not start you higher. And the first cycle here does not increase, whatever was planned elsewhere, because one cycle at a known strength under this clinic’s care is what establishes that it is tolerated before anything moves.

Switching from one of these medicines to a different one has no established conversion. It is an explicit decision a prescriber makes and writes down, not an equivalent dose looked up in a table.