Practice information from Dr Syed Kashif Hussain Kazmi, Consultant Endocrinologist. View professional profile on Top Doctors.
Obesity is a long term health condition influenced by hormones, medicines, genetics and environment. A medical weight management assessment looks for contributing conditions and discusses based on evidence options in line with NICE guidance. Dr Kazmi offers virtual care across the UK and in person care in Cambridge. Results vary and are never guaranteed.
What is obesity?
Obesity is a chronic, relapsing health condition, not a failure of willpower. Body weight is influenced by genetics, appetite-regulating hormones, sleep, mental health, medicines, life circumstances and the surrounding environment. Excess body fat raises the risk of type 2 diabetes, high blood pressure, fatty liver disease, sleep apnoea, joint problems and some cancers.
NICE guidance looks beyond body mass index (BMI) alone, taking into account waist size, ethnic background and the effect of weight on your health. An endocrinologist can help identify whether hormonal conditions or medicines are contributing, and can discuss the full range of treatment options in line with national guidance.
What health problems can be linked to excess weight?
Weight-related health problems may show up as:
- Raised blood glucose, high blood pressure or abnormal cholesterol on routine tests
- Snoring, disturbed sleep and daytime tiredness (possible sleep apnoea)
- Joint pain or reduced mobility
- Irregular periods or features of polycystic ovary syndrome
- Fatty liver found on a scan or blood test
- Rapid or unexplained weight gain, especially with other new symptoms
When should you see an obesity specialist?
A specialist assessment may be appropriate when:
- Weight is affecting your health and previous attempts have not led to lasting change
- You have weight gain with other symptoms that could point to a hormonal cause
- You take medicines that may promote weight gain and want to review options
- You have type 2 diabetes, prediabetes or fatty liver alongside excess weight
- You would like to understand whether prescription weight management medicines are suitable and safe for you
- You are being considered for, or have had, weight-loss surgery and need medical follow up
How is weight assessed medically?
Assessment is unhurried and nonjudgemental. It typically covers:
- Your weight history, eating and activity patterns, sleep, mood and medicines
- Height, weight, waist measurement and blood pressure
- Blood tests such as HbA1c, cholesterol, liver and thyroid function
- Further hormone testing only when your history or examination suggests it is worthwhile
- Screening for sleep apnoea and other related to weight conditions where appropriate
What treatments are available for obesity?
There is no single right answer, and outcomes differ between people. No result can be guaranteed. Options discussed include:
Nutrition and behaviour
Sustainable changes to eating, activity and sleep, with signposting to dietetic and psychological support when helpful.
Medicines that act on weight
Where criteria are met, licensed medicines may be considered in line with NICE and MHRA guidance. Benefits, side effects, monitoring, cost and what happens when treatment stops are explained so the decision is shared and informed.
Reviewing other medicines
Looking at whether any current medicines contribute to weight gain and whether alternatives exist, in discussion with the prescriber.
More complex needs
Where related to weight health needs are complex, assessment can identify whether input from other professionals or a specialist weight management service may be appropriate.
Surgery and specialist services
Referral to a bariatric (weight-loss surgery) team when appropriate, and medical follow up afterwards.
Treating the consequences
Managing diabetes, blood pressure, cholesterol and fatty liver disease in parallel.
Can a hormone problem cause weight gain?
Most weight gain is not caused by a hormone disorder, but some conditions can contribute, including an underactive thyroid, polycystic ovary syndrome, Cushing’s syndrome and some medicines. Testing is most useful when weight gain comes with other symptoms or is rapid, unexplained or out of proportion to changes in eating and activity.
Is weight gain usually a hormone problem?
Usually not. Weight reflects energy intake, activity, sleep, genetics, medicines and life circumstances. Hormone conditions are a less common cause, and where they do contribute the effect is often modest. A medical cause is worth looking for, but it should not delay support with the everyday factors that do matter.
Which hormone conditions can contribute?
The main ones to know about are:
- Underactive thyroid (hypothyroidism), which can cause some weight gain along with tiredness, feeling cold and constipation
- Polycystic ovary syndrome (PCOS), linked to irregular periods, excess hair growth and insulin resistance
- Cushing’s syndrome, which is rare and caused by too much cortisol, with features such as easy bruising, purple stretch marks and muscle weakness
- Low sex hormone levels in some people
Can medicines cause weight gain?
Yes. Steroid tablets, some medicines for mood, epilepsy and psychosis, and some diabetes treatments can increase weight. Never stop a prescribed medicine on your own. Discuss concerns with the clinician who prescribed it, because alternatives may exist.
Which tests are worth doing?
Your clinician chooses tests from your symptoms and history. A thyroid function test is common and easy. Tests for PCOS, diabetes risk, cholesterol or cortisol are added when the picture suggests them. Routine panels without a reason can produce confusing borderline results.
When is a specialist opinion useful?
A specialist review can help when weight gain is rapid or unexplained, when it comes with features of a hormone condition, when results are borderline or conflicting, or when weight has been difficult to manage despite sustained effort and you would like a structured medical assessment.
When to seek urgent help
Do not start prescription weight-loss medicines bought from unregulated sources. Seek urgent medical help for severe, persistent abdominal pain, repeated vomiting, or signs of dehydration while taking any weight management medicine.
Common questions
Do you offer weight-loss injections?
Prescribing depends on a medical assessment, whether national criteria are met, and safety considerations. These medicines are not suitable for everyone and are discussed as one option among several.
Will you weigh me and judge me?
Measurements are part of the medical assessment but the consultation is respectful and focused on your health, not on blame.
Can weight problems be caused by a hormone condition?
Occasionally. Conditions such as an underactive thyroid, Cushing’s syndrome or polycystic ovary syndrome can contribute, which is why a clinical assessment guides which tests are worthwhile.
Will treating a thyroid problem make me lose a lot of weight?
Correcting an underactive thyroid can remove some weight gained because of it, often a modest amount. It is not a weight loss treatment in itself.
Are there medical treatments for obesity?
Yes, there are evidence-based options alongside diet, activity and behavioural support, and eligibility is set out in national guidance. Whether any is suitable depends on a personal assessment.
Related patient guides
- When should you see an endocrinologist?: Signs a hormone, thyroid, diabetes or bone problem may need a specialist, and how to prepare.
Further reading
- NHS: Obesity
- NICE guideline NG246: Overweight and obesity management
- NHS: Underactive thyroid (hypothyroidism)
- NHS: Polycystic ovary syndrome (PCOS)
Clinical content awaiting consultant review.