New Weight Loss (Oral Treatment)

About You

To help us understand that one or more of our treatment options are right for you, please answer the following questions. If you get stuck or need any help, you can contact us.

Are you aged between 18 and 74 years old?

Yes

Please enter your HEIGHT and WEIGHT to check your Body Mass Index (BMI).

Treament can only be provided if your BMI is above 30 or if you have certain risk factors then a BMI above 28.

Please select either Metric or Imperial measurements :

Metric (Meters and Kilograms)
Imperial (Feet and Pounds)

Height

feet inches

Weight

stone lbs

Check BMI

BMI Calculation :

Do you have diabetes, heart disease, high blood pressure or high cholesterol?

The presence of any of the above conditions means you maybe suitable for treatment with a lower minimum BMI of 28.

Yes

About the Condition and Treatment

To help us understand that one or more of our treatment options are right for you, please answer the following questions. If you get stuck or need any help, you can contact us.

Have you ever had an eating disorder e.g anorexia nervosa or bulimia?

Yes

Are you pregnant, breastfeeding or intending to become pregnant or start breastfeeding whilst taking this medication?

Yes

Have you ever had an allergic reaction (hypersensistivity) to orlistat?

Yes

Are you using an oral contraceptive?

Please note: Orlistat can reduce the absorption of oral contraceptives and therefore reduce their effectiveness and increase the risk of their failure. You should use additional forms of contraceptive whilst taking orlistat.

Yes

Are you taking any medication for high cholesterol, diabetes or high blood pressure?

Please note: you must speak to your GP to discuss the dosage of any of the above medication when your weight changes.

Yes

Have you been diagnosed with any of the following?

Problems absorbing food (chronic malabsorption syndrome) diagnosed by a doctor
Liver problems
Kidney problems
Thyroid problems
Surgery to remove your gall bladder (cholecystectomy)
Cholestasis (condition where the flow of bile from the liver is blocked)
Any serious medical condition which may require immediate hospitalisation

Yes

Do you take any of the following medicines:

Medicines that thin the blood (such as warfarin)
Acarbose (to treat diabetes)
Ciclosporin (to prevent organ rejection)
Lithium (for mental health problems)
Amiodarone (for heart problems)
Medicines to treat epilepsy or seizures
Medicines to treat HIV
Medicines to treat psychosis or other mental health issues

Yes

Are you currently taking any other medication

including over the counter, prescription or recreational drugs

Yes

About the Condition and Treatment

To help us understand that one or more of our treatment options are right for you, please answer the following questions. If you get stuck or need any help, you can contact us.

Do you understand that treatment cannot be continued if you gain weight 3 months after starting the treatment?

A target of 5% weight loss should be achieved after 3 months of treament.

Yes

Do you understand that the treatment must be stopped once your BMI drops below 28?

Yes

Do you understand that this treatment is only effective when used as part of a calorie-controlled diet? You will also get the best results by increasing your physical activity.

Yes

Do you understand that you should take a multivitamin (that contains vitamins D, E, K and beta carotene)? It should be taken once a day at least 2 hours before or after taking Orlistat.

Yes

Do you consent to us sharing consultation information with your GP? (optional)

Yes

Do you agree to the following?

You will read the patient information leaflet supplied with your medication.
You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
The treatment is solely for your own use
You have answered all the above questions accurately and truthfully.
You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.
I have read and agree to the Terms and Conditions

Yes

All Conditions

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