Private weight management clinic in London, same-day endocrinology.

Worth excluding first

• an underactive thyroid, and less commonly Cushing's syndrome
• PCOS, which makes weight loss harder and is very common
• medicines — some antidepressants, antipsychotics, steroids, insulin and beta-blockers
• sleep apnoea and poor sleep, which disrupt appetite hormones directly
• undiagnosed type 2 diabetes or prediabetes
• depression, anxiety and binge eating

What actually predicts success

• A modest target. Losing 5 to 10% substantially improves blood pressure, blood glucose, cholesterol, sleep apnoea and joint pain. You do not need to reach a 'normal' BMI to get most of the benefit.
• An approach you could still be doing in a year. Anything you are enduring rather than living with will end.
• Protein and fibre at each meal, which affect satiety more than calorie counting alone.
• Regular self-monitoring — weighing weekly, or recording food — is one of the strongest predictors in the research.
• Strength training alongside any weight loss, to preserve muscle.
• Sleep and stress, both of which drive appetite independently of willpower.
• Ongoing support. Programmes with regular contact consistently outperform advice given once.

Medical options

Where lifestyle change alone has not been enough, weight loss medication is now genuinely effective and appropriate for many people — see our separate leaflet. Bariatric surgery remains the most effective intervention for severe obesity, particularly with type 2 diabetes, and is worth discussing rather than treating as a last resort.