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Most people arrive having already tried everything
They have done the diets. They have joined the gym in January. They have lost twelve kilos twice and found them again both times. Somewhere along the way they have been told, usually kindly, that they simply need to want it more.
That is not what the biology says. Weight is defended. When you lose it, appetite hormones rise, resting energy expenditure falls, and the body works, competently and relentlessly, to put it back. That is why the regain is so predictable, and it is why treating obesity has to look like treating blood pressure: a long term plan, reviewed regularly, adjusted when it stops working.
What has changed in the last three years is that there is now genuinely effective medical treatment to put alongside the diet and the exercise, rather than instead of them. That has also brought a great deal of noise, some of it dangerous. Most of this section exists to cut through it.