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.

Mounjaro has the opposite effect it’s completed final trials and about to be approve for cardio vascular disease treatment.

Well that’s fair if you like to do everything the more difficult way, then it’s natural you wouldn’t want to try them.

For me, four years of trying and failing to re-lose the weight meant it was a choice between staying obese at the potential chance that maybe one day I’d manage it again (even if it came at a massive cost to my own mental health) or try something different.

There’s no reward for doing things in the hardest possible way apart from
self gratification. But as someone who’s done both, I don’t feel any less proud of myself this time. The cooking/exercise/calorie counting has required the same amount of effort, the only thing that’s different is the battling of the cravings and the obsession over why I’m not eating.

And as an aside, the fact that these drugs have altered my response to food and hunger so dramatically makes me realise this is absolutely a biological issue for me & I can’t hold myself entirely responsible for that.

But as has been said more times than I can count now, whatever anyone wants to do is down to them and as long as there’s no name calling & derision on either side, that’s how it should be ❤️

Thanks!

i don’t see it as taking less personal responsibility to use meds for what they are intended, and don’t feel I need to struggle harder as its my fault, I tried everything to lose the weight and couldn’t and my health is more important than how easy or hard it is, for me it was not about the method, but the end result and getting healthy.

same with stopping smoking, I used cessation aids asi couldn’t do it on my own, and again for health it was critical I stopped.

im now a slim healthy weight and I don’t smoke. So result achieved.

However you do it. What’s important is doing it and getting healthy again and I wish you luck on your journey.

The thing is, it is not medically supervised, and a lot of people (not all, but a lot) are not using it safely. They are using it to emulate anorexic behaviours. You're not supposed to titrate up until you cannot eat or from other threads "struggle" to eat 800 cals a day.

If you're using it as it should be used, as an aid to eat a minimum of 1200 calories a day of mostly whole foods (and many nutrition experts argue that is too little for most people), while gradually increasing activity and resistance training, great. But, from what I have read online and what I've seen in friends using it, that's not what people are doing, nor what suppliers are encouraging people to do.

You might get the odd email from a supplier advising how to manage the side effects and paying lip service to healthy eating, but very few suppliers are giving actual nutrition advice or paying attention when their clients are losing unsafe amounts of weight per month.

That's how people are losing bone density, hair and heart muscle.

If they’re not being medically supervised how do we know they’re losing bone density? I lost hair dieting without the aid of WLI, so I’m not sure thats as relevant as people want to make it.

I know older of people using them, none are emulating anorexic behaviours. If the people you know are, that’s not great. But neither set of anecdotes is backed up by evidence. People have to take responsibility for their own actions, people misusing medication isn’t evidence that a medication is dangerous.

Fair point, but cost is likely a factor for at least some of the people the OP is referring to and that might be because it costs £5 or £300 that someone doesn't have. The entire thread is about why people aren't considering it - lot's of numbers being bandied about, but it doesn't really matter what it costs if you don't have surplus.

Yes and as has been acknowledged more times than I can count, I’m not saying everyone can or should be able to afford it. Or that they want to. Or any of the other reasons people have given. All perfectly legit.

but as I said referring to it as £300/month is daft when it doesn’t cost the majority of users anything like that.

It would be like me saying no one joins the gym cos it’s so expensive - it’s £300/month. Doesn’t mean gyms are affordable for all, just that the price point being used as an example is disingenuous.

I don’t see that at all, looking at all the monthly threads on here, all the posts in Reddit, I see people eating healthy and losing 1/2lbs a week

sure some abuse, absolutely , many drugs fall into a category they are abused, but the majority I don’t think so, it’s normal reasonable people doing this for health.

These drugs don’t make you lose weight faster for most, they make you lose longer as you can stick to a deficit, and lose consistently.

Over a million people in the UK are using WLI, the large majority via “medically unsupervised” online pharmacies. I seriously doubt that a lot of them (10%? 20%?) are using WLI inappropriately. Or before I’d believe that I’d want to see some evidence, rather than anecdote. People are generally assumed to be able to follow instructions when they are prescribed medication. Certainly I’ve never been “medically supervised” when I’ve been prescribed medication by the NHS. Including when I was prescribed Clexane self injections after my c sections. Just sent home with them and that was that.

It’s actually 2 and a half million now.

@Empis welcome. Your math ain’t math’in. But keep commenting nonetheless

Indeed, and if it is then we have a problem that goes a long way beyond WLIs, given that so much medical care relies on patients being truthful and accurate.

But yes, there's no reason to assume one set of anecdata is any more valuable than another. Having read people claiming to engage in very unhealthy behaviours whilst taking a drug that's a frequent ragebait topic doesn't exactly constitute valuable evidence. I would be astounded if nobody were taking WLIs dangerously, but that's about as far as it goes.

First post nails it.
MN is not representative of the majority of the country. Most people live paycheck to paycheck

Until it’s prescribed easily on the nhs we won’t notice a difference in society

Also people get a lot of pleasure from food and alcohol and don’t want to give it up

Well I think we will notice 1 to 2 million people using WLI to move out of obesity. Obviously that’s skewed towards those on higher incomes, so the impact on those at the lower income end will be minimal.

@ChunkyMonkey36 your mum does realise that she should try to eat less anyway, right?

You’d think, but ar 2 and a half million, it’s only ten percent of the eligible population. The uk has a real obesity problem, it’s two thirds of the population are over weight or obese. There are so many people eligible the nhs can’t afford it and think it would cost 9 billion a year. So they need people to pay privately, to start to reduce the impact on the nhs from obesity related illnesses.

i quoted the numbers above, but we spend over 6 billion a year on the nhs treating obesity related illnesses. It’s more than the police, fire brigade and judiciary system combined. We spend another 75 billion in sick pay, lost time etc due to obesity, it is, no pun intended , an enormous financial burden to society , due to the ill health it causes people.

its the number one cause of cancers in non smokers, the number two in smokers, and that’s all cancers that are preventable. It causes heart attack, stroke, diabetes, fatty liver, and skeletal and joint degradation, the list is huge and the nhs spends literal billions treating it. The cost to society is enormous.

And it’s all preventable; if you cure obesity then you reduce or remove these issues from your population, and you free up the money to spend on something not preventable. Or to improve other services, like schools or the police, Sen or mental health provision.

so it’s not just about the individual, the micro level. At a macro level this is a huge huge positive for us.

so no I don’t think we will notice a ten percent reduction, and thays why the WHO have said countries now need to get involved in the cost of these meds and making them available to their populations. As the cost is prohibiting huge swathes of people taking them,

yes there will always be those who abuse them. Those too scared to take them or other prescription meds, those who can’t do the work on them and will continue to eat and drink as they did, knocking themselves sick and forcing themselves to come off, those who are contraindicated, but the vast majority can take them, and we need to widen access, as right now, big pharma is in control.

I wonder how many of those 2 million users will regain eventually. If I could take them (I can't because of history of ED), I think that would be my main worry for starting – that I would end up back at square one, plus more, if I couldn't afford to be on them forever.

@Passingthrough123 sometimes I think that people are really hoping that it’s 100% of people who regain and even put on more weight. It seems to be a bit of an obsession on threads on this topic.

I have ended up back at square one for every diet I have ever done, for decades now. I can afford to be on WLI long term, and I intend to be, if necessary, to maintain my weight loss. They will eventually become cheaper as generics become available in the next decade. I feel incredibly fortunate to be around at a time when these medications are available, albeit not to everyone who would like them due to cost.

It’s a good question.

many will,stay on, I am. So I won’t regain. I’m on a maintenance dose.
some will regain snd go back on, so as long as within a year most pharmacies will let you restart, so no one needs to wait till they are obese again.
some will regain snd not start again, but I assume small.
some will be able to maintain on their own.

so id say overall as it’s not once and done, you can go back on, for example gain half a stone, buy a pen, go back to maintaning, or you can stay on a low maintenance dose like me, ensuring you never regain, it’s likely going to be very low indeed.

this is where it has the benefit over dieting. The drugs remain available to you.

@Donteatmychips

Gosh, maybe not. I’ll let her know.

I've not seen any comments saying they hope everyone regains all their lost weight! But in the context of this thread asking why obese people don't just go on them, it's a relevant point of discussion.

You are one of the lucky ones who can stay on them for life.

In fairness, a colleague lost 8 stone on Mounjaro last year. After she came off it she gained 1.5 stone of it and seems to have maintained there.

That’s still a worthwhile net loss, by most people’s estimations!

Sanctimonious WLI users are the new reformed smokers.

Eyes on your own waistband OP. No one else's is any of your business.