Obese... Sick of it... What help can the NHS provide

[Platypusdr]

I am severly obese. My BMI is 44 and I am pre diabetic. I asked my GP for support and they directed me to their 'wellness coach' who I found not that helpful. The main thing he told me is to use the portion plate and to eat a olate of vegetables /salad first and then go to eat the rest. I found this quite helpful. But things are not moving down (In 2 months I have lost 2 kgs).

However I feel like the meetings arent dealing with the underlying reason as to why I eat. The last meeting was a disaster (me crying all over the appointment around pumpkin and whether it should be a carb or a veg... As he said I should limit it but couldn't really give me the reasons why and where it should be in the 50% veg, 25%carb 25%protein portion plate and seemed to say it is veg out carb and couldn't decide which made it so confusing and so many other things). I then mentioned that I feel the meetings are nice enough but the main message is limit food, but not really dealing with the underlying issues as to why I eat, which I feel is not sustainable.

Anyways... I want to know if there is anything else that I can ask for help from from the NHS, or is this it? I would like to go to the next meeting prepared and know exactly what I can ask for as I know that this would be helpful.

I wouldn't worry about the long term just now. You need to lose weight now. If you lose weight you'll feel better about yourself. You can worry about the future later on.

I will start by asking do they have a diabetes nurse at your gp practice. If so ask to see her/ him. I am not diabetic but my local nhs put on a course for 6 weeks and the diet information was given by the diabetes advisors who were excellent. I agree the underlying issues need addressing but I will share a couple of things that helped me. I could not watch anything on television about food as it would immediately make me start thinking what to eat. Secondly I could not buy in food like multi pack bars of kitkats…if I had it in I would at some point eat it. When I craved that sort of thing I would have a couple of teaspoons of peanut butter and chocolate spread. I think I am addicted to sugar. One big thing is to eat plenty of protein because then you don’t feel hungry. Chicken for example but enough to make you feel full not the measly amount in a takeaway. It is hard to exercise if you are overweight but hopefully if you lose some weight you can do a bit more. I am not sporty at all and don’t do enough exercise so have no tips. Good luck.

If you can possibly afford the injections buy them. I would go without more or less anything to be able to afford them.

Weight loss injections

I’m on injections (paid for privately). I’ve lost 3.5 stone since October. My starting BMI was at a similar number to where you are at the moment. They’re not a miracle cure but they make it far easier to diet, they seem to give me more willpower. I started with mounjaro which is apparently more effective, but I was allergic to something in it and came out in hives all over my body. I then took a month off jabs and started with Wegovy and it’s working in a similar way but without the skin issues (touch wood!)

Edited to add that I anticipate being on these long term, hopefully on a maintenance dose. I’ve lost over 6 stone before and then put it back on again.

it is not sustainable long term and doesnt deal with underlying issues/why we eat.

In that case you might like to read Dr Jenkinson's book Why We Eat (Too Much)

It's very interesting.

OP, so many people are in a yoyo diet cycle that keeps worsening. Diets make almost everyone who tries them fatter long-term - go on multiple diets in your life and you end up a lot fatter (ask me how I know!). Low carb and fasting regimes are enormously triggering for bingeing; the more you try them, the more severe the binge urges become. Your body is programmed to respond to restriction by eating more and moving less and you're fighting your own survival instincts by trying and trying to do the opposite.

In my experience, Mounjaro is the only thing that works for me. I tried tons of therapy to fix these elusive 'underlying issues' but the issues were a lifetime trying to exist in diet culture while living in a body that wanted to be bigger than I wanted it to be. My whole life has been a battle against that. Mounjaro corrects the wonky signals my body is sending. Nothing else can or will do that - it's been life changing.

I also recommend mounjaro. It sounds like you know how to eat healthily already but you are getting in your own way. Sometimes being very heavy is a self fulfilling prophecy. You are fat, which makes you sad which means you lose motivation and fall off the wagon. Repeat.

It can also seem like such a long journey that it seems unachievable.

I've struggled with my weight my whole life. On paper I'm a healthy eater. I can stick to a diet for weeks or months but always plateau after a stone or so lost. Then cave as cravings become unbearable (literally change my character).

Mj was a real game changer and very very different to any method I tried before. I tried to binge on mj and lost interest three spoonfuls in.

My costs worked out at about £30 per week. One takeaway and a few snacks worth. Probably saved money overall.

The fact that you have ketoed in the past is great. Keto and mounjaro are great in combination.

My friend was pre diabetic and put on tablets that act as suppressants (like mounjaro but cheaper) and he’s found it a great help. That was via the gp. I think you can return to your gp and say, the wellness coach isn’t working and I’d like to explore suppressant medication.

I’m paying for mounjaro but I’m not pre diabetic so I didn’t feel gp would be helpful for me. Otherwise, save up for injections. They’ve been life changing for my emotional eating! I’ve lost 25lbs since November. Initially I was calorie counting everything but now I just eat “normally” and rarely snack. I’m still losing without obsessive food logging.

In your position OP, I would:

1. Continue with a healthy eating regime
2. Start using Mounjaro while telling your medical professionals you're doing so
3. Be patient, go slow and stay low with the dosage (e.g. you don't have to increase month on month)
4. Look into counselling in about six months' time after you've given the injections a chance to help you clear your head.

I suggest this because this is what I'm doing, and it's working. It's the most successful method to approach emotional eating ime. Get rid of the food obsession first, then you have a chance to unpick why it was there in the first place.

@RoseGoldenGlow this us exactly how I feel.

Thanks for all the cool menus. So much for for thought

Once it’s got a grip, it’s really really hard to deal with severe emotional eating / an addictive relationship with food, as it’s a way of managing stress etc, and unlike alcohol you can’t avoid eating, and then once you are very overweight, you don’t have as much energy and you feel bad about yourself but it all feels impossible, so often snacking on the sofa is a way to distract from that.

I think it’s possible - if you have the time, money, and emotional resources - to improve things with a specialist therapist. But it’s expensive full stop and finding someone with genuine expertise is really hard.

A diet plan is not going to fix it because as you say that isn’t the core problem.

So if you can get together any cash I would prioritise the jabs as they reduce the food noise and your appetite and are life changing for people in your situation. Alongside that specialist therapy is helpful but if he two together are too expensive then there are some good books on adopting a compassionate attitude to yourself and food, which you can combine with a sensible diet - the most important thing is to eat regular meals I find. If you want some resources recommendations PM me (this post is long enough!)

My BMI was 50 at the start of July last year, it's now 34 and continuing to get lower. Weight loss injections have enabled me to get a grip on my weight and given me the head space to consider what my longer term options are once I'm at my final goal weight and to plan for that.

Also. Mounjaro is a 2 year course currently. In two years there may well be a maintenance pill. The NHS may prescribe them like statins as they seem to have far reaching benefits to heart health, addiction etc.

There will be more and probably cheaper options by the time you have to stop.

Thanks. I know my biggest issue isn't healthy eating (i eat quite healthy). It is portion control. What I should eat leaves me so hungry

Privately pay for in mentions and while on this address the main psychological eating issue.

A BMI of 44 is literally terminal and you need to get away from this health crisis as soon as you can and work on the rest
Going forward.

I recommend private doc.

Weight loss Injections, Mounjaro...but don't wait for the NHS to prescribe, there are huge hoops to jump through and it may take years.

Put it on a credit card, sell stuff, honestly this stuff is life changing. I've lost just over 4 stone in 7 months, blood pressure from very high back to normal, fatty liver reversed.

It’s probably a combo of emotional hunger and eating things that aren’t filling enough?

Anyway I do think WLI combined with regular meals, a balanced diet and a compassionate attitude to yourself will be your solution - and my god the injections make the rest of that a lot easier, for people with real emotional problems with food.

I'd be going for injections in this position. If the NHS won't for any reason I'd be looking to pay. Once you've lost some weight your whole mind set could change and a longer term plan you can start thinking on.

If you're really demotivated and feeling hopeless it's difficult to do anything. Could you possibly start to imbed long term habits during the time you're on the injections. I wouldn't discount them.

@Platypusdr have you thought about buying a walking pad that you can then tuck under the sofa or in a cupboard? That way you can get lots of extra steps in once your child/children have gone to bed and watch some tv at the same time? Apologies if you already have one of these. In terms of food, are you eating satisfying meals so that you feel full - but still eating healthy meals. Are you able to bulk out your meals with pulses like lentils to keep you full and cut down on meat consumption (if that is something you would consider) Even if your weight loss is steady, it’s better than being on injections that you could need to stay on for life. Not to mention these also can have unpleasant side effects. Best of luck to you!

Do you feel hungry with small portions or every time you eat, does drinking a glass of water or a piece of fruit before you eat stave off the hunger. Have you had blood glucose readings recorded recently

What I should eat leaves me so hungry

It is OK to feel hungry. You will get used to it and won't feel so hungry the more you live with the feeling of hunger.
If you give into every hunger pang with more food, you will just over eat. Drink a huge glass of water or some cups of tea with no sugar when you feel hungry or distract yourself with tasks.

Edited this to say this is for AFTER you've eaten what you're supposed to for the day ie technically had enough to sustain yourself. I'm not suggesting you just starve!!

Noom is good - it has a start up but where you do quizzes to work out why you eat the way you do.

It pins down why you want to lose weight. Really why.

Then you track what you eat in the app and there are daily tips.

The free version is fine.

In your shoes I’d also consider injections.

If you are eligible and can afford it then get
mounjaro, it really helps.

Pumpkin is disgusting don't eat it. Problem solved. The NHS will provide a gastric sleeve but the waiting list is long and you have to lose weight first.
You can buy mounjaro yourself. I'm on it right now. Shemed is the cheapest £99 per month for one year.
Posters have provided other good advice.