To worry about friend's weight loss?

I've been referred for weight loss jabs via the NHS and yes they do offer psychological support with the programme

The work that poster is referring I assume is overhauling diet to healthier options, eating less generally long term and addressing emotional eating patterns. Rather than simply relying on undereating and a jab to take away the hunger pangs.

It forces a lifestyle change. Certainly eating habits anyway. It's how that looks when people come off it. People who I know who have came off it have kept up the good routines and are maintaining or still losing. It helps mindset massively.

You HAVE to "do the work". The jag doesn't magic fat away, eating in a calory deficit does, just like every other diet. The difference is, and the reason that it's successful, is because it's easier to eat in a deficit because you aren't permanently starving.

I’d have been far more worried about her when her bmi was 40.

@SharpOpalNewt well, given that you didn't post any of that content in your first post, it was not clear what the relevance was. But thank you for clarifying.

So, she is likely not be having any digestive discomfort, given the stats.

I don't look ashen, or like a deflated balloon. Or like I'm ill. I look massively more healthy than when I was morbidly obese. The OP has not said that her friend looks like that either.

My gut reaction is she has lost far too much in the timescale and is now addicted to the weight loss.

I started the injections at the same time and have lost far less, have gone from bmi of 39.6 to 32.4 in the same timescale. Some people do lose it quicker but even a 5 stone loss for me in that timescale would have only dropped my bmi to 28 starting from same bmi as your friend.

Your friend has taken drastic measures if she has really dropped from 40 to 20 in same time, if she was my friend I would be concerned too.

However she may stop soon and just be trying to adjust to her new normal etc and how to go on from here, maybe just see how she is and check in with her regularly over the coming months

It is directly relevant as I was wondering what kind of digestive discomfort her friend is having to put up with to lose weight and how it would affect her health overall to continue to take this at a fairly low weight.

People I have seen who have lost a lot of weight too quickly, or too much, on injections tend to look rather ashen in pallor and like they have had the air let out of them rather than toned and fit. Rather like if you had an illness causing weight loss.

As 20 is a normal BMI I wouldn’t worry about it tbh

Some people on some occasions get mild to moderate gastric side effects. The figures quoted in the patient info is 1 in 10. So most don't. If you do, they are often things like a bit of nausea, or they can be easily sorted with OTC treatments or slight changes to diet. It's no different to every other medication with regard to side effects.

If you're overweight you would not be prescribed weight loss injections, unless you deliberately tried to lie to fraudulently obtain prescription only medication.

None of this is relevant to the OP's questions about her friend.

Don't people get horrendous side effects from these jabs?

I am overweight but fit, and used to feeling quite healthy so I don't think I would cope well with the digestive disturbance.

The medication makes you look and act like you've ED. In some people. It stops you wanting to eat and weight loss is addictive.
I do worry for people on these drugs sometimes. If they were suffering from anorexia it might never get picked up. I guess they just think well, the person can just stop taking the jabs. But they get addicted to that feeling.

I hate to suggest ,
she may not be truthful with her pharmacy , I thought below BMI of 24/25 , they won't prescribe.
Which sadly makes the situation worse ,and it has become an obsessive goal , to be thinner, then thinner still.
These injections are to help you think less of the obsession of food ,amongst other things.
But sadly it can be replaced by the obsession of the jabs themselves.

Thank you, I don't tell many people in 'real life' because of the reactions. I've always struggled with my weight but mostly managed to keep a BMI of around 26/27 because I'm quite active despite the over eating. I've usually been able to diet/exercise it off but then I hit my mid 30s, stressed myself out to anxiety/burnout through my healthcare job and weight rocketed. I just couldn't get it under control with conventional methods I think because my cortisol was so high and I was in fight or flight mode constantly. It's been a life saver and now I'm working really hard to maintain it, had a lot of private counselling, much less stressed and anxiety under control. Hoping to maintain it for as long as possible.

Has she been doing 'the work' or just relying on the jab? If she hasn't actually changed her lifestyle she would need to stay on them

The lack of psychological support is not really good enough I think. I did mine alongside a Noom subscription as I wanted to overcome my emotional / stress eating which is what led to my rapid weight gain in the first place. I was well aware that the jabs would only help with weight loss and not the underlying cause. But this takes some personal insight and I think it's really overlooked. It wouldn't be hard to incorporate some mandatory modules alongside the subscription to help you maintain healthy patterns.

Until her BMI is lower than 18.5 she’s not actually underweight. As long as she stops then she should be ok. The point about these jabs is precisely the unnaturally fast weight loss so you can’t really compare it with losing weight normally.

The crunch is whether she can normalise eating after this dramatic weight loss and whether she can modify her self-image to understand the fat person in her head is gone.

I was on Wegovy for just over a year. Initially BMI 33 now 25. When my BMI hit 24 the provider stated their protocol was to not prescribe any further medications. There is some variance here, if you have weight related co morbidities you can be prescribed the medicine with slightly lower BMI, some providers continue on a maintenance dose for a while. You are always asked your current weight and sometimes photographic evidence but this relies on being honest. I can't think of any of them that would prescribe for someone with BMI 20 if they had been honest about this. As for psychological support, there isn't any really as let's be real, they just want your money. I've coped really well with my weight loss, I'm still a bit heavier than ideal BMI but I'm eating much more intuitively, really enjoying my exercise again especially long hikes and I feel so much better and more energetic. I think you know yourself from your mental health background that your friend probably needs some support in this as may be entering eating disorder territory / body dysmorphia. It's hard to offer support unless she's asking for it though as she may interpret this as judgement (regarding jabs, there is so much of it).

Is it normal/reasonable for her to still be on medication even though she's a normal BMI? What would be the standard protocol?

Yes it's normal/reasonable to still be on medication now she is in the healthy BMI range. The "standard protocol" is varied and personalised. If she continues to lose weight then it is likely that her prescriber will stop prescribing it for her. Working out how to maintain a healthy weight range is as much of a challenge as losing the weight in the first place.

For people on this medication, how have you coped with the psychological effects of so much weight loss and is there anything I should be doing/saying to support my friend?

You're the mental health expert that works with people with eating disorders, so I would imagine that you know more about this than any one individual who has lost a significant amount of weight.

Personally, and it is a very individual opinion, I cannot stand people wanting to talk to me about the "emotional" or psychological effects of losing weight. It's usually patronising and simplistic, often coloured by their own issues around eating and weight. The NHS would not be offering "concurrent psychological support" for people on WLI or for those who have had bariatric surgery.

You could ask your friend what her long term plan is for maintenance and just try to listen and be a good friend without judgement.

I'm on the jabs and have lost a lot of weight reasonably quickly, now a bmi of 23. I think maybe it takes your brain to catch up a bit as I'm aware I'm a healthy weight, a size 8-10 and look slim in photos but when I look at my body all I see is more fat to lose (that could be because I have some loose skin). My supplier now I'm a healthy bmi has moved to a maintenance dose (a lower dosage than I'm currently on) although if I still lose I'm not sure how long they will continue this for but it is easy to lie, I could just tell them I'm a heavier weight than I am and they would continue to prescribe

I can't use these because I had pancreatitis in the past (due to migrating gallstones in the common bile duct) so I had to do it the hard way. Generally my attitude to anyone using the jabs is good for you, but stories like this remind me of the whole VLCD in the 90s where people got stuck on the meal replacements and couldn't go back to normal eating for fear of putting all the weight back on. Anyone with a BMI of 20 who is pushing for more weight loss is suffering from disordered eating. I have no advice to offer other than to say I think you are right to be concerned. I suspect that these jabs will become harder to obtain in the future.

She may not be being truthful with the supplier OP.

@Agix kindly, your situation is different. You were anorexic. People with anorexia would never be allowed to be prescribed the jab, so your comparison of the both is unfair.