Problems with your metabolism can affect your weight, whether you have trouble gaining or losing it, or find it difficult to maintain a healthy balance. Obesity is the most common manifestation, with excess body fat often leading to additional health issues. Consulting with someone who can assess you completely can be helpful, as they can consider whether there is anything behind the weight issues such as adrenal or thyroid disease.

Obesity, metabolism and diabetes are closely related, with diabetes affecting the metabolism and in turn your weight. We offer diagnostic and therapeutic advice for Type 1 and Type 2 diabetes, and diabetes that is secondary to other conditions such as obesity. This can happen in The Guthrie Wing, at our private clinics or on the ward. In every case we try to have you see the right doctor, recommending other specialists where necessary.

Hypoglycaemia – where your blood sugar levels fall below the normal range – needs prompt investigation, whether it occurs on fasting, after meals or unpredictably. Whether you are certain you have hypoglycaemia or are concerned that it might be responsible for your symptoms, we can assess the majority of patients quickly and safely as an outpatient.

If you have hypoglycaemia in the context of Type 1 diabetes and/or insulin therapy please email us first so we can have you seen by the right person straight away.

There are now many medicines that can be used to control weight as well as treat diabetes. The best among these are the GLP-1 (glucagon-like peptide-1) agonists, which include liraglutides such as Saxenda. These act like the natural hormone glucagon which helps to regulate blood sugar levels and appetite, and which is reduced in Type 2 diabetes. In every case, we consider which medicine will be right for you and design a plan to monitor how it is working. Often we do this in conjunction with an experienced dietician, who will help you to make the most of the medication and/or adjust your diet to help it work as well as possible. This is particularly important with orlistat, which changes how dietary fats and lipids are digested and reduces their absorption.

Obesity can be so harmful to some patients’ health that their weight needs to be reduced quickly. Surgery, when the right operation can be found for the right patient, and appropriately followed up, is a reliable way of doing this. We work with you to find the correct operation and the best surgeon to carry it out, and then work with them to make it as safe and effective as possible. Your post-operative diet and nutrition will often need attention, and we can help you with this. If you are diabetic, your control may improve after the operation and we can down-titrate and/or stop your medicines as and when this is appropriate.

Weight-reducing surgery changes how nutrients move through the body and this in turn can lead to swings in blood sugar after meals. These can be difficult to deal with, and we are here to help you understand what is happening, advise on how you can adjust your diet and/or provide the right medication to reduce this problem.

In some obese or overweight patients, fat is deposited in the liver, a condition known as metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic steatotic or fatty liver disease (NASH/NAFLD). The deposited fat often has metabolic consequences that need to be treated. It can also directly irritate or inflame the liver, causing hepatitis. If this inflammation persists it can lead to scarring, cirrhosis, hepatocellular cancer and liver failure. These outcomes are rare, but they are possible, so some patients require a detailed assessment, sometimes in conjunction with dieticians, liver ultrasound experts and liver physicians, so that we can diagnose and treat them. 

You may already know that you have anorexia nervosa or bulimia nervosa, related problems or atypical manifestations of these. If so, we can consider how it has affected you, looking specifically at your endocrine and skeletal health. If you do have a diagnosis, we may recommend that you meet with specialist colleagues in psychological medicine to help understand your health more fully. For longer-term care, many patients are helped by dieticians with specific experience of anorexia in our team. Anorexia and bulimia nervosa are very different diagnoses, only discussed together because your endocrine and metabolic care may be similar in some respects. Problems with menstruation, fertility, erections and skeletal health are common and often need treatment; your thyroid and adrenal axes may also be affected but often don’t require specific treatment. 

Competitive or high-performing athletes have a recognised syndrome of relative energy deficit and sport (RED-S). Usually this is typified by impaired physiological function, affecting metabolic rate, menstrual function, bone health, immunity, protein synthesis and cardiovascular health. It is more common in female athletes where menstrual changes are easy to notice, but male athletes may notice changes in their libido and erections too. We have experience of assessing your health, sometimes alongside sports physicians, psychologists and dieticians, supporting you in how you choose to protect your health today and in the long term.

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