Who This Programme Is For — And Who I Turn Away
中文摘要在文末
This is probably the least commercially sensible article on this website, because a good part of it explains why I might say no to you.
I'm writing it anyway, for two reasons. The first is that you deserve to know the criteria before you spend money on a consultation. The second is that the reasoning behind the "no" tells you more about how I practise than any description of the programme would.
The criteria
I follow current guideline criteria rather than my own preferences. Broadly:
An Asian BMI in at least the overweight range, together with at least one metabolic comorbidity. Or diabetes.
That's the gate. Asian BMI thresholds sit lower than the international ones for good reason — metabolic risk shows up at lower body weights in Asian populations, which is why using European figures here would miss people who genuinely need help.
"Metabolic comorbidity" means things like raised blood pressure, disordered lipids, fatty liver, insulin resistance, or PCOS — the cluster of problems that travel with excess weight and do the actual long-term damage.
Note what the criteria are built around. Not a dress size. Metabolic disease.
The absolute exclusions
These apply regardless of BMI, regardless of how much you want the programme:
Certain thyroid conditions
A family history of pancreatic cancer
Certain eye conditions
These relate to side effects that are uncommon but serious. Uncommon is not the same as acceptable when the alternative is simply not prescribing.
All of this gets screened before anything starts — history first, then bloods. Nobody begins this programme on the strength of a conversation alone.
The conversation I have most often
Here's the situation that comes up regularly.
Someone comes in. Their BMI is normal, or overweight with no metabolic problems whatsoever. Their bloods are fine. They feel well. And they'd like the medication because they'd be happier ten kilos lighter.
I understand the request completely. There's no judgement in this at all — wanting to look different is one of the most human things there is, and they've usually seen someone online whose results looked effortless.
But I say no. Let me explain properly, because "no" without reasoning is just an obstacle.
Every medication carries risk. Not high risk here — but real, non-zero risk. That's not a formality; that's the actual situation.
So the job of a doctor is to weigh risk against benefit for the specific person in front of them.
When someone carries excess weight and has metabolic disease, that calculation is clear. Untreated metabolic disease damages arteries, liver, kidneys and eyes over years. The risk of leaving it alone substantially exceeds the risk of the programme. So we treat.
When someone has a normal BMI and wants this for appearance, the calculation runs the other way. There's no disease being prevented. The benefit is cosmetic, and the risk — small as it is — is now the largest thing on the scale.
At that point, prescribing isn't just questionable judgement. It's unethical, and it's unlawful.
I'd rather tell you that directly than take your money and hope nothing happens.
"But my friend got it and she's thinner than me"
I know. And I'd be careful about what conclusion you draw from that.
There is a great deal of weight loss medication moving through Malaysia at the moment, and not all of it is being prescribed after anyone weighed risk against benefit. Some of it is being handed over as a transaction. Some is being bought online with no prescription at all.
That your friend obtained it doesn't mean it was appropriate for her. It means she found someone willing to supply it.
The same logic applies to the results you're seeing on social media. You're watching a highly filtered sample — the people it worked well for, posting during the window it was working,
without the muscle loss data, the side effects, the cost, or what happened twelve months later.
What "metabolic reset" actually means, and why I keep insisting on it
This programme is designed as a metabolic reset. Weight is one measurement of whether it's working. It's not the point.
I labour this because the framing changes everything downstream.
If the goal is a number on a scale, then anything that moves that number is a success — including losing muscle, including crash approaches, including regaining it all in six months. The number went down. Mission accomplished.
If the goal is metabolic reset, then a week where the scale doesn't move but your body fat percentage drops and your muscle mass rises is a good week. Improved lipids and blood pressure are the actual result. And regaining everything within a year is a failure regardless of how low the number went at its lowest.
That's why we track body composition rather than weight alone, why the supplement stack protects muscle, why resistance training is built in, and why we repeat bloods three months after the programme ends. Everything follows from what we're actually trying to achieve.
If I turn you down
I'll explain exactly why, in detail, and it won't be a brush-off.
And where something else is appropriate, I'll help with that instead. Sometimes the real finding is a metabolic problem the person didn't know they had, which changes the conversation completely. Sometimes it's a thyroid issue — I've had a patient already on weight medication from elsewhere whose actual diagnosis was hypothyroidism that nobody had looked for, and treating that solved a problem five months of injections hadn't touched.
Sometimes what's needed is a proper conversation about eating patterns, without any medication at all. That conversation is available to you whether or not you qualify for the programme, and honestly it's the part that produces the durable results anyway.
And sometimes the answer is that you're fine, and the thing that needs attention is how you feel about a body that is medically healthy. I'd rather say that than prescribe around it.
Before you come in
Worth having ready: your medical history including family history, any medications and supplements you're on, previous weight loss attempts and what happened with each, and any bloods done in the last year.
If you've already been on weight loss medication from elsewhere, bring the details — what it was, what dose, how long, and what happened. I won't lecture you about it. It's clinical information I need.
Klinik Dr Tan, Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu. WhatsApp 017-234 7328. Appointments preferred, since screening takes proper time.
Book a consultation with Dr. Tan — Book Online or WhatsApp 017-234 7328.
简要说明
我是陈医生，亚庇 Lintas Square 的 Klinik Dr Tan。
这篇文章的一大部分在解释我什么时候会拒绝你。我还是写了，因为你有权在花钱之前知道标准，而拒绝背后的理由，比任何计划介绍都更能说明我怎么行医。
标准（依照现行指引）：
亚洲人 BMI 至少在过重范围，并且有至少一项代谢共病；或
糖尿病
亚洲人的 BMI 门槛比国际标准低是有原因的——亚洲族群在较低体重就会出现代谢风险。「代谢共病」指的是高血压、血脂异常、脂肪肝、胰岛素阻抗、多囊卵巢综合症等。请注意标准是围绕代谢疾病建立的，不是围绕体型。
绝对排除（不论 BMI）：某些甲状腺疾病、胰脏癌家族史、某些眼疾。这些跟罕见但严重的副作用有关。所有人都会先做病史筛查和抽血，没有人只凭一次对话就开始。
我最常遇到的对话： BMI 正常（或过重但完全没有代谢问题），血液报告正常，身体健康，只是希望瘦十公斤会比较开心。
我完全理解这个要求，也没有任何批判的意思。但我会说不，理由是：
任何药物都有风险——这里的风险不高，但是真实存在的。医生的工作是为眼前这个人权衡风险与好处。
过重加上代谢疾病时：不治疗的风险（多年下来伤害血管、肝、肾、眼）明显高于计划的风险 → 我们治疗。
BMI 正常、只为外观时：没有疾病需要预防，好处是美观的，而那个不大的风险变成天平上最重的东西 → 这时候开药不只是判断不当，而是不合伦理也不合法。
「可是我朋友拿得到」：目前马来西亚有大量减重药物在流通，其中不少并没有经过风险与好处的评估，有些是当作交易递出去的，有些根本是网购来的。你朋友拿得到，不代表那对她合适，只代表她找到了愿意供应的人。社交媒体上看到的也是经过筛选的样本——效果好的人、在效果最好的那段时间发文，没有肌肉流失的数据、副作用、费用，也没有一年后的情况。
「代谢重置」的意思：如果目标只是磅秤上的数字，那么任何让数字下降的方法都算成功——包括流失肌肉、包括极端做法、包括半年后全部胖回来。如果目标是代谢重置，那么体重不动但体脂下降、肌肉上升的那一周，是好的一周；血脂和血压改善才是真正的成果；而一年内全部复胖就是失败，不管最低点曾经多低。
如果我拒绝你：我会详细说明原因，而且会协助处理真正需要处理的问题。有时候会发现患者不知道自己有的代谢问题；有时候是甲状腺问题（我有位病人在别处打了五个月减重针，真正的诊断其实是甲状腺功能低下）；有时候需要的只是好好谈一谈饮食习惯，完全不需要药物——这个对话不论你是否符合资格都可以进行；有时候答案是你其实很健康，需要处理的是你对一个医学上健康的身体的感受。
来之前请准备：病史与家族史、正在服用的药物和补充剂、过去减重的经历与结果、一年内的血液报告。如果你曾在别处使用减重药物，请把细节带来——用什么、剂量、多久、发生了什么。我不会说教，这些是我需要的临床资讯。
Klinik Dr Tan，Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu。WhatsApp：017-234 7328。建议预约。
预约陈医生 — 在线预约 或通过 WhatsApp 联系 017-234 7328
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