Week 4
Dealing with judgment and stigma
You'll learn how to handle judgment, misunderstanding and comments from others, so you can stay true to your own choices.
Stigma & social pressure
Your GP and weight loss medication
Can you get weight loss medication from your GP?
More and more people walk into the surgery with that question. The answer is rarely a plain yes or no. It depends on the guideline GPs follow, on how much time a consultation allows and on reimbursement. Here is what is and is not possible in the Netherlands.
The short answer
A GP is allowed to prescribe weight loss medication, but rarely does. The guideline puts lifestyle treatment first, most medicines are not reimbursed, and the guidance that belongs with this kind of treatment does not fit into a ten-minute consultation. People who still want to consider medication usually get a referral, or look for a clinic where treatment and guidance come together.
What does a GP prescribe, and what not?
For overweight and obesity, Dutch GPs work with the NHG Obesity Standard and with the multidisciplinary guideline on overweight and obesity in adults. Both put lifestyle treatment first. Only when that produces too little result and there is a clear medical indication does medication come into view, and then alongside lifestyle treatment rather than instead of it.
That is why in practice you are more likely to get a referral than a prescription. Many GPs refer to a combined lifestyle intervention or a dietitian. With a strongly raised weight and additional conditions, the referral more often goes to an internist or a hospital obesity clinic.
What a GP usually does do
- Map out your weight, blood pressure and blood values
- Refer you to a combined lifestyle intervention (GLI)
- Refer you to a dietitian, physiotherapist or psychologist
- Treat weight-related conditions such as high blood pressure or type 2 diabetes
- Refer you to an internist or obesity clinic when weight is high and complications exist
What rarely happens
- Prescribing a GLP-1 medicine with weight loss as the only goal
- Prescribing Ozempic to lose weight, since in the Netherlands that medicine is authorised for type 2 diabetes
- Building a dose up step by step over months and adjusting it along the way
- Following up every week on side effects, food and exercise
A GP is legally allowed to prescribe these medicines. Whether it actually happens depends on the guideline, on reimbursement and on the guidance a practice is able to offer.
Why your GP often says no
A refusal easily feels like unwillingness, while something else is usually going on. Four things weigh heavily.
A prescription on its own is not a treatment
GLP-1 medication only comes into its own with guidance around it. The dose is built up in steps, side effects call for changes in what you eat, and without attention to protein and exercise you lose muscle along with fat. A doctor who cannot offer that would rather not prescribe.
The time a consultation allows
A consultation lasts about ten minutes. Weight treatment calls for check-ups, adjustments along the way and guidance over a year or longer. That does not fit into the schedule of a GP practice, however much a GP might want it to.
Reimbursement
Most medicines for weight treatment are not in the basic health insurance package, or only for a small group and under strict conditions. Your GP knows the bill then lands with you, and would rather not start a treatment you have to stop after a few months for financial reasons.
Shortages and responsibility
There have been periods of shortage for semaglutide and tirzepatide. Professional bodies have asked doctors to keep supply available for people with type 2 diabetes. That makes GPs cautious about prescribing these medicines outside their authorised use.
Do ask follow-up questions if you hear no. Your GP can explain which criteria apply in your situation, and a referral to a lifestyle programme or to an internist is often still possible.
What is needed besides a prescription
If medication is the right step for you, what surrounds it largely determines how things go. These are the parts that make the most difference in practice.
A dose that suits you
What feels comfortable for one person makes another nauseous. A doctor looks at your starting weight, your symptoms and how you responded to the previous step before the dose goes up.
Building up calmly
A titration schedule is not a law. Staying on the same dose for longer is sometimes wiser than moving on as planned, certainly while your stomach is still adjusting.
Lifestyle guidance that softens side effects
Nausea, constipation and fatigue are tied to what and how you eat. Smaller portions, enough fluid and fibre and less fat on your plate often help more than a lower dose.
Attention to muscle mass
Rapid weight loss costs muscle as well as fat. Enough protein and strength training keep your muscles up, which matters for your metabolism and for how fit you feel.
Continuous monitoring
Weight, blood pressure, symptoms and blood values belong under regular review. That is how you notice in time when something needs adjusting.
A plan for afterwards
Stopping without a plan leaves many people with weight that returns. The habits you build in the meantime determine how steady your weight stays afterwards.
What's included in the programme
A programme that goes further than you think
Not just about food and exercise. Also about stigma, emotional eating, sleep, self-confidence and what changes when hunger comes back. Every week you build on what you've learned, at your own pace.
- weeks
- 52
- modules
- 200+
- slides
- 2000+
Themes we cover
- GLP-1 & side effects
- Nutrition & muscle preservation
- Emotional eating & mindset
- Stigma & social pressure
- Relapse & maintenance
- Sleep, stress & recovery
- Movement & strength
- Identity & behaviour
Examples from the program
Modules that resonate most with our members
Week 8
Stomach hunger, head hunger or emotion?
Recognise the difference between physical hunger, cravings and eating driven by emotions. The foundation for more mindful choices.
Emotional eating & mindset
Week 1
GLP-1 and side effects
Which side effects are common, what's normal and what you can do yourself to keep symptoms manageable.
GLP-1 & side effects
Week 6
Stay true to yourself on holiday
How to eat flexibly and mindfully during holidays, parties and days out, without the struggle.
Stigma & social pressure
Week 10
Become who you want to be
The difference between outcome goals and identity, and how small actions strengthen your new sense of "I am" every day.
Identity & behaviour
Week 3
Preserving muscle while losing weight
With strength training and protein you stay strong and protect your metabolism, even while using GLP-1.
Nutrition & muscle preservation
Week 14
Setbacks are part of it
A setback isn't a failure, it's a normal part of change. You'll learn to recognise it, recover and keep going.
Relapse & maintenance
Week 7
Sleep supports your choices
Lack of sleep affects your hunger, motivation and mood. You'll learn how sleep works and why it matters so much.
Sleep, stress & recovery
Week 31
Less motivation, more system
How to build routines that keep working, especially on the days when you have less energy or drive.
Relapse & maintenance
Is weight loss medication reimbursed?
A consultation with your GP is insured care and does not come out of your deductible. The combined lifestyle intervention is also in the basic package and falls outside the deductible. Your GP can refer you for it.
The medication itself is a different matter. Reimbursement from the basic package applies only in exceptional cases, for a limited group with a strongly raised weight and a weight-related condition, and usually only after a lifestyle treatment has been completed. In most cases you pay for the medicine yourself at the pharmacy.
The conditions and the list of reimbursed medicines change regularly. To find out where you stand, check medicijnkosten.nl from the National Health Care Institute and ask your health insurer about your policy. Supplementary insurance does not usually cover this medication.
Which medicines exist?
Below are the medicines that raise the most questions. Each information page explains how the medicine works, which side effects occur and when it is not suitable. Whether medication fits your situation, and if so which one, is always a doctor's assessment.
- Ozempic (semaglutide)
Authorised in the Netherlands for the treatment of type 2 diabetes. Use with weight loss as the goal falls outside that authorisation, which is why it happens rarely.
- Wegovy (semaglutide)
The same active substance as Ozempic, but authorised for weight management in obesity, alongside lifestyle treatment.
- Mounjaro (tirzepatide)
Acts on two gut hormones instead of one and is authorised for both weight management and type 2 diabetes.
- GLP-1 in tablet form
Medicines you swallow rather than inject are becoming available. This page sets out what exists today and what is still under study.
- The Wegovy pill
The tablet form of semaglutide for weight management, with an explanation of where things stand in Europe.
This is general information, not advice about a specific medicine. Always read the package leaflet and talk it through with a doctor.
What if losing weight does not work?
Years go by without result, and at the surgery you hear that you should eat less and move more. On paper that advice is correct. It simply passes over what happens in your body once you have lost weight. Your metabolism drops, your hunger rises and your sense of fullness weakens. That is biology, not a lack of willpower.
If you recognise that, our page on getting stuck explains what is happening and what you can do about it.
Frequently asked questions about GPs and weight loss medication
The questions that come up most often at the surgery and in our chat.
A GP is allowed to prescribe Ozempic, but does so almost only for type 2 diabetes. That is what the medicine is authorised for in the Netherlands. Prescribing it to lose weight falls outside that authorisation, and during the supply problems doctors were asked to keep it available for people with diabetes. Other medicines are authorised for weight management.
Usually only once lifestyle treatment has produced too little result and there is a clear medical indication, such as a strongly raised weight combined with a weight-related condition. Even then, many GPs prefer to refer you to an internist or a hospital obesity clinic, because the guidance involved does not fit into the surgery.
Yes. Any doctor with a BIG registration may prescribe prescription-only medicines, including those authorised for weight management. In practice it happens rarely, because the guideline puts lifestyle treatment first and the treatment calls for long-term monitoring.
The consultation itself is insured care and does not come out of your deductible. The medicine is in most cases not reimbursed, so you pay for it yourself at the pharmacy. What you pay depends on the medicine and the dose. Medicijnkosten.nl, run by the National Health Care Institute, lists current pharmacy prices and reimbursement conditions.
Yes. There are online clinics where a BIG-registered doctor assesses whether treatment suits you and where guidance is part of the programme. Your GP does not have to drop out of the picture. We recommend telling your GP that you are in treatment, so your record is accurate and other medicines you take are taken into account.
Wondering whether treatment suits you?
A short questionnaire shows whether you meet the medical criteria. A BIG-registered doctor reviews your answers. If you are not eligible, you hear so and you pay nothing.
Blog about medical weight loss
Read our articles about medical weight loss, lifestyle, nutrition, medication, obesity, exercise and healthy living.
Wegovy pil goedgekeurd in Europa: de eerste GLP-1 pil voor gewichtsbeheersing
De Europese Commissie heeft de Wegovy pil goedgekeurd als eerste GLP-1 pil voor gewichtsbeheersing in de EU. Wat is er precies goedgekeurd en wanneer komt de pil naar Nederland?
Ontsteking en obesitas: waar start de vicieuze cirkel?
Een diepgaande blik op de complexe relatie tussen obesitas en chronische ontsteking, hoe ze elkaar versterken, en hoe leefstijl en nieuwe behandelingen zoals GLP-1 medicatie deze cirkel kunnen doorbreken.
GLP-1 ervaringen: wat kun je verwachten bij afvallen?
Wat zijn de ervaringen met GLP-1 bij afvallen? Lees wat je realistisch kunt verwachten: hoe het voelt, veelvoorkomende bijwerkingen, het verloop per fase en waarom ervaringen per persoon verschillen.