My Best Weight

My Best Weight A NEW approach to managing weight - Our clinic provides evidence based medical management for those

08/09/2026

Stable does not mean ineffective.

A plateau can feel unsettling—especially when appetite or food noise becomes more noticeable than during the response phase, although usually remaining better regulated than before treatment. This does not necessarily mean that treatment has stopped working. Maintenance is still active treatment.

What does the evidence show?

• In STEP 5, the average response to semaglutide 2.4 mg plateaued around week 60 and was maintained to week 104 with continued treatment.

• In SURMOUNT-MAINTAIN, participants were approximately 22% below baseline after 60 weeks on tirzepatide 10 or 15 mg. At week 112, those continuing that dose remained 21.9% below baseline, compared with 16.6% after reducing to 5 mg and 9.9% after switching to placebo. Because placebo was followed for only 52 weeks, 9.9% may not have been the final position.

• An Oxford-led BMJ review of 37 studies estimated regain after stopping at 0.4 kg per month and return to baseline at 1.7 years; for semaglutide and tirzepatide, the estimates were 0.8 kg per month and 1.5 years. These are modelled averages, not individual predictions.

• ATTAIN-MAINTAIN examined continued treatment by switching to once-daily oral orforglipron. After 72 weeks on tirzepatide, participants were 21.5% below baseline and remained 16.8% below baseline after 52 weeks on orforglipron. After 72 weeks on semaglutide, the corresponding figures were 16.5% and 15.1%.

Maintenance does not automatically mean a lower dose, and reducing, changing or stopping treatment may mean preserving less of the response.

Response moves towards the level supported by the particular medication and dose taken long term—not necessarily the level reached during the initial response phase on a different treatment.

Treatment should be individualised around health, response, side effects, affordability and sustainability.

References:
- Garvey WT et al. STEP 5. Nature Medicine, 2022.
- Horn DB et al. SURMOUNT-MAINTAIN. The Lancet, 2026.
- Aronne LJ et al. ATTAIN-MAINTAIN. Nature Medicine, 2026.
- West S et al. BMJ, 2026;392:e085304.

04/09/2026

A glimpse into some of today’s clinic conversations.

Obesity is a fascinating area of medicine and an incredibly rewarding one in which to work. It’s a real privilege to support people in improving their health and managing obesity.

If any of these topics interest you, drop a comment below and I can explore them in more detail in future Reels.

01/09/2026

When a healthcare provider uses a patient’s body to promote treatment, one person’s experience becomes a marketing claim.

A carefully selected result is anecdote - not evidence. It cannot show the typical response, variation between people, adverse effects or whether any change was sustained. Lighting, posture, clothing, filters, Photoshop and AI can make the comparison even less reliable.

And it is only a snapshot.

We do not know what happened between the photographs, what the experience cost physically or psychologically - or what happened five years later.

We would not advertise treatment for diabetes or high blood pressure using photographs of patients’ bodies. Why should obesity care be different?

These images act as social triggers: the “before” is presented as the state to escape and the “after” as the state to pursue. That can reinforce unrealistic expectations, weight stigma, body dissatisfaction and disordered eating. It is familiar diet-culture marketing, now wrapped around biological treatments.

The fictional dolls in this Reel intentionally mirror that visual convention to critique it - not to suggest that one body is healthier, happier or more desirable than another.

Consent also changes over time. Someone may agree to share an image today and later withdraw that consent. The original can be deleted, but screenshots, reproductions and altered or stolen copies may remain online indefinitely.

People should be free to tell their own stories. Healthcare providers should not turn those stories - or their bodies - into advertisements.

Good obesity care should be evidence-based, individualised and judged by medical and metabolic health, mobility, psychosocial health, long-term health and quality of life.

You are not a “before.”
You are not an “after.”

The problem isn’t the medication. It’s when marketing replaces medicine.This fictional graphic is deliberately ridiculou...
26/08/2026

The problem isn’t the medication. It’s when marketing replaces medicine.

This fictional graphic is deliberately ridiculous. The questions behind it are not.

Obesity medications can be valuable, evidence-based treatments. Online care can also be excellent. This post critiques the models of care used by some providers—not people seeking treatment. The concern is when convenient access to a product is presented as comprehensive clinical care.

Red flags may include aggressive marketing, a focus on speed or guaranteed results, pressure to start immediately, referral codes or paid testimonials, vague information about risks and adverse effects, and no clear explanation of alternatives. Other concerns include no direct clinical conversation, limited access to an identifiable and appropriately qualified prescriber, and little or no follow-up after a prescription is issued.

A prescription should sit within an individualised treatment plan: comprehensive assessment, shared decision-making, clear guidance about options, dosing and adverse effects, a plan for what to do if concerns arise, and ongoing review.

Patients should understand why treatment is considered appropriate, how to use it safely, what to expect at different stages, which symptoms should prompt medical advice, how adverse effects will be managed, when treatment will be reviewed and who to contact if problems arise. A prescription without clear information, continuity or follow-up is not the same as comprehensive care.

Response should be considered in terms of health, function, quality of life and the person’s experience—not the scale alone.

Customer-service teams and automated systems may support care, but they cannot carry clinical responsibility.

Decisions requiring informed consent and clinical judgement should be guided by evidence, individual circumstances and patient preferences—not commercial pressure.

Obesity is a complex chronic disease. Access to medication matters. What surrounds the prescription matters too.

20/08/2026

Obesity treatment should not make food joyless - enjoying food and improving your health are not opposing goals.

When people feel they need to pause obesity medication to “enjoy eating”, it raises a bigger question: have we allowed the same old diet-culture cycle of restriction and permission to shape how we think about treatment?

Complete appetite suppression is not the goal. Neither is eating as little as possible or losing all enjoyment in food.

But they are two sides of the same diet-culture mindset: restriction in everyday life, permission on special occasions, then back to restriction again.

Complete appetite suppression is not the aim of treatment. Neither is losing all pleasure in food.

Good treatment should offer another path: helping to regulate appetite and reduce food preoccupation while supporting adequate nutrition, enjoyable meals, better health and a better quality of life.

Obesity care has to work in real life—not only at home, but in restaurants, at celebrations and on holiday.

If medication is making food unpleasant, causing troublesome side effects or affecting your quality of life, that is not something you should simply have to endure. Speak to your prescriber; the dose or treatment plan may need to be reviewed.

Good treatment should help people live more freely, it should fit into our lives and make that life better - not create another set of rules you need a holiday from.

A bit late to this trend 😂 but here goes…Reasons to Follow or Unfollow Me 👇Evidence over hype. Health over numbers. No m...
10/08/2026

A bit late to this trend 😂 but here goes…
Reasons to Follow or Unfollow Me 👇

Evidence over hype. Health over numbers. No miracle promises. Questionable analogies. Occasional rants. Colourful language.

And if you give me a microphone, you’ve been warned. 🎙️😂

08/08/2026

We’ve been conditioned to think that when it comes to obesity, the smaller the number on the scales, the better the treatment must be working.

But that’s diet culture thinking, not obesity care.

In medicine, we don’t treat numbers in isolation - we treat people.

A reduction in weight can accompany meaningful improvements in health, but the number alone tells us very little about how that change happened, what mechanisms drove it, or what it has meant for the person living it.

Was weight lost through improved metabolic health, reduced appetite dysregulation and better energy balance? Or was it driven by nausea, restriction, loss of lean mass or persistent difficulty with intake? The mechanism matters, because it shapes both health outcomes and lived experience.

Good obesity care should make life better, not smaller.

It should support health, function and quality of life. It should make appetite easier to live with rather than make eating impossible. It should reduce the burden of the disease rather than replace it with the burden of treatment.

And sometimes one of the most meaningful changes is having more space for everything else - family, work, relationships, movement, enjoyment—when food, dieting and weight are no longer occupying quite so much of it.

Weight matters. But mechanism and context matter more.

Ultimately, the question isn’t simply “How much weight was lost?”

It’s “How much health was gained - and how was that change experienced?”

I’m delighted to have the opportunity to write this piece for TheJournal.ie discussing how our understanding of obesity ...
19/07/2026

I’m delighted to have the opportunity to write this piece for TheJournal.ie discussing how our understanding of obesity has evolved, why that matters, and what modern, evidence-based obesity care looks like.

The ‘eat less, move more’ myth: Obesity was never a failure of willpower. Science has moved on

https://jrnl.ie/7101597

For too long, obesity has been framed as a simple lack of willpower or personal responsibility.

Our understanding has changed dramatically over the past few decades, yet many of the conversations around obesity haven’t kept pace with the science.

I hope you find it informative - let me know what you think.

Fair warning: The article reflects the current evidence. The comments section reflects the internet and may be somewhat less evidence-based.

We won’t make you thin. We won’t make you happy.… but we can help improve your health, function & quality of life.A 1950...
15/07/2026

We won’t make you thin. We won’t make you happy.

… but we can help improve your health, function & quality of life.

A 1950s-style advertisement with a message for modern obesity care.

Obesity care shouldn’t be built on unrealistic promises, quick fixes or the idea that a number on the scales determines health or happiness.

It should be built on evidence, compassion and honesty.

At My Best Weight, we treat obesity as a complex chronic disease. Our focus is personalised, evidence-based medical care to support better health and quality of life over the long term.

Health over hype. Every time.

09/07/2026

One of the most interesting conversations I have with patients doesn’t happen when they lose weight.

It happens when they say:

“I’m eating the same foods I’ve always wanted to eat… but now I actually feel full & satisfied.”

Or:

“For the first time, I’m not thinking about food all day.”

Healthy eating, regular movement, good sleep and managing stress are important for all of us - regardless of weight. They improve health, wellbeing and reduce the risk of many chronic diseases.

Most people living with obesity don’t need another lecture about these behaviours.

They already know they’re important.

The challenge is implementing that knowledge while living with biology that drives hunger, food seeking and weight regain, in an environment where food is everywhere, alongside all the competing demands of everyday life.

For many people, healthy behaviours alone may not be enough to confer meaningful or sustained weight change.

The goal of obesity treatment isn’t to replace healthy behaviours. It’s to reduce the biological barriers that make them difficult to maintain.

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Dalkey
A96A8F8

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