Thanks all, for the advice.
And I meant to say in my previous post that I've structured my plan going forwards based on advice given throughout this thread. So thanks very much to everyone who has helped, I've read through all the posts.
Another point I want to add - several posters have questioned why I'm asking for advice on this if I'm a GP, and have asked what I'd say to a patient if they came to me with the same problem, and some have mocked me and poked fun at me saying I'm a GP, insinuating that I'm not really. To those posters:
I trained in medicine.
I didn't train in weight loss.
I am not trained in GLP-1 meds being used for obesity. The only training I've had for GLP-1 is for targeting HbA1c levels, and even that is limited.
So the introduction of private GLP-1 use for weight loss being used by people who do not have DM is new to GPs and I can assure you that none of us have had any training whatsoever in how to manage patients using this treatment. We are receiving letters from private pharmaceutical companies in their hundreds to inform us that our patients are using GLP-1s privately for weight loss. We are holding meetings to discuss this, such is the influx of letters. We have all highlighted that none of us have training or knowledge about this area. My medical practice is actively considering invoicing a private fee to every patient we receive a private pharmaceutical letter about, every time they write to inform us about the commencement of a GLP-1, and all the subsequent letters we receive about dose changes, because it is taking up a huge amount of admin time filing these letters and informing GPs and updating medical notes. It is private healthcare which has tipped into NHS time taken to deal with admin for hundreds of patients on an ongoing basis. Hence the private fee that my surgery (and I know many others within the icb are planning on doing the same) are planning to charge directly to these patients, for each and every letter we receive re starting the treatment and dose changes. And it's a steep fee they're planning to charge, too.
On top of that we know there are many more patients who haven't told us they are using GLP-1s because they don't want it on their medical notes. I'm not sure how people get round this, as every time I place an order the company I use generates a letter to my own GP, but apparently there are ways around it.
And the point is none of us know how to manage or advise patients on their weight loss treatment. Because we've had no training. I can manage your hypertension. I can manage your cardiovascular disease. I can manage your respiratory disease. I know how to manage your renal disease. And your diabetes. I can assess your low mood and screen you for risk of suicide. I can help you when you've got a bacterial infection. I know what to prescribe for these conditions and I know how to monitor the effectiveness of your medication. I know the red flags to assess you for and when to refer you under the 2 week wait rule for suspected cancer. I know all this from med school and GP training and on the job experience. But I cannot manage your weight loss with the use of GLP-1. I am not trained in obesity as a disease. And nor are any of my colleagues. In meetings we are holding about this topic, the comments my colleagues make show that they know nothing more about this topic than an average member of the public. GPs I work with are very misinformed about obesity in general, continuously trotting out the "It's easy, people just need to eat less, move more, and stop eating McDonald's. Join Slimming World if they can't grasp how to eat less". This is what I have listened to in meetings. I know it is much more complicated than that for some people. But my colleagues don't, and they demonstrate this to me when I challenge them.
Another issue is that there is a general horror amongst GPs (certainly the ones I work with) about patients buying GLP-1s privately. The medical profession doesn't like patients taking matters into their own hands and buying private prescriptions. They don't like it one bit. Much despair about this is generated from GP meetings. They roll their eyes in a "What on earth do these patients think they're doing" way.
So on top of very much needed but severely lacking training required for GPs in this area, there is stigma and prejudice to overcome amongst the medical profession too. We've been flooded by huge numbers of patients receiving treatment for a disease that we have no training in.
So in answer to what I've been asked on this thread, if a patient came to me to ask why they're not losing weight on 15mg of MJ and they assured me they were following a strict daily calorie deficit and exercising regularly, I'd run some bloods on them and do some general obs. If all results and findings were within normal range, and I found no concerns about any underlying medical conditions, then I wouldn't know the answer to why they haven't lost weight over the past 6 weeks of dedication. I'd refer to colleagues, knowing that they wouldn't know, either.
There is a pervasive misunderstanding amongst certain sectors of the general population that GPs have the answer for everything health related. We really don't always have the answer. We can test and examine and prescribe for the medical conditions we are trained in. We can refer to secondary care colleagues if we need further support and guidance. But we are not trained in weight loss. We are not trained in obesity as a disease. And there is no obesity team to refer patients to, like there is a respiratory team or a cardiac team. There are enormous gaps in training and understanding in this field. There is woeful ignorance about obesity and the complications of weight loss amongst my profession.
But one thing I know I wouldn't do if a patient presented themselves to me who had my profile, is patronise them, in the way that a few posters have patronised me on this thread.
It is a misnomer that GPs are experts on the complications of weight loss and exercise regimes. If they were, then no GP would be overweight, no GP would be paying for and following diet plans, and no GP would hire personal trainers. In fact, the opposite is true.