Curious Imbalance in What Care we can Offer 

Care seeking in a pressurised system

Rising rates of obesity and cardiometabolic disease, combined with limited access to timely NHS services, are prompting many people to take a more proactive role in managing their health. Patients are increasingly researching options, asking informed questions, and seeking interventions they believe will make a meaningful difference to their wellbeing. As a result, demand for certain services in the private sector has grown significantly. Treatments such as weight-loss injections, for example, are now highly sought after. Many clinicians, pharmacists, and healthcare providers offer these services privately, and they have become an established part of today’s healthcare landscape. 
 
It is within this context that I find myself reflecting on what we are permitted to offer, what we are restricted from offering, and what this may say about how we currently define acceptable care. 
 

Permissions and Paradoxes

In a private general practice setting, clinicians are permitted, without complexity, to offer aesthetic procedures such as Botox, provided appropriate training has been undertaken. There is a reasonable argument that medical training, grounding in anatomy and physiology, and clinical governance offer patients an additional layer of safety. 
 
Meanwhile, access to certain core clinical procedures in private general practice remains known to be constrained by regulatory requirements. Contraceptive procedures such as intrauterine device and implant fitting and removal, though routinely and safely delivered in NHS settings, often require complex approval processes in private practice. These regulatory hurdles stand in marked contrast to the relative ease with which other injectable treatments can be offered.

This contrast invites reflection. 
 
Similarly, while injectable weight loss treatments are permitted, despite no formal training, no prior experience for clinicians and long-term outcomes unknown, the formal delivery of lifestyle medicine, despite its strong evidence base and low risk profile, remains difficult to insure and therefore difficult to offer in a structured, protected way. Many defence unions simply refuse to provide indemnity for Lifestyle Medicine. 
 
I find myself puzzled how these distinctions have come to be drawn. 
 
 

Finding a Way Back to Meaningful Practice 

‘I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug1’. 
 
My interest in lifestyle medicine emerged during a period of professional disillusionment. Like many GPs, I spent years caring for patients living with multiple long-term conditions, often managed through an ever-expanding list of medications. While pharmacology has an essential role, it became increasingly clear to me that many of the underlying drivers of illness were rooted in lifestyle factors. 
 
At the time, I did not feel equipped to address this effectively. 
 
Discovering the British Society of Lifestyle Medicine was quietly transformative. It offered not only evidence and structure, but a community of clinicians asking similar questions and seeking to practise medicine in a way that felt safe, benevolent and sensible. 
 
Since then, lifestyle medicine has become a meaningful part of my clinical work. I have seen patients reduce medication burden, improve metabolic health, and experience tangible improvements in wellbeing and quality of life. These experiences have been deeply affirming, not because they reject conventional medicine, but because they complement it. 
 

Holding Complexity Around Weight Loss Injections 

Weight loss injections sit within this reflection as an area of genuine complexity. I remain open-minded. I have seen patients benefit significantly, particularly those who have struggled with weight for many years. There is no doubt that, for some, these medications can be life-changing and may reduce future disease risk. 
 
At the same time, I have observed serious adverse effects, including hospital admissions. As with many medications we prescribe routinely, the balance between benefit and harm will become clearer with time, data, and experience. 
 
What feels less clear to me is how we support patients beyond the pharmacological intervention itself. Already studies are showing that weight and cardiometabolic benefits often return to normal within 1-2 years of stopping these treatments2. 
 
Weight loss, when achieved, therefore raises important questions about sustainability and long-term behaviour change. Without parallel support to help patients develop skills, habits, and understanding, the benefits may be difficult to maintain. 

A Quiet Question 

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health”3.  
 
Lifestyle medicine is not a new concept. The relationship between nourishment, movement, rest, and health has been recognised for centuries. Much of what it promotes is neither radical nor experimental; rather, it is structured, evidence-based support for change. 
 
And so I find myself returning to a quiet but persistent question: 
 
Why is it relatively straightforward to offer injectable treatments, yet so difficult to formally provide education, support, and guidance that helps patients sustain their health in the long term? 
 
This is not a rejection of medication, nor an argument against innovation. It is simply an invitation to reflect on whether our current systems fully align with what we know about prevention, chronic disease, and human behaviour. 
 
For now, I will continue to practise as thoughtfully as I can within both the NHS and he private sector. I will continue to support patients with lifestyle change where possible, advocate for evidence-based prevention, and engage in conversations with professional bodies, educators, and policymakers. 
 
I remain hopeful that, over time, lifestyle medicine will find a more secure and recognised place within mainstream care — not as an alternative, but as a foundation.