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.

5 years ago I had a gastric sleeve with a bmi of 45. I lost 7 stone in a year and more or less maintained this for 4 years. Bmi around 32. Started mounjaro in September and lost a further 4 stone, now have a bmi of 21.
I paid for these privately, but the nhs is an option for surgery, the waiting list is just very long so maybe get the ball moving soon. In the mean time they might bring the inections onto the nhs for weightloss so you might not need to go as drastic as surgery.

If there are underlying reasons for you struggling with your diet / portion sizes, then yes these need addressing and there are areas you can get help from the NHS. For example

1. Mental health practitioners to discuss or explore any psychological reasons
2. Physio - if you are in pain from an injury or long term condition
3. Social prescriber - if there are other social issues I.e. loneliness, debt etc

These are just some options available to you through your gp practice.

Best of luck in everything 💐

Could you afford to try something like JanePlan were meals are delivered. You only eat what is delivered, with veggies so it takes the guess work out of how many calories you are consuming. Maybe try it for a month.

My suggestions:

1. Write down EVERYTHING you eat daily for a week then work out the average daily calorie intake.
2. Think of ways to reduce food intake which will drop 500 calories a day from your food consumption. This is not as difficult as it sounds. If you eat a 100 gram bar of chocolate every day, eliminating that will do.
3. A 500 calorie deficit per day equates to 3500 calories per week which is equivalent to one pound of fat. That is what you are aiming for, a 1 lb reduction in weight per week. You might start off with a greater reduction than that due to a reduction in water retention.
4. Do some exercise, ideally something that challenges your muscular strength to reduce the amount muscle being lost alongside the fat.
5. Keep it up for several months and don't expect fast results.

Try to minimise poor quality calories (e.g. foods high in saturated fat/sugar/trans-fats) and cook good quality meals such as lean meats with generous portions of vegetables.

Don't think you need tons of willpower. Willpower is of limited supply and quickly exhausted. What you need to do is make healthier living a habit, like having a shower or going to work. Things you do daily are not necessarily done because you enjoy them, they are done because they are necessary and you just do them, a healthy lifestyle is the same. There are times I don't feel like going to work but I do because it it has to be done and it is part of my weekday routine.

I’m on mounjaro, I pay for it privately, my GP said he’d had amazing results from other patients that started taking it and he would gladly prescribe me it himself if he were allowed (beginning of September 24, BMI 39, yo-yo for years with various NHS weight loss steps, slimming world etc and always piling more back on, was always overweight/obese as a child and teen then medication for my mental illness really piled it on) - the jabs are like magic, my BMI is now 32 (I know I’ve still a way to go) I’m down to a dress size 14 and I’m feeling confident and happier with myself than I have in forever (was always the ‘fat friend’ that laughed and joked and ‘didn’t care about how big I was’) I know some report negative side effects, but honestly the only side effects I’ve got are not being hungry or thinking about food all the time and stopping eating when I’m full.
Yes they cost money, but in all honesty it’s probably equal to what I used to spend on takeaways, junk food and drink.
If you’re not freaked out by needles (they’re tiny and genuinely don’t hurt) and can afford it then try it for a month.
I honestly don’t care if I’m paying for maintenance doses forever once I reach my target as for me, it’s a miracle for my weight struggles.

Only thing that worked for me was the window method where you eat a reasonably normal meal or snack but leave a 6/7 hour gap between eating

I have a bmi of 48 and none of the things suggested on here work. The NHS has nothing to offer but short term courses and fat shaming. Over the years I have tried every diet, app and slimming club going but usually end up putting more weight back on. Is this isn’t just me and my experiences and prejudices. Nearly everyone who loses weight with the approaches mentioned here puts it back on again and all of the follow up data on a whole range of approaches shows this to be true. The main issue is treating a psychological problem as a physiological one and treating fat people as being weak characters who have no grit to stick it out.
If you are pre-diabetic as well as having a high bmi you could fall into the category of people eligible for one of the new injections - if that’s something that would work for you.
The programme with the best long term follow up data is Noom. You could try that.
I now focus on enjoying my life, eating healthily and minimising processed foods. I try to spend time in green spaces every day and try to get a good night’s sleep. I know I will never be a size 10 again but that’s not going to stop me having the best life I can. I have given up the diet and fail cycle - it is too destructive.

Have a look at Gloji.co.uk
This was recommended to me by my doctor and it’s free. You have a 12 week course with a few videos to watch each week and you get a weekly call from a mentor. It’s all based around changing your mindset around food permanently and isn’t a diet but is a change of lifestyle. The mentors are really kind and there is also an online gym where you can join fitness classes live or watch pre-recorded ones. I am 3 weeks in and the aim is to steadily lose a couple of pounds a week while changing your mindset. I am calorie counting alongside which my mentor isn’t keen on as I have a tendency to restrict myself too much but I don’t have the confidence yet to trust myself to limit my portions without counting and weighing everything!

If your BMI is over 35 you qualify for GLP1 injections on the NHS which I would highly recommend. Speak to your GP about this asap

I've been trying for years to address the underlying reasons for my overeating which has seen me be obese and/or morbidly obese for decades.

I've concluded some things can't be unpicked or cured.

But Mounjaro is working.

OP, so many posters suggested injections - are you against them or do you want to get it on NHS?

This isn't practically the case. The rollout isn't starting till the summer, patients would need to already be on the weight management tiers, and have at least two co-morbidities alongside the BMI of over 35.

Take out a loan and get a bypass done privately. Best thing I ever did and with I had done it 10 years earlier. I lost 9 stone in a year and I don’t think about food at all anymore.

I’d argue it’s somewhat irrelevant whether the pumpkin is a carb or not. Nobody with complex eating behaviours should be aiming to lose and sustain that weightloss by denying certain food groups (though one does become nerdy to macros and whatnot when actively on a mission to lose, I find).

You’ve said yourself that it’s the reasons why you overeat than need to be tackled. Do you know what these are? Would you be happy to share?
After this is does come down to calories in versus energy used no matter the form of those calories (carbs, protein etc.). It’s also a fact that the more muscle you have the more energy you require and therefore the easier you burn calories each day, and for this muscle build up, protein is undeniably required but, in my opinion, that’s farther down the line for you to be concerning yourself with currently.
With this in mind, are you familiar with BMR and TDEE? If not calculate yours and then use the several free food trackers (My Fitness Pal being one of them) to track every item you consume so you can see where you are not in a sufficient calorific deficit to lose weight. Again, without tackling the triggers for eating it will be tough to deny yourself the foods that you then come to realise are taking you over your calorie allowance for the day so the two things have to go hand in hand.
As others have said, gaining control of your dietary habits is crucial and for me weight loss injections have helped me. The term “food noise” is bandied about. I didn’t even think I experienced it but with it switched off, I now realise I was experiencing it all along.
mounjaro has helped me and despite what programmes say, you may not even require the higher doses. If within reach, affordability wise, I’d recommend trying it.
check out Diary of a CEO podcast on the subject of GLP-1 and also Johan Hari on the subject.

My BMI is 40. I lost 26lbs on the Weight Watchers app back in 2020, but then they changed their plan and the new one didn't work for me, so the weight went back on again. In December, they added lots more 'free' foods to their current plan and I am finding it very easy to follow. I also have a very fatty liver, so it's really imperative I do my best to lose weight. Hope you find something that works for you long-term.

I am now 57, I had a BMI of 50. I asked the Dr for weight loss surgery. They referred me immediately.

I saw the bariatric team in the beginning of 2020. I had a lot of online lessons, then had a by-pass in July 2023. I have lost 13st now have a bmi of 29.

There was no expectation to lose weight prior to the surgery, as there has been previously, as they say tht was just setting people up for failure.

It IS a radical step. I had researched and researched. I had spoken to a lot of people who had had the same. I am extremely happy with the outcome. I took the online lessons seriously. I had tried a lot of things before and felt helpless.

I get that it's not for everyone but it's certainly something to consider.

This is good. I could do with the counselling and the cooking classes.

Type 2 diabetic here.

Facts:

I'm on Ozempic (wegovy/semaglutide)
Prior to Ozempic I was on other similar drugs (tablets and injections, empagliflozin and liraglutide)
I've lost 30+kgs, from well over 110kgs to about than 70kgs.

My take on this?

Ozempic made me feel really, really nauseous. This pushed me into changing my diet drastically, so that I now eat a lot more easily digestible food I did before, so fruit, veg, eggs, fish. I also eat a lot of high calorie foods because I was losing weight too fast, but it was small portions to avoid the nausea.

It's also changed my eating habits dramatically. I eat a lot more fruit and veg, my calorie intake comes from high-value calorific foods (I eat butter, cream, full fat cheese, rather than "light" foods). This has also resulted in my cholesterol results being much improved (overall cholesterol is down, good cholesterol is up, bad cholesterol is down).

The medical professionals that I've talked to have all agreed on one thing. Ozempic, etc, works primarily because some people have a defective gene that switches off the "I'm full" hormone (60% of labrador dogs have the same problem apparently). Switching on the (glp1) hormone fixes that problem. They cant explain the nausea (at least the nausea before eating, whereas the nausea during/after eating can be put down to overeating). But counteracting the nausea, by eating the easily digestible food and stopping the overeating, works towards weight loss.

It's not a miracle cure, I've started gaining weight again after 2 years of weight loss. But my hba1c (if you're diabetic you know what that is, for everyone else its the highly important measure of blood sugar that us dbs need to keep track of) is holding steady at 51, and has done now for 18+ months. GP has moved me from 6 monthly checks to yearly checks. Overall my metrics are vastly improved and my diabetic specialist nurse and my gp are extremely happy with my progress.

I'm on Ozempic for life probably. For anyone looking to lose weight you would probably not want to be on it more than 2 years (read up on the side effects) and so you should develop new eating habits that you will be able to sustain once you move off it. Though from my experience 2 years seems to be the weight loss limit anyway. I'm on it for the hba1c results anyway not the weight loss.

Please dm me or reply here if you have questions, I will do my best to answer

Go well xx

Mounjaro is your friend here, OP. It's a game changer. Do whatever it takes to find the money. You will be amazed at how your life and attitude to food transforms.

Also, as mentioned above, read Ultra Processed People and vow to never let the giant food companies who are killing us with their crap take another penny of your money.

And never drink sweet drinks, fizzy or otherwise, low cal or otherwise. They just perpetuate a sweet tooth and alter your perception of what real food tastes like.

I have lost 5 stone on Mounjaro. It is a wonder drug for me. I still have to watch what I eat but it makes it much easier to do that.

My weight crept up perimenopause then escalated post menopause with significant abdominal weight. I had health issues high cholesterol pre diabetic and dx with a chronic condition. I had no energy and poor sleep. Like you I feared for my dc.

A few years back, i lost 14kg over 9-12mths- low carb almost keto, 10k steps sometimes more, using elliptical 3x week. I tried hard then a workbissue tripped me up and put it all back on.

I am on MJ. Yes it’s expensive up front but you won’t eat biscuits take aways crisps chocolate wine/alcohol (because you don’t want to). So in my book it’s almost cost neutral. Despite a similar low calorie/low carb diet without the same level of exercise I have lost more faster. So the MJ also does something to your metabolism as well as stopping the food noise. I started at BMI 35 and now bmi 25.

Ask your gp for a health check with view to starting - there are some contradictions against it. Then invest in yourself. Find the money, give up the bad food habits that cost money. Forgo a holiday, nights out. It is possible to afford this in the UK. Look at the MJ threads on here and réddit/facebook etc (just be aware of some bad advice on some threads).

Ask your GP/practice nurse to give you the link to the Liva app. It is free to use but you have to have an NHS referral. You can join a group or use the app on your own with a personal coach. You get loads of great advice, help to understand nutrition and an opportunity to set goals for exercise, diet and habits.

oviva.com/uk/en/

If your BMI is over 40 you can request your gp to refer you to oviva who run Tier 3 weight loss for nhs.

My gp did refer me on my request but as I had lost a bit of weight in the meantime my BMI dropped to 39 so I didn't qualify.

Weight loss surgery is no easy fix. It’s major surgery with many complications. As an ex nurse who has actually witnessed patients die after this surgery I would not consider it for myself. Have you had a Thyroid test ? You can never lose weight with an under active thyroid ! No matter what you try. I would ask for a test if you haven’t had one. The it’s cutting down long on food and upping exercise long term I’m afraid. We have to take responsibility for our own health , the poor old underfunded and on its knees NHS can’t fix everything.

But things are not moving down (In 2 months I have lost 2 kgs).

If your BMI is 44 and you are 1.60 metres tall then you probably weigh around 110kg. If you are really losing 1kg per month and can keep that up, then in 30 months you will drop out of the obese category. You will also have developed good eating habits that you are likely to be able to maintain for a very long time.

It took you many years to get to your current weight, and you are probably going to need to be patient, but if you can string together month after month of reductions you will be able to feel positive about the journey without the financial and physical side-effects of the drugs.