“Every doctor just tells me to eat less and move more — I’ve heard about the jab, can I have it?”

A weight-management consultation done well hinges first on LANGUAGE and FRAMING: weight is stigmatised, so use non-judgemental, person-first language, ask permission to discuss weight, acknowledge the patient’s courage and the unhelpfulness of past "eat less, move more" messaging, and frame obesity as a COMPLEX, relapsing-remitting chronic condition with biological, psychological and social drivers — not a willpower failing. Assess HOLISTICALLY before reaching for "the jab": weight history and previous attempts, diet/eating patterns (including emotional/binge eating), activity, sleep, mood (the bidirectional link with low mood/self-esteem), medications causing gain, secondary/endocrine causes where indicated (hypothyroidism, PCOS, rarely Cushing’s), and social determinants, alongside comorbidities (here prediabetes and hypertension), BMI/waist and readiness. Establish structured LIFESTYLE and behavioural support plus tiered weight-management services as the foundation, with realistic health-focused goals (modest, sustained weight loss improves blood pressure and blood glucose (a clinical goal rather than a guideline figure); NHS Diabetes Prevention Programme and Digital Weight Management Programme), framing pharmacotherapy and surgery as adjuncts. Discuss GLP-1 receptor agonists (semaglutide/liraglutide; the dual agonist tirzepatide) HONESTLY — effective appetite-reducing adjuncts, but for her a SPECIALIST route (NICE TA875 semaglutide and TA664 liraglutide are specialist-service drugs; under NICE TA1026 and NHS England’s phased cohorts, primary-care tirzepatide needs at least 4 of 5 qualifying conditions and she has 1), GI side-effects plus pancreatitis and gallbladder risks, the need to combine with lifestyle, likely weight regain on stopping (a long-term-use question), pregnancy avoidance with effective contraception (MHRA Drug Safety Update June 2025; oral contraception may be less reliable with tirzepatide) and cost if private — and mention orlistat (NG246); outline BARIATRIC SURGERY criteria for those meeting thresholds (NICE NG246: BMI ≥40, or 35–39.9 with a significant condition weight loss could improve, such as her prediabetes) as part of the tiered approach. Manage expectations that the jab is a tool, not a magic cure or "last hope", make a shared decision aligned to her values, address the comorbidities, and convey realistic hope rather than stigma or over-promising, with follow-up.