Outcome of "Ethical Dilemma"
First of all, many thanks to all who commented. I was a little surprised by the unanimity of the response, though perhaps I shouldn't have been. Now, of course, either because of Jewish guilt (have to find something to beat up on myself about) or in the name of Continuing Education/Quality Improvement (same thing) I'm wondering why it was so hard for me to come up with that answer. Sometimes things aren't quite so clear on the spur of the moment, with a walk-in standing in front of me and other patients waiting. I'm not sorry about my answer (make an appointment to discuss it) and as it turns out, offering to teach her to self-inject was probably the only thing that made her agree to come back.
I weighed and measured her. Her BMI is 21.5. She doesn't feel she's fat; no depression; no eating disorder; marriage/life is fine; she's perfectly happy. She just wants to lose some of her "storage fat"/"cellulite" (she used both terms.) She gets palpitations when she tries to run, which she is convinced is because of "excess weight." She declined my offer of a cardiac workup, saying she'd already had one and everything was fine. When I tried to explain the status of the treatment as unproven and useless, she wasn't the least bit fazed: she'd done her research (a book written by a DOCTOR; 30 years ago, but still...) and read all about it. She believed it would work, and one way or another she was going to do it. Thanks for your time. No hard feelings.
Verdict: Altie. Allergic to reason and intolerant of science. Oh well.
I did what I could, and that's all I could do.
Once again, thanks to all for opinions.
[*waving @ bean*]