Medical assistance

Your doctor's surgery may be able to help you with weight loss.

Some doctors run obesity clinics or can refer you to a dietitian. They will not be able to give you any miracle diets, but you may find the support of being in a group, or from speaking to a dietitian, helpful. What is on offer varies from area to area, so contact your GP's surgery for information.

There are prescription-only drugs available to help obese people with a BMI of 30 or over to lose weight loss. These are not, however, miracle drugs and need to be used in combination with a healthy diet and exercise plan.Weight loss drugs can only be prescribed for one year and they have the same problems as diets - if you do not change your underlying behaviour you will put the weight back on again.

There is also surgery, available for people who are extremely obese (BMI 40 or over), but surgery carries a risk of dangerous side-effects.

* Dietitians

You can be referred to see a dietitian at your GP practice or local hospital. Dietitians have specialist training in nutrition and they are able to provide practical dietary advice.

A dietitian will be able to tailor their advice to suit your individual needs and circumstances.

There are a number of other organisations which can provide dietary information and help, click here to find out more.

Orlistat (Xenical)

Orlistat is a drug that is available on prescription for people with obesity.
  • Orlistat reduces the amount of fat that your body can absorb from food in your diet.
  • It encourages you to follow a low-fat diet, otherwise you experience the unpleasant side effects of fat passing through your digestive system without being absorbed.
  • The side effects of eating fatty foods while taking Orlistat include stomach pain, bloating, fatty stools and diarrhoea.

When combined with a low fat and low calorie diet and lifestyle changes, Orlistat can produce moderate weight loss.

There are certain conditions under which Orlistat can be prescribed, according to guidelines from the organisation NICE. NICE (the National Institute of Clinical Excellence) makes recommendations about safe practice in healthcare.

According to the NICE Obesity Guidelines, which were last amended in 2010, Orlistat can be considered for:

  • adults with a BMI of 30 or more
  • adults with a BMI of 28 or more if there are associated risk factors such as high cholesterol or high blood pressure.
  • Additionally, prescribing a drug treatment for weight management should only be considered after dietary, exercise and behavioural approaches have been started and evaluated.

Regular reviews are recommended to monitor the effect of the drug. The length of time you take the drug may depend on how effective it is at helping you to lose weight.

Occasionally, drug treatments may be used to maintain weight loss rather than to continue weight loss.

People who have used drug treatments to manage obesity should be offered continued support to manage their weight after the drug is no longer taken.


Alli is a weight loss drug that is available over-the-counter.

The over-the-counter Alli pill is a lower-dose version of Orlistat (Xenical). It can be bought by adults aged 18 and over with a BMI of 28 or greater. Pharmacists are required to weigh customers before they can sell the pills.

There are several groups of people who should not take the Alli pill, including:

  • people who have a problem with absorbing nutrients
  • pregnant or breastfeeding women
  • people taking other prescribed medicines such as ciclosporin, warfarin or other oral anticoagulants
  • people with some liver problems.

It is vital that you have a consultation with the dispensing pharmacist or professional to ensure that the Alli pill is right for you and that you have the right information and support to use it effectively.

During your consultation you'll also have the opportunity to discuss your general health and cardiovascular risk factors, and to get a full assessment of your health needs.

Weight loss medicines should only ever be taken if you are also committed to making changes to your diet and lifestyle. They should not be considered as a quick-fix stand-alone treatment.

Good to Know! The emphasis on long-term rather than quick-fix improvement might help you lose weight and keep the weight off.

Clinical guidelines in the UK state that weight reduction surgery should be available for:

  • people who have a BMI of 40 or over,
  • or for people with a BMI of 35-40 who have other significant disease such as type 2 diabetes or high blood pressure that could be improved if they lost weight.

In the above cases, other criteria must be fulfilled which are:

  • non-surgical options such as lifestyle interventions or medication must have been tried for at least 6 months, and failed to produce or maintain sufficient weight loss
  • the person must receive intensive management within a specialist obesity service
  • the person must be fit to undergo anaesthetic and surgery
  • the person must commit to long term follow up

Weight reduction surgery is also recommended as a first line option (instead of medication or lifestyle interventions) for people with a BMI of more than 50.

Taken from NICE guideline CG43 on the use of bariatric surgery

There are two main types of surgery:

Restrictive surgery

This can involve removing part of the stomach, or putting a tight band around the stomach, so that you feel full without eating as much.

This type of surgery still relies on you eating sensibly if it is to work. Eating smaller amounts of food but choosing things that are high-fat and/or high-sugar will stop you from losing weight.

It is also important that, if you are only eating small quantities of food, you chose food high in vitamins and other important nutrients, to keep the rest of your body healthy.

Malabsorptive surgery

This type of surgery involves bypassing part of your digestive system, so food is not properly digested and fewer nutrients are absorbed from the food you eat.

Both types of surgery have the potential for serious side effects, including internal bleeding and severe infections. These can lead to a need for further surgery and, in some cases, death.

Surgery is, therefore, not a quick fix or an easy option but, for someone who is extremely obese, should be considered.

See the BOSPA (the British Obesity Surgery Patient Association) website for more information on surgical options.

Benefits of weight loss surgery

Research shows that both types of surgery usually result in people losing about 50 per cent of their excess weight; in many cases this can be up to 65 to 70 per cent of excess weight lost.

This can lead to great improvements in quality of life and reduction in weight-related illnesses. In the long term, people who have had successful bariatric surgery are less likely to develop conditions such as diabetes or high blood pressure than people who remain obese.

Risks of weight loss surgery

Weight loss surgery is not to be considered lightly. There are some very serious risks associated with the surgery itself, as well as complications that may develop afterwards.

Any major surgical operation carries the risk of dying during or after the surgery. With obesity surgery this risk is small – less than 1 in every 100 people, depending on the type of procedure you have.

Other possible risks to bear in mind are:

  • your surgical wounds may become infected
  • you may develop hernias, ulcers and gallstones
  • you may start to suffer from heartburn and constipation
  • you could develop severe nutrient deficiencies, which could lead to undernourishment and possibly bone disease
  • you may be left with excess skin around the stomach
  • you may lose your hair (this is usually only temporary)
It is important to note that if you develop any of these complications, you may need to have further surgery.

Your surgeon should explain in detail all the risks and benefits associated with the surgical option he/she is suggesting. It is important that you ask questions and address any concerns you have before agreeing to the treatment. For some people the benefits of surgery will outweigh the risks.

Important issues to consider about your diet after surgery

It is important to be aware that after surgery you will need to make changes to your diet for life if you are to lose weight and minimise discomfort, unpleasant side effects and the need to have further surgery. In other words, what and how you eat and drink will change forever after weight loss surgery. For example:

  • You will only be able to eat very small meals for the rest of your life – equivalent to eating from a saucer.
  • You will need to take vitamin and mineral supplements for the rest of your life.
  • You will need ongoing visits to see various specialists, including a dietitian, for life. He/she will be checking that your diet is as balanced as it can be so that you can limit the chances of developing bowel disorders (because of the low fibre content of your diet), iron deficiency (anaemia) and bone disease in later life.
  • Because your stomach will be much smaller after surgery, you will always have to think carefully about the foods you eat.

These changes are likely to affect not only you but also your family and friends, at home and in social situations too, such as family meals and eating out with friends. Your specialist bariatric team will tell you what to expect so that you can prepare your family and friends for the challenges and changes ahead.

* Some information on this page has been produced with the kind permission of the British Heart Foundation, which is the joint copyright owner with Weight Concern

Excess skin

Weight loss surgery can be very successful and lead to a large amount of weight loss relatively quickly. As a result, the skin may not shrink back fully, leaving you with considerable excess skin around your abdomen. Some people choose to have additional surgery (often called a ‘tummy tuck’) to reduce this excess skin and improve their appearance cosmetically.

It is important to bear in mind that this type of surgery is currently considered non-essential and is unlikely to be covered on the NHS. So, if you are thinking about bariatric surgery, you may need to consider the cost of cosmetic surgery although it is a matter of personal choice and not everyone needs it or has it done.

What if surgery is not a suitable option?

Bariatric surgery will not be the best solution for everyone. This is the purpose of the initial assessment – to find out whether surgery is the best option for you and your personal circumstances. For example, if you have a history of eating disorders, you may be referred to a clinical psychologist for therapy and may be refused surgery as this could put your health at risk. This is because not everyone is able to control their eating to the level required after surgery.

Availability of treatment in the UK

According to the NHS Information Centre, there are several thousands of hospital procedures for weight-loss stomach surgery carried out every year in the UK. However, even if you do meet the above guidelines for surgical treatment, you may have to wait some time to get an assessment appointment, as there is currently higher demand to be referred for surgery on the NHS than supply.

If bariatric surgery is not available in your area, you may wish to seek the support of the British Obesity Surgery Patient Association ( or to contact your local PCT who may have to request an out–of–area referral.

Weight loss surgery is available as a funded option as well as privately. Costs vary depending on type of surgery, for more information visit the NHS website (

* Content on this page is produced with the kind permission of the British Heart Foundation, which is the joint copyright owner with Weight Concern