He was in the care of Dr Varipatis from 1997 to 2011. The court found in February that Dr Varipatis had been negligent in not sending Mr Almario, 68, to an obesity clinic or arranging for a surgeon to assess his suitability for gastric-band surgery. Mr Almario weighed 140 kilograms and was 154 centimetres tall. Justice Stephen Campbell found Mr Almario had terminal liver cancer as a result of liver disease linked to his obesity and awarded him $364,000.

A three-judge panel of the Court of Appeal has dismissed the judgment. It found the evidence of GPs did not suggest a doctor was obliged to do more than ''take reasonable care'' of a patient by advising weight loss - which Dr Varipatis had done. ''The duty of care stopped short of requiring an exercise in futility.''

Medical insurer Avant, which led the appeal, said the original decision had caused significant concern in the industry because it might have forced GPs to ''practise defensively''.

Dr Varipatis told GP industry journal Medical Observer he felt exonerated but was sorry for Mr Almario's state of health: "I realise that he and his family will be very disappointed and upset right now.''

Mr Almario, of North Parramatta, has been given less than a year to live and is being cared for at home by his wife. His solicitor did not return calls.