On a cold Thursday evening in January, I found myself at The Private Clinic on Harley Street for a rather different conversation on weight loss.

what might be the most honest conversation about weight loss I’ve heard in years. Not the usual “eat less, move more” rhetoric. Not another miracle drug launch. This was about what happens after—the bit nobody talks about until you’re already dealing with it.

The panel, moderated by health journalist Emma Guns, featured consultant plastic surgeon Michael Mouzakis, aesthetic doctor Victoria Manning, nutritionist Layla Gordon, and consultant surgeon Professor Sandeep Virdee. The topic? What really happens after rapid weight loss, particularly with GLP-1 medications like Ozempic and Wegovy.

And the answer, it turns out, well.. it’s complicated.

The Prep Nobody Mentions

Gordon opened with something I’d never considered: you’re supposed to prepare for weight loss. Not just mentally brace yourself on a Sunday with a fridge full of salad, but actually prepare—bloodwork, microbiome checks, nutritional assessments.

“Unfortunately, I think when a lot of people come to see us, they’re at breaking point,” she said. “You want it fixed quickly, so you go straight in with something. But GLP-1 medication should be something that is prepped for.”

Did anyone in the room know this? No

If you’re already deficient in omega-3, magnesium, B vitamins, zinc, or vitamin C, rapid weight loss makes it worse. And those deficiencies affect how your skin recovers. “At the end of the journey, you don’t just want to be a lower weight,” Gordon said. “You want to be looking sculpted and healthy.”

Up to 40% of weight loss on GLP-1s is muscle mass. Not fat, muscle. And research shows you can still eat junk food and lose weight on these drugs. Which sounds convenient until you realise you’re losing the wrong tissue while your nutrition tanks.

“I’ve seen dramatic weight loss, and I’ve seen ageing around the face,” Layla said. “The face is looking 10 years older.”

So You’ve Reached Your Goal Weight. Now What?

“People are losing the weight, but what now? We don’t want them piling the weight back on, which we’re seeing is happening, or going back to old ways with their diet.”

When you start the medication, cravings for sugar and alcohol disappear. Great. But when you come off it? They return. And you’re back to square one, except now you’ve lost muscle mass and aged your face.

“We all have to keep an eye on our diet,” Layla pointed out. “I do. You do. We all do at any stage of life, but particularly after being on the drug.”

Dr Manning herself has been on Ozempic herself three years ago, lost three stone. Then discovered she was pre-diabetic and on the 91st percentile for insulin resistance and obesity risk. The scale weight had dropped, but her metabolic health hadn’t improved.

“We’re trying to give patients bandwidth,a little bit of time while they haven’t got that food noise—to actually make lifestyle changes,” she said.

The “Melting Candle Effect”

Dr. Mouzakis introduced a term I won’t forget: the melting candle effect. What happens when you lose weight too fast without supporting your body.

“We see patients that are so happy they’ve lost the weight. They are winners,” he said. “But they wake up one day and say, well, now what do I do with this?” They see the sagging breast tissue, the deflated chest—men and women both dealing with the same issue.

Rapid weight loss doesn’t just leave you with loose skin. Your face ages. Your body loses structure. And GLP-1s won’t change your fundamental shape, if you had big hips before, you’ll still have big hips, just smaller. “This drug cannot change your identity,” Dr. Mouzakis said.

Less is more, he emphasized. Fat is “liquid gold” in plastic surgery—used for reconstruction, contouring, everything. Why waste it by losing it too fast?

Dr. Manning explained that for every 10 kilograms you lose, you’re losing significant facial volume. Your skin is like an elastic band—ping it too far, and it snaps. Slow weight loss gives skin time to adapt.

“If you lose it fast and you’re not doing anything about it, skin laxity is inevitable,” she said.

Body contouring isn’t just removing excess skin—it’s restructuring underlying tissues, fascia, deep layers that give your body shape. “We’re not just contouring skin, we’re contouring the underlying deep tissues to make you more sculpted, more defined to your own frame,” Virdee said.

But these are big operations. Meant to be done once. “What we don’t want is to go back there again,” he said. “You don’t want to do these again.”

Surgery isn’t a magic eraser for poor lifestyle. If you’re not addressing nutrition, exercise, stress, sleep—you’re setting yourself up to repeat the cycle.

When GLP-1s Don’t Work

Not everyone is a candidate for GLP-1s. Dr. Mouzakis discussed lipedema, a disease only recognised by the NHS two years ago that causes abnormal fat deposition in specific areas—thighs, calves, upper arms. These patients don’t respond to the medication.

“These patients feel like they have two different bodies,” he explained. “The upper body is very slim and toned, and the lower body is completely different.”

For years, GPs would tell these patients they simply ate too much. They didn’t. It’s a disease affecting two in ten Mediterranean women, and it requires a completely different treatment approach, vaser liposuction and surgical intervention, not medication.

If you’re trying GLP-1s and certain areas won’t budge despite overall weight loss, it might not be resistance. It might be a medical condition that needs proper diagnosis.

Beyond The Scale

GLP-1s aren’t magic. They’re tools. And like any tool, they work best when used correctly, with support, and with realistic expectations.

The beauty industry loves a quick fix. We all do. But rapid weight loss without preparation, nutritional support, and proper guidance doesn’t just leave you with loose skin, it can age you, compromise your metabolic health, and leave you worse off than when you started.

If longevity is about extending your health span (see the other panel I attended this month), then GLP-1s need to be part of a much bigger conversation about metabolic health, muscle preservation, and sustainable lifestyle changes. Not just a shortcut to a lower number on the scale.

GLP-1 work. No doubt about that. Getting to goal weight is the easy part. Maintaining it without losing muscle, ageing your face, or tanking your metabolic health? That’s where most people realize they skipped a few steps.

By Raluca Tudose

For more information about The Private Clinic’s weight loss protocols, visit theprivateclinic.co.uk