Why are many severely overweight people not using GLP-1 treatments?

[Donteatmychips]

Just a pondering when I was on a day out yesterday. I know of course that there is an economic cost to GLP1s, but is there really really any excuse to such widespread obesity these days? I was walking around a seaside town and a National Trust property, and I would say a good half of those around were still large. I understand they are not that easily prescribed on the NHS, but I believe you can shop around and find deals from various online pharmacies. Is it just more that people don’t want to?

For full disclosure, I am on a GLP1 that I acquired elsewhere by walking into a pharmacy and just asking for it. Yes, it cost a lot of money and I know I am lucky to be in a position to have done that. I fought being on one for a long time and it’s not a magic bullet, but it does help and I’m grateful for that.

I know that modern versions of obesity are skewed, but I am talking really about people maybe 250lbs or over now, not just a stone to lose.

I think the immediate and potential long term side effects are a good enough reason to not take it. Not just an irrational ‘I don’t want to’

That’s incredible. Well done and good luck! I was working with much lower figures but had the same mindset about not wanting lifelong dependency on WLI.

I don’t know about the blindness thing but that @SorryNotSorry00 is correct in that not everyone would use them if given the choice.

Not quite so flush now but I had plenty of disposable income at the start of my weight journey - I moved from London to a bigger yet cheaper flat in a smaller town and made an instant saving of £500-700 a month from the various lower housing and traveling costs, but I still chose not to use them. I also have family who would pay it for me if I asked so I wouldn’t even have to use my own money. I may even have been eligible for it at one point on the NHS but again had no desire to use it.

@C152 fear is completely different to ‘I don’t want to’. And far more valid and powerful actually.

Oh come on op; it is a bit goady to couch your question by saying “but is there really really any excuse to such widespread obesity these days?” as though it is offensive to your eye! Especially when there are lots of highly legitimate reasons for not taking it eg:

✅ heart arrhythmia
✅ pancreatitis
✅not wanting to lose muscle, especially from the heart
✅cost
✅ scientists suddenly deciding they are not very good for you after all (as they have with PPIs)
✅the fact that a significant proportion of people put the weight back on after stopping treatment

The immediate and long-term effects of obesity are also quite severe.

That's probably a rhetorical question, but of course I understand that. People react differently to any drug, however. Of the three people whom I know on Mounjaro, one is losing rapidly (and no - is definitely not overdoing it).

All three are eating healthily plus exercising. All three were well above the BMI specified by ethical providers.

At the point that I was warned not to take it, my BMI on paper was just under 31. I suspect that those who are at the normal threshold for provision of the medication or below are more likely to have problems.

I've since checked and at least one online provider has said "BMI between 25 and 30 (off-label use): In some cases it is possible to initiate GLP-1 medication at BMI's between 25 and 30."

In my first post on here, I said that I'd looked into it but (even before being warned off it) had decided that it wasn't for me, particularly given that I've inherited the family gastric reflux problem (which in one very slim family member caused severe repercussions unrelated to any dietary problem).

As I said, I'm following the advice of my doctors and I'm pleased for those who are using the medication with no issues.

Definitely.

I could afford the outlay myself, and for both medical and weight reasons would qualify for NHS prescription.

Still - it’s not for me.

You cannot lose heart muscle with mounjaro - in reverse it will actually benefit the heart as the fat goes away.

There's this, regarding Wegovy and heart benefits as well:

https://www.bbc.co.uk/news/articles/cz90595pgzlo

Right! Many of us feel like that.

It is just strange that some people can’t grasp that despite the wide range of reasons — beyond cost implications- that have been stated, some of us wouldn’t even take it even if it were free.

I mean we are all different so it shouldn’t be that hard to understand!

I do think it’s reasonable to be a little surprised that someone with a BMI over 40 and 4 out of the 5 serious health conditions listed as criteria to be eligible on the NHS, and so cost is not an issue, would not be interested at all in response to being recommended it by their GP. I wouldn’t necessarily say that to them or express that opinion to them, but I would be wondering why they would not want to take a medication that was recommended by their GP for the conditions that they have.

Clearly, as people have explained already, for some people there are issues for them with taking WLI that for them outweigh the possible benefits to them. Which is obviously their choice and I would not in any way suggest that people should take a medication that they don’t want to.

Cannot be healthy

Mine’s currently 41 - down from 43, 3 weeks ago.

As a result, I have gallstones, pre-diabetes and early fatty liver.

I don’t qualify for Mounjaro, but do for Wegovy - I was told this literally yesterday by my GP.

However, I have no interest in taking it whatsoever.

What I need to do is commit to a lifestyle change, and continue getting my BMI down - I’m aware that will be a challenge.

I don’t want to be forced into changing behaviour and habits by taking medication, I want to make those long term changes unassisted by medication so I’m more likely to keep them up.

I personally don’t see the benefit in being prevented from eating but learning nothing about how to actually live better without that help. I know myself well enough to know that I’d use it in that way.

I’m not worried about side effects, injection pain, or future impact, I’m aware enough of my own habits to know that I do need to lose weight, but need to make meaningful and lasting changes. Which is not what I’d do if on WLI, I’d use them as a crutch and then fall apart once I came off them.

Maybe fear of the unknown and because they don’t want to risk health complications. I have a friend who was on it and ended up in excruciating pain and had to wait two months for a gallbladder op. Apparently this issue is a common side effect with these weight loss drugs.

see option 4.

No one has mentioned any of them being irrational.

@ChunkyMonkey36 I am sorry if it came across like I was asking for a justification or an explanation, that was almost what I was trying to say wasn't necessary. You want to lose the weight without using medication which is absolutely your choice and not one you need to explain or justify. I wish you continued success with that.

I could not do it without the aid of medication. I was just getting bigger and bigger with my BMI tipping over 50, although thankfully no other apparent health issues - somehow no pre-diabetes, fatty liver or gallstones. So, a different set of circumstances and a different decision.

@SilenceInside

Don’t worry, no offence taken here. I know you didn’t expect justification but my response was really for those that do.

Even my own mother asked why I didn’t “just” go on WLI (she’s on 2.5mg Mounjaro for T2 diabetes), and as a large woman I get quite regular recommendations to use them.

I think there are others who are less polite about their curiosity, or are outright judgmental about people who don’t want WLI, so really what I wanted to do is get the point across that not all obese people want them, and it’s not always fear. Sometimes it’s outright stubbornness 😂

Completely agree. There’s all sorts of reasons for people not wanting to take them. No matter what their BMI is it wouldn’t surprise me if they declined it.

My BMI was 32 and for me yeah stubbornness probably did play a part.

I’d been overweight in uni and then lost that weight in my early 20s and kept it off for over for over a decade as a size 8/BMI 22. So when the weight came piling back on mainly during the pandemic I refused to listen to the voices who basically said “this time you’re trying to lose weight as a woman over 35 now so you’d better get on the WLI.”

Fear of the unknown and concern about side effects are completely valid.

Gallbladder issues can happen with WLIs, but they’re not unique to them. Rapid weight loss itself (whether from dieting, illness or surgery) is a known risk factor for gallstones.

That would make sense if it was easy, but most people who are obese have tried eveyring possible and not been able to get the weight off and keep it off. Some can, but most fail on the journey or regain. Many find it impossible. As said earlier no one takes these drugs as the first resort. It’s the last resort.

so wanting to do it without is fine if achievable, but many know it simply isn’t for them,

I don't think that's true. I don't know a single obese person who hasn't lost weight at least once during their lives. If you are an outlier who has never ever lost weight, I think it is education you need, not WLI. The WLI industry wants you to think you cannot do it without them, but you can. You probably have a few times.

It is true that people initially lose more on WLI, because they are less tempted by cheat days, less likely to underestimate their calories, less likely to cave and have that buttered toast for supper...

The problem most people face is maintenance, and recent studies have shown that those who stop using GLP-1s are more likely to regain their weight and gain more than those who use traditional methods. In terms of long-term success, both methods have the same issues in pretty much the same numbers.

There's also the fact that the average weight loss on WLI is 15-20% before the effects start to taper. If I'd lost 15% of my bodyweight, I'd still be obese.

If it helps you, great, happy for you, but stop pushing others into following in your footsteps. It's not a magic bullet. It doesn't work for everyone. It's expensive, has side effects, and, long-term, is no more effective than other methods for most people.

If I was wrong they’d no longer be obese surely. The fact fhey are proves I’m right.

and the trial data was over a limited time period, in real life people lose much more. I lost about 35 percent,plus the trial was an average

I don’t think it’s meant to be easy.

It took me about a decade to get to the size I am now, it’s not just going to fall off and it’s going to need some help to stay off.

I just don’t believe that help has to be medical.

And that’s fantastic you have achieved it. But I’m sure you understand many can’t.