When the scale refuses to move

Mr A has been attending my clinic for the past few years. Recently, he shared his frustration at not being able to lose weight, despite trying different diet regimes and going to the gym nearly every day. He told me that he is now contemplating using a weight-reducing medication because “nothing else would work”.
The look on his face was not simply disappointment. It was the quiet exhaustion of someone who has done everything he was told to do and still feels he has failed. I have seen that look many times, and it rarely has anything to do with laziness.
We live in a culture that treats body weight as a simple equation: eat less, move more, and the kilogrammes will melt away. When they fail, we blame ourselves for lacking willpower or discipline.
Over time, this can lead to anxiety, low mood, guilt around food, and a sense of helplessness. The weight is carried not only on the body but also on the mind.
The truth is that weight is shaped by much more than effort. Genes, hormones, sleep, stress, certain medicines, and the way our bodies defend against weight loss all play a part. When we cut calories sharply, the body often responds by slowing down and increasing hunger. This is biology, not weakness.
So, it is understandable that the new generation of weight-loss injections, which act on appetite signals between the gut and the brain, sound like a rescue. Although they can genuinely help, they are not magic and not free of cost.
The most common side effects are nausea, vomiting, diarrhoea, constipation, and stomach pain, especially in the early weeks. Less commonly, people may develop gallstones or inflammation of the pancreas, which can be serious.
Rapid weight loss can also mean losing muscle, not just fat, unless diet and exercise continue. Many people regain much of the weight once they stop, so treatment may need to be long-term. There have also been reports of low mood in some users, so anyone with a history of depression should be monitored closely.
I also worry about people buying these medicines online from unlicensed sources, where fake products circulate.
The psychological side deserves equal attention. If a person believes that a smaller body will finally bring happiness, confidence, or acceptance, they may be disappointed even after the weight comes off. A medication can change appetite, but it cannot, on its own, heal the inner critic. For some, the urge to 'fix' the body may hide something deeper, such as emotional eating, stress, or a long history of being judged.
So what did I tell my Mr A? I did not tell him to avoid the medication or to rush into it. I suggested that he speak honestly with an obesity specialist, who can check whether he truly needs it, look for medical causes such as thyroid problems or sleep apnea, and follow him safely if he starts.
I also encouraged him to be kinder to himself. Going to the gym nearly every day is an achievement, whatever the scale says. His heart, his muscles, and his mood are benefiting even if the number has not moved.
Perhaps the healthiest question is not 'How do I lose weight at any cost?' but 'How do I look after myself, body and mind, for the long run?' Sometimes the answer includes medication. It should never begin with self-blame.