A walk-through of the private GP pathway for GLP-1 weight-loss treatment in London — from the first consultation and baseline assessment to ongoing monitoring and shared decision-making with Dr Adam Wander.
GLP-1 medications are now one of the most discussed options in weight management, but the public conversation often skips over what matters most: the clinical relationship that should sit around them. As a private GP in London, my role is not to hand over a prescription and step away. It is to build a structured, ongoing partnership that starts with a thorough assessment and continues through monitoring, adjustment and support.
This article describes what that pathway looks like in practice — session by session — for patients considering GLP-1 weight-loss treatment at the Hospital of St John & St Elizabeth. It is not a sales pitch for any medication, and it is not medical advice for your specific situation. It is simply an honest outline of how I work.
The first consultation: understanding you, not just your weight
The first appointment is deliberately unhurried. Before any decision is made, I need to understand your full health picture: your history, your previous attempts at weight management, your current medications, your lifestyle, your expectations and your concerns. Weight is never just a number on a scale, and the reasons someone has found it difficult to lose weight are usually multifactorial.
We will talk through sleep, stress, eating patterns, activity levels, alcohol, and any symptoms that might point to an underlying endocrine or metabolic issue. We will also discuss what has and has not worked before. This conversation often reveals that the most useful first step is not medication at all — it might be addressing thyroid function, sleep apnoea, mood, or a medication you are already taking that is promoting weight gain.
Baseline assessment and investigations
If, after the initial discussion, GLP-1 treatment remains a possible option, the next step is a structured baseline assessment. I do not believe in starting any weight-loss medication without first knowing where we are starting from. The baseline work typically includes:
- A full physical examination including blood pressure, pulse, weight, height, waist circumference and BMI
- Baseline blood tests guided by your history — commonly HbA1c and glucose, full lipid profile, kidney and liver function, thyroid function, and a full blood count
- An ECG where age, symptoms or risk factors indicate it
- A careful review of all current prescriptions, supplements and over-the-counter medicines
- Screening for disordered eating, depression or anxiety, and any personal or family history that would make GLP-1 treatment unsafe
This is also the point at which we document any conditions that would affect suitability, such as a history of pancreatitis, gallbladder disease, severe gastrointestinal disease, or certain endocrine conditions. The aim is to make the next decision an informed one.
The shared decision-making conversation
Once the assessment is complete, we sit down and talk it through properly. I explain what the options are — including continuing with lifestyle change alone, referring to a specialist, or considering GLP-1 treatment within a supervised plan. We discuss the likely benefits, the common side effects, the less common but serious risks, and what the evidence actually says.
I am careful not to make specific promises about how much weight someone will lose. Clinical trials report averages; individual response varies. We also discuss the reality that these medicines work best alongside sustained changes to nutrition, movement, sleep and stress management. If someone is not in a position to engage with those wider changes, the value of medication alone is limited.
Eligibility is only one part of this conversation. UK guidance generally points to people: BMI of 30 or above, or 27 or above with a weight-related condition such as type 2 diabetes, high blood pressure or sleep apnoea, alongside previous lifestyle efforts. But eligibility on paper does not automatically mean treatment is the right next step for you. That is the point of the conversation.
What ongoing monitoring looks like
If we proceed, the work does not stop at the first prescription. GLP-1 treatment requires a monitoring relationship. In my practice that usually means regular follow-up appointments to review progress, tolerability and any side effects. The exact frequency depends on the individual, but early follow-up is typically closer together — often every few weeks at first — then spaced out once things are stable.
At each review we look at weight and waist circumference, blood pressure, how you are tolerating treatment, and whether any other medications need adjusting. We repeat relevant blood tests at appropriate intervals. If side effects arise — commonly nausea, reflux, constipation or reduced appetite — we manage them together, adjusting the approach or pausing treatment if needed. If something more serious is suspected, we act on it promptly.
Over time, the plan evolves. Some patients continue for a defined period; others need longer support. Some find that the medication gives them the breathing space to embed lifestyle changes and then taper off; others need a different strategy altogether. The key is that the decision is reviewed, not assumed.
Why this differs from an online-only prescription
There is a growing market for weight-loss medications prescribed via app-based or online-only services. Some of these are legitimate; others are concerningly thin on clinical oversight. The difference in my practice is the relationship: I examine you, I review your full history and medications, I order and interpret baseline investigations, and I see you again to monitor what happens next.
A private GP pathway is not about making access easier in the sense of skipping steps. It is about making access better — giving you time, continuity, and a clinician who knows your case. Prescription-only medicines exist for a reason, and that reason is not just bureaucracy. It is that these treatments need judgement, monitoring and the ability to respond when things change.
Medication as part of a wider plan
The patients who do best are those who use GLP-1 treatment as a structured window of support rather than a standalone fix. While the medication can reduce appetite and food noise, the long-term outcomes depend on what happens around it: how you eat, how you move, how you sleep, how you manage stress, and how your metabolic health is tracked over time.
That is why my weight-management consultations sit inside a broader general practice review. We are not just targeting a number on the scales; we are looking at cardiovascular risk, metabolic markers, mood, energy and quality of life. The medication, when appropriate, is one tool within that bigger picture.
Booking a private GP consultation
If you are considering GLP-1 weight-loss treatment and want to discuss it through a private GP pathway in London — with proper assessment, shared decision-making and ongoing monitoring — you are welcome to book a private consultation. There is no obligation to proceed with any particular treatment. The aim is to give you clear, personalised advice and a plan that fits your circumstances.