What happens

Your first consultation

In person at the clinic, and at least 45 minutes.

A full assessment. Your weight history, what you have tried, what happened, your medical history, family history, medication and how you actually live. Height, weight, BMI, waist measurement and blood pressure, all measured rather than reported. A full body composition scan. Dr Hazel will also arrange blood tests where they are needed, which is most of the time, because thyroid function, blood sugar, insulin resistance and hormonal causes are worth ruling in or out before starting anything.

You will also be asked about your eating patterns, your mental health and your expectations, because all three matter to whether this works and whether it is safe.

Your plan

Built around what the assessment actually found. It will always include nutrition and lifestyle, because nothing else works without them. Where medical treatment is clinically appropriate and you are suitable for it, that is discussed fully, including what it does, what it does not do, the side effects and what happens when you stop.

You will be given a realistic picture of what to expect. Around half a kilo to a kilo a week is a safe and sustainable rate. Anything faster is usually costing you muscle, which is the opposite of what we are trying to achieve.

If there is any chance you could become pregnant, effective contraception is required throughout treatment and for a period afterwards. This is explained fully before anything is started.

Ongoing review

Reviews are frequent at the start and settle down once things are stable. The pattern is broadly this:

• Two to four weeks after starting, to check how you are tolerating things
• Every four weeks while the dose is being adjusted
• At three months, for a proper look at progress, weight, BMI, waist and blood pressure
• At six months, a full review of whether this is working and whether to continue
• At least every six months after that

Reviews can be in person or by video, or a mixture, whichever fits around your life. The body composition scan can only be done in person, so it is worth coming in for some of them. Many patients do video for the short check-ins and come to the clinic for the three and six month reviews.

One thing to be clear about. No further prescription is issued without a review. That is not an administrative rule, it is how treatment is kept safe, and it applies to everyone.

Why the nutrition part is not optional

Losing weight quickly without proper nutritional support costs you muscle as well as fat.

That matters at any age and it matters a great deal in midlife, when muscle mass is already falling and bone density is changing. Losing muscle slows your metabolism, which makes the weight easier to regain and harder to lose the next time. It also affects strength, balance and long-term health in ways that show up years later.

Protecting muscle and bone while you lose fat takes adequate protein, resistance exercise and proper monitoring. It is built into the plan from the first appointment rather than added at the end, and it is a large part of why this service costs more than an online prescriber.

Measuring it, rather than hoping

Every review includes a full body composition scan.

The scales tell you that you have lost four kilos. They do not tell you whether those four kilos were fat or muscle, and that is the difference between a change that lasts and one that quietly sets you up to regain it.

The scan separates them. At every appointment you will see your fat mass and your muscle mass tracked individually, along with visceral fat, which is the fat stored around the organs and the type most strongly linked to metabolic risk. It also breaks the results down limb by limb, so muscle loss in the legs, which is both common and consequential, shows up early rather than years later.

This is what turns protecting your muscle from a good intention into something we can actually watch. If the balance starts going the wrong way, we see it and change the plan, rather than finding out at the end.

The scan is included in your monthly programme fee. There is no separate charge for it.

What weight loss does to your face

Nobody warns you about this one, and it catches a lot of women out.

Losing weight quickly takes fat from your face as well as everywhere else, and the face is where you notice it. Cheeks flatten, the area under the eyes hollows, skin around the jaw and neck loses its support and starts to look loose. In midlife it is more pronounced again, because collagen is already falling and skin has less capacity to shrink back to fit.

This is not caused by any particular treatment. It happens with rapid weight loss however it is achieved, and it is largely a matter of how fast the weight comes off and how much there was to lose.

A good deal of it can be prevented. Losing weight at a sensible rate rather than the fastest possible one, eating enough protein and maintaining muscle all help, and those are already part of the plan here for other reasons.

Where the change has happened and it bothers you, there is a great deal that can be done about it, and it does not need to be filler. Collagen stimulating treatments such as Sculptra rebuild support over several months rather than simply adding volume. Polynucleotides, skin boosters and radiofrequency microneedling improve skin quality and firmness. Dermal fillers restore structure where it has genuinely been lost. Medical-grade skincare underpins all of it.

Dr Hazel runs the aesthetics side of this clinic as well, so if this is something you want addressed it can be discussed at a review rather than becoming somebody else’s referral. Equally, if it does not bother you, nobody is going to raise it.