GP Weight Management Consultation Note

History

• Attends for weight management review and requesting pharmacological support. Reports progressive bilateral knee OA pain and mild exertional SOB. No chest pain or palpitations.

Past Medical History

• PMH: HTN, pre-diabetes (HbA1c 44 mmol/mol on 12/02/2025), bilateral knee OA. PSH: Laparoscopic cholecystectomy (2018). FH: Maternal T2DM, paternal IHD. DH: amlodipine 5 mg PO OD, paracetamol 1,000 mg PO QDS PRN. Allergies: NKDA. SH: Office administrator, lives with husband.

History of Weight Gain

• Gradual weight gain of approx. 18 kg over the past 5 years, triggered by transition to a sedentary desk job and peri-menopause. Previous trials of commercial slimming clubs yielded temporary 4 kg loss, subsequently regained.

Diet

• Skips breakfast; lunch typically meal-deal sandwich and crisps; large evening meal (heavy carbs/processed meats). Frequent evening snacking on biscuits and chocolate due to work stress. Low vegetable and fibre intake.

Exercise

• Sedentary occupation. Walks dog for 15 mins 3x/week. Limited further activity due to knee pain.

Alcohol

• Red wine, approx. 10 units/week (2–3 glasses on Friday and Saturday evenings).

Smoking

• Ex-smoker, quit 10 years ago (previously 10 pack-years).

Sleep

• 6 hours/night, poor quality. Reports loud snoring and daytime somnolence, though no witnessed apnoeas (Epworth Sleepiness Scale 8/24).

Examination

• BP: 138/84 mmHg
• Weight: 102.4 kg
• BMI: 36.7 kg/m²
• Pulse: 76 bpm, regular

Advice

• Lifestyle: Keep a daily food and mood diary to identify stress-related eating triggers; aim to reduce alcohol intake to cut liquid calories.
• Diet: Adopt a Mediterranean-style calorie-deficit diet (approx. 1,500 kcal/day). Prioritise lean protein and high fibre at every meal to aid satiety; swap evening snacks for fruit or unsalted nuts.
• Sleep: Advised on sleep hygiene (regular bedtime, avoiding screens 1 hr pre-bed, weight loss to improve snoring).
• Exercise: Aim to build up to 150 mins/week of moderate-intensity activity; recommended low-impact exercises (swimming, aqua aerobics, cycling) to offload knees.
• Discussed GI side effects of GLP-1/GIP therapy (nausea, diarrhoea, constipation) and red flags (severe persistent abdominal pain radiating to back — stop drug and seek urgent medical attention due to pancreatitis risk). Repeat U&Es, LFTs, HbA1c, and lipids in 3 months.

Starting Mounjaro Medication

• How to Use: Initiate tirzepatide (Mounjaro®) 2.5 mg SC once weekly for 4 weeks, then titrate to 5 mg SC once weekly if tolerated. Administer on the same day each week into the abdomen or thigh (rotate injection sites). Ensure adequate hydration.