The GP’s role in weight loss management

NICE guidance: Overweight and obesity management

January 2025 marked the release of new NICE guidance on Overweight and obesity management, placing greater emphasis on personalised, holistic care across all age groups. This shift has important implications for everyday practice in primary care. 

In this article, we review the GP’s role in supporting patients with weight loss management according to this guidance. NICE also provides a helpful overview of key points to remember in Overweight and obesity management: the potential care journey.

Patient-centred care to support weight loss management

Starting a conversation about weight with a patient can feel uncomfortable, but addressing it is an important part of a GP’s duty of care given the health risks associated with overweight and obesity. Using positive, supportive and non-judgemental language is essential to avoid stigma and build trust.

The NICE guidance includes a visual summary highlighting five patient-centred principles of care that can help frame these discussions: respect, support, understanding the patient’s life and their feelings, and communicating clearly. GPs should be mindful of their own biases, consider the wider context of a patient’s overweight or obesity, and always seek the patient’s permission before discussing the issue.

Finally, the guidance also emphasises the need to document the outcome of the discussion, helping to ensure continuity of care and a coordinated approach across the healthcare team.

Identifying overweight and obesity 

Everyday encounters such as new patient registration, long-term condition reviews and routine health checks provide GPs with natural opportunities to ask permission to discuss weight and take measurements. If a patient presents with another concern, this should always be addressed first.

With consent, GPs should record height and weight to calculate BMI. In addition, for adults with a BMI under 35 kg/m², waist-to-height ratio offers a practical way to assess central adiposity and related cardiometabolic risk. Classification of the degree of overweight or obesity should follow NICE recommendations for adults and for children and young people.

Clinicians should interpret BMI with care, as it does not directly reflect central adiposity. Lower BMI thresholds apply for people from South Asian, Chinese, other Asian, Middle Eastern, Black African and African-Caribbean backgrounds, as cardiometabolic risk occurs at lower BMI levels in these groups.

Discussing referral options 

Patients with overweight or obesity should be informed about its severity and associated health risks. GPs should be familiar with local and national weight management services, referral criteria, and processes, and be ready to discuss referral options when appropriate.

NICE recommends considering referral to specialist overweight and obesity management services if:

• Underlying causes need assessment
• Complex conditions cannot be managed adequately in behavioural overweight and obesity management services
• Less intensive approaches have failed
• Specialist interventions, surgery, or certain medications are being considered.

Adult patients can be offered referral for assessment by specialist overweight and obesity management services to see whether bariatric surgery is suitable if: 

• They have a BMI of ≥40 kg/m2, or between 35 kg/m2 and 39.9 kg/m2 with a significant health condition that could be improved if they lost weight (lower thresholds apply for people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African–Caribbean background)

• They agree to the necessary long-term follow up. 

Conversations should also explore the drivers of weight gain. To address these and for assessment of comorbidities, GPs may need to refer patients to other services, such as social care, physiotherapy, behavioural or mental health support, eating disorder services, the NHS Diabetes Prevention Programme, or the NHS Digital Weight Management Programme.

If a patient declines referral, their choice should be respected, while keeping the door open to revisit the discussion in the future.

Encouraging lifestyle and behaviour change

GPs should work with patients to set personal health goals and agree on the type and level of intervention, taking into account previous experiences, potential barriers, and available support. 

Lifestyle and behaviour changes, tailored to the patient’s preferences, fitness, health, and lifestyle, are key to weight management. Encouraging physical activity and improved diet quality is important, even if weight loss is limited, as these changes provide other health benefits. Physical activity should follow a gradual approach, working to agreed goals, while dietary plans should be flexible, nutritionally balanced, and maintain a calorie deficit. Low- or very-low-energy diets are not recommended long-term and should only be used within specialist services. Patients should be offered ongoing support and follow-up to achieve and maintain a healthier weight. 

Considering medication options

Weight management medications are one component of NHS England’s holistic approach to obesity, complementing lifestyle support, behavioural interventions, and bariatric surgery. Medicines should only be considered after dietary, exercise, and behavioural strategies have been introduced, alongside counselling and information on patient support programmes.

NICE currently recommends four medications for adults: tirzepatide, semaglutide, liraglutide, and orlistat. In England, semaglutide and liraglutide are limited to specialist services. In primary care, options include:

• Tirzepatide: for adults with BMI ≥35 kg/m² plus ≥1 weight-related comorbidity (lower thresholds for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds)
• Orlistat: for BMI ≥30 kg/m², or ≥28 kg/m² with additional risk factors.

Tirzepatide was rolled out from June 2025 using a phased approach to support safe and structured implementation, education, and sustainable use of NHS resources. As a Black Triangle medication, ongoing monitoring of real-world patient outcomes is essential.

Concerns about private prescriptions for weight loss medication

Weight loss medications are not suitable for everyone and may cause side effects, so careful medical evaluation and ongoing follow-up are essential. However, many patients unable to access tirzepatide through the NHS have turned to private prescriptions or online sources, raising concerns for GPs and NHS primary care practices due to:

• Extra workload from adding to a patient’s medication record and from requests to share patient medical history
• Uncertainty about patient consent for sharing information
• Managing side effects from privately obtained medication
• Safety risks if patients provide inaccurate information to online prescribers or purchase treatments without medical oversight.

Good Medical Practice requires prescribers to have adequate knowledge of a patient’s health as well as access to enough information to prescribe safely. Furthermore, the General Pharmaceutical Council guidance for pharmacies providing on-line services states that prescribers of medicines for weight-management should independently verify the person’s weight, height and/or BMI. This means GPs may receive many requests for patient information to support private prescriptions.

The BMA General Practitioners Committee England provides guidance for GPs in ‘Focus on Tirzepatide (Mounjaro) for Weight Management in General Practice’, including how to respond to such requests for patient information. It recommends that private providers encourage patients to share their on-line medical records with them.

Support for GPs taking a proactive approach to weight loss management 

NHS practices may have signed up to the NHS Enhanced Service Specification for Weight Management 2025/26. This is designed to support practices take a proactive approach to identifying patients living with obesity, engaging patients in conversations around weight and referring them to appropriate weight management programmes, as well as ensuring that healthcare professionals have the required skills and training. 

As a key element of this service, it is vital that GPs receive appropriate training to support patients with weight management, especially given the introduction of new options for weight loss medication. 

Training and education on this topic for both NHS and private practitioners is available from various providers, including:

• The healthy weight coach e-learning programme: recommended for practices signed up to the NHS Enhanced Service Specification for Weight Management 2025/26.
• The Royal College of GPs obesity hub: eLearning courses and a podcast on all aspects of obesity, including consultation skills and weight management options in NHS and private primary care settings.