Accepted answer
Retrospective documentation almost always counts, a commercial app almost never counts on its own, and "documented outcome" explicitly includes failure — that clause exists to establish that conservative management was tried, not to require that it worked.
What reviewers are looking for. The criterion is scored on four elements. Get all four into the chart and it passes; miss one and it pends.
- A defined window. Two dated encounters at least six months apart, with the intervention documented as ongoing across the interval. Reviewers look for the endpoints, not a diary of every week.
- Dietary component. Named and specific: a calorie or macronutrient target, a structured plan, or a dietitian consultation. "Advised to eat healthily" fails. "Reduced-calorie plan, approximately 1,500 kcal/day, reviewed 14 March" passes.
- Activity component. Similarly specific: a frequency and duration. The 150 minutes/week figure from general physical-activity guidance is the number most policies were written around, so documenting against it is the path of least resistance.
- Outcome. Dated weights at both ends of the window. If weight was flat or rose, that is the outcome and it is the outcome that supports the request.
Your existing records are worth more than you think. Ask your GP to write a summary note that pulls forward what is already documented: the dated weights they do have, the advice given at each visit, and an explicit statement that dietary and activity modification were undertaken continuously across a named date range without clinically meaningful weight reduction. A retrospective summary attesting to documented history is a normal clinical document and reviewers accept it routinely. What they will not accept is a bare attestation with no underlying dated data, so the four weights you have are load-bearing — make sure the note cites them by date.
The app and the gym. Not sufficient alone, but useful as an appendix. Export the food log summary and the gym attendance record and attach them as evidence supporting the clinician's statement. The clinician's note is the primary document; your exports corroborate it.
Why the criterion exists at all. It is a mirror of trial design. The pivotal obesity programmes all delivered the drug on top of a lifestyle intervention rather than instead of one — STEP 1 randomised on a background of reduced-calorie diet and increased activity [1], and STEP 3 layered semaglutide onto intensive behavioural therapy with a low-calorie diet lead-in [2]. SURMOUNT-3 went further and enrolled only people who had already completed a 12-week intensive lifestyle lead-in, then randomised the ones who had lost at least 5% [3]. Payers point at that design and say the labelled use is adjunctive, so document the adjunct. It is a defensible position even when the six-month number itself is arbitrary.
One thing to check before you build anything. Read whether your criteria say "prior to" or "in conjunction with". A meaningful minority of policies accept concurrent lifestyle intervention, which means the six months does not have to precede the request at all. People burn half a year satisfying a requirement their own plan did not impose.
5The prior-versus-concurrent distinction saved me six months. My policy said in conjunction with and nobody at the office had read it. – tenth_of_a_unit 8 months ago 6Second the retrospective summary note. Mine cited four weights over 19 months and was approved first pass. – Dr_Hanne_Solberg 2 days ago add a comment