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Apollo Based Health, LLC
nformed Consent Related to the Treatment of Weight Loss Conditions Through Telehealth
Telehealth Weight Loss Consent
Informed Consent for the Treatment of Weight Loss Conditions via Telehealth
Purpose: In accordance with the Florida Board of Medicine Rule on Standards for the Prescription of Drugs for the Treatment of Obesity (64B8-9.012(5)), healthcare professionals must obtain written informed consent from patients before prescribing, dispensing, or administering weight loss medications. This document outlines the potential benefits and risks associated with weight loss treatments.
Purpose of This Consent Form
This form is designed to help you understand the potential benefits and risks of starting a weight loss program. It is essential that you inform your healthcare team of any symptoms, concerns, or questions—even if they seem minor—to ensure the safest and most effective treatment possible.
Potential Benefits of Medically Supervised Weight Loss
Losing approximately 10% of your starting body weight (for example, 20 pounds from an initial weight of 200 pounds) can:
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Lower blood pressure
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Reduce cholesterol levels
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Improve blood sugar control
Your primary care provider may need to adjust the dosage of your medications as your health improves. Additional benefits may include enhanced mental and emotional well-being, improved social interactions, and increased levels of physical activity.
Potential Risks and Side Effects
General Medical Risks
All medical treatments carry the possibility of unexpected adverse effects, including rare but serious complications such as death.
Side Effects of Caloric Restriction
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Dizziness, fatigue, bad breath
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Constipation or diarrhea
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Cold sensitivity, slowed metabolism
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Muscle cramps, dry skin, brittle hair or hair loss
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Irregular menstruation
Most of these effects are temporary and tend to resolve once caloric intake is normalized.
Electrolyte Imbalance and Potassium Loss
Low potassium can cause serious heart problems. Overeating after a low-calorie diet can lead to bloating, fluid retention, and gallbladder issues.
Gallstones
People who are overweight have a higher risk of developing gallstones, especially with rapid weight loss. Symptoms may include nausea, fever, and abdominal pain. Women, smokers, and individuals who use estrogen are at greater risk.
Pancreatitis
Often associated with gallstones, binge eating, alcohol use, or medications. Symptoms include abdominal pain, fever, and nausea. It may require hospitalization or surgery.
Binge Eating Disorders
Some individuals may experience an increase in binge eating episodes at the start of a restricted diet, although studies also show long-term improvements with structured plans.
Riesgos Durante el Embarazo
If you become pregnant, you must stop all medications immediately and notify your provider. A restrictive diet may harm fetal development. Avoid becoming pregnant during treatment.
Risk of Weight Regain
Most patients regain some or all of the weight lost over time. Long-term success depends on:
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Regular exercise
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A low-fat, low-calorie diet
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Strategies to prevent relapse
Only a small percentage maintain full weight loss after several years.
Risk of Sudden Death
Patients with severe obesity—especially those with high blood pressure, heart disease, or diabetes—face a higher statistical risk of sudden death compared to healthier individuals.