How online weight loss consults work, from anywhere in India

Key takeaways

• The first step is a Rs 499 eligibility consult by video. It decides whether treatment suits you, and it can end in a "no".
• Online consults in India follow the Telemedicine Practice Guidelines, 2020, which set rules on identity, consent, prescriptions and when an in-person visit is needed.
• If you join, you get monthly reviews with me, WhatsApp support, and a written taper and maintenance plan from month one.
• Any GLP-1 medicine, such as semaglutide or tirzepatide, is a prescription decision I make after assessment.
• The plan rests on what I call the Triad: dose, protein and strength training, with the right supplements.

Why is weight care online when hair care is in clinic?

Hair treatment needs an examination of the scalp and in-clinic sessions, so it happens at our four centres. Weight care is different. Basically, it depends on a careful history, an honest conversation, regular reviews and steady adjustments. All of that can be done well over video.

That is why I run The Endgame Weight Programme online across India. Someone in Pune, Nagpur, Delhi or Guwahati can be reviewed by me as easily as someone who lives near our Thane centre.

What rules govern online consultations in India?

In India, video consultations are governed by the Telemedicine Practice Guidelines, 2020, issued by the Ministry of Health and Family Welfare. In plain terms, they say:

• Only a registered medical practitioner may give a teleconsultation, and the same professional and ethical standards apply as in person.
• No anonymous consults. The doctor and the patient each confirm who they are. The doctor states their name and qualifications.
• Consent. When you request the consult yourself, your consent is implied.
• Registration numbers must be shown on prescriptions, websites and electronic messages such as WhatsApp.
• Prescriptions need enough information. A doctor should prescribe only once they have adequate details about your age, health and medical conditions.
• An in-person visit when needed. If a physical examination is essential, the doctor should arrange it rather than continue by video. You can also always choose to be seen in person.

I think these rules are sensible. They mean an online consult should be just as careful as one across my desk.

What happens in the Rs 499 eligibility consult?

The eligibility consult is exactly what the name says. Its job is to decide whether treatment is suitable for you, and if so, what kind.

Before the call, it helps to have ready:

• Your current weight and height, and if possible, your waist measurement.
• A list of every medicine and supplement you take.
• Any recent blood reports.
• Your medical history, including diabetes, thyroid problems, gall bladder or pancreas problems, and any family history of thyroid cancer.
• For women, whether you are pregnant, breastfeeding or planning a pregnancy.

During the call, I go through your history, your past attempts at losing weight, your eating pattern and your daily routine. People often say, "Doctor, just give me the injection." I'm happy to, if it suits you. But first I want to understand why weight has been hard for you, not just how much you want to lose.

At the end, you hear one of three things: treatment looks suitable, more information or tests are needed first, or treatment is not right for you. A "no" is a legitimate result. For example, MedlinePlus advises that people with a history of certain thyroid tumours, or with Multiple Endocrine Neoplasia type 2, will usually be told not to use semaglutide, and that it should be stopped two months before a planned pregnancy.

What does the programme include if I go ahead?

The taper and maintenance plan is the part people often do not expect. Normally people ask "what happens when I stop?" months into treatment. I write it down at the start, which is why the programme is named after the chess endgame. The story behind that is in why I plan treatment like a chess endgame.

How are GLP-1 medicines used in the programme?

GLP-1 medicines, such as semaglutide, and related medicines such as tirzepatide, are prescription medicines. Whether you take one, which one, and at what dose, is something I decide after assessment.

The dose is the skill. General protocols suit most people, but adjusting for the individual is where the care lies. That is one reason the monthly review matters: it is where I check the dose against how you are actually doing.

These medicines are commonly given as a once-weekly injection under the skin, in the stomach area, thigh or upper arm, rotating the site each time. The needle is a fine, insulin-type needle. Common side effects listed by MedlinePlus include nausea, vomiting, diarrhoea, constipation, stomach pain and heartburn. Tell me about any side effect at your review, or on WhatsApp in between.

I have taken GLP-1 treatment myself, even though I do not like injections. I have written about that in "I don't like injections. I still took this one."

What is the Triad, and why does it matter online?

Medicine is one part of the plan. It's a triad, actually:

1. Dose. Right for you, adjusted at each review.
2. Protein. Enough at every meal, from foods you will actually eat: dal, paneer, curd, eggs, chana, soya, sprouts, fish or chicken if you eat them. Start your meals with protein.
3. Strength training. To help protect muscle while weight comes down.

I add the right supplements where needed. An online programme makes the Triad easier to follow in daily life, because the plan is built around your own kitchen, your work hours and your city, not a clinic schedule.

How we approach this at Dr Tvacha

If you are considering weight treatment, start with the Rs 499 eligibility consult on the weight loss page. I will tell you whether treatment suits you, what it would cost in writing, and what the end plan looks like. If you would like to understand the consultation process in general, read what happens at your first consultation. The decision stays with you.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.