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.

Fair enough that there aren’t those kinds of posts yet on this thread, but whenever the topic of WLI is discussed inevitably you have several people chipping in with comment along the lines of it’s pointless and a waste of money as all the weight will “pile” back on as soon as you stop.

It’s not a reason to not try WLI, as weight regain happens regardless of how you lose weight. There is no weight loss approach that can show that people can lose the weight and keep it off long term, in majority numbers.

that would be lovely if it was always possible.

My answer to your original question is because they choose not to.

It will be a reason not to try for many though, hence why I mentioned it. Potentially thousands of pounds spent, only to end up back where you were. It's a concern.

I know what you mean OP. I've sucessfully lost alot of weight on them and feel almost evangelical about them. I would never approach anyone, but when I see an obese person who is struggling with health issues I would love to know why they wouldn't try just for 1 month even.

£69 for the lowest dose.

Agree the price is hideous for the highest doses though. It would put me off!!

Seriously? You think we can all "find" the money if we change our priorities? You do know some people literally live hand to mouth? I had a cold bath last night as I can't afford to top the gas meter up until tomorrow. I had pasta with a tin of soup as sauce to eat as that's all I have right now.
Not sure what I could cut back on to find that £90 every month.

I am not one of the people you are talking about, but I think that if I was 250lbs-ish, I wouldn't take them to lose weight...yet.

The reasons for that are that I have an elevated risk for some cancers due to genetics and worry about the elevated risk of some cancers using GLP-1s. I also think if something seems too good to be true, it probably is. The other thing is the money. I have little kids and that money could be used elsewhere. The people I know who have had weight loss with mounjaro especially have had to stay on it as they regained the weight when they stopped. Finally, I hate the diet industry and would prefer to lose weight without paying anyone else for it if at all possible.

I do support other people if they choose to use them. I know they have been an absolute god send for some, and, for me, if I was very, very high bmi and really unhealthy due to my weight, (like the people who can access it on the nhs), I would take them despite my reservations. As the risk would be outweighed by the benefits (for me)

I do not think anyone should be coerced or shamed into using them which is hoe this op reads I'm afraid. Fuck that!

@Passingthrough123 I guess if people are very worried about the issue of possibly regaining and getting back to their current weight then yes it wouldn’t be worth trying for them. The chance of losing weight from obese to healthy and maintaining it for 5 years or more is already extremely slim via any method of weight loss.

I’m personally thrilled that I took that chance and will be giving maintenance my best effort. I’ll let you know in 5 plus years time how I get on.

It’s highly unlikely though,no, as all you have to do is buy a pen or two if you start to regain and knock it back on its head. I. Mean some won’t sure, but the vast majority, you already see it on the different threads, if they start to regain they just buy a couple of pens and knock it off.

not many will chose to spend all that money, although likely not thousands, to jisy sit back and say, meh, don’t think I will spend another 200 on a pen, will just regain it all.

I'm talking about people trying them in the first place, as per OP's question about why obese people don't just take them.

I think if you start and spend £££ and then regain, then of course it makes sense to start again. But if you have to stop in the first place because of lack of money, it will be a tough call.

Yes if your finances change and you stop due to money then yes you prob can’t buy a pen or two to maintain, so again I guess you’re saying it’s money, cost that’s the issue.

but for anyone who can afford it, and successfully loses to goal, they can either come off, and try to maintain like after any other diet, they can stay on a low dose, or they can come off, try to maintain, give themselves a buffer, and find if they drift up just buy a pen or two and knock it off and go back to maintenance

so as long as you can afford and cost isn’t the issue, then you certainly don’t need to regain or even risk it, you don’t even need to stay on a maintence dose, you can just buy a pen or two to ensure you stay within your buffer, say once or twice a year.

im staying on a maintainance dose, for many reasons, I know no matter how hard I try it will go back on again, life gets in the way, diet fatigue sets in, and I don’t want to live my life constantly feeling deprived and struggling and watching the scales, feeling my clothes getting tight.

beem there, done that. No thanks.

but more importantly I want all the benefits of the drugs.

reduced cancers
improved cardio vascular, kidney and liver health
anti ageing, as it’s been shown the reduction of inflammation, which is effectively what ageing is in our cells, allows the cells to regenerate, in our internal organs.
reduced inflammation in itself
perfect insulin control and blood sugar management,

also now likely reduction in dementia.

my husband also is staying on a maintenance dose. His family has a history of high cholesterol heart disease and dementia, and his blood test results show him healthier than he has been in years, as do mine, so it’s worth it for these reasons. And quite simply not having his belly any more is a huge health benefit.

ifyou take a drug and it proves itself to bring you back to full health, then unless you can’t afford it, it isn’t optimal to stop.

others will feel differently

I'm a little confused about using injections to maintain . Once bmi is below 30 they do not prescribe it?

No they prescribe down to 22, 19 for some pharmacies.

30 bmi is to start it, not stop it, or bmi 27 with some health conditions, some now offering at bmi 25.

the drugs are to get you to a healthy weight, which is always below 25/
. They are licenced and recommended for long term use,

I started at bmi 32. I’m now bmi 20, have been for about 14 months, completely stable weight on a low dose.

as said, 30 is the start bmi tk take them it’s obese, not to stop them. That’s 22, often 19.

Oh I see that makes sense would that be for most weight lose aids or just the WLI ?

I don’t know what the weight loss aids are, but for weight loss injections, mounjaro or wegovy it is

to start :

bmi 30 or 27 with some health conditions, could be high blood pressure or menopausal. Some pharmacies now offering at BMI 25.
you can take the drugs down to a healthy bmi of your choosing, with some cut offs at below 23, well one, many at 19 bmi or 20. As long as you don’t drop below this you are prescribed.
the drugs are licensed for maintenance

this is because obesity is a relapse disease, 80 percent of people who lose weight through diet regain it all and more within 5 years, for health reasons its critical people are supported to not regain. So prescribing a maintenance dose is key.

you can chose to come off, but as long as it’s within a year. Most pharmacies will start you again, so you don’t need to become obese again.

so for example you can maintain at BMI 20 for 10 months, find it starts drifting up. Say to 23 and you can go and get another pen, and bring it back down again.

or you can do as I do, stay on a maintenance dose for the reasons listed. Personal choice.

the strength of the maintenance dose is also a personal choice, it’s whatever works for you.

It’s interesting that you draw parallels between weight loss and quitting acknowledged addictions such as smoking. I personally am convinced that ultra-processed food addiction is real, and a significant factor in the obesity epidemic.

You say no-one forced you to eat carbs, just as no-one forced you to smoke. That’s true - but does it mean that the addiction is your fault? I don’t believe it does. People vary in how susceptible they are to addictions. If you are susceptible, and you are exposed to it, you are likely to become addicted. And one of the features of addiction is that it hides itself from the sufferer. I don’t believe the addicted individual is responsible for the fact they became addicted.

You also seem to saying that people ought to try to try to escape their addictions without medication in the first instance, only resorting to them if they have tried and failed to quit without. I wonder why that is? If it’s because all medications have side effects, and quitting without them means you don’t get the side effects, fair enough. Or is it a moral thing? Kind of - if you’re weak enough to get addicted, you have some sort of duty to try really really hard to get clean, and only use meds as a last resort.

Oh I see thank you.

Side effect profile.

Yeah I’d agree that food addiction is real, and a significant factor.

Personally I don’t feel that I have an addiction, I have unhealthy eating habits rather than necessarily food types. My relationship with food has also never been great - I had an ED in my late teens. Dieting at all remains a big step for me, and it’s important to me that it’s done on my own terms.

I do think it’s an obligation of sorts, but on an individual/personal level rather than a societal thing. I don’t care what others think I should do, and wouldn’t expect anyone else to either.

I see it a little like cleaning up my own mess, encouraging kids to put toys away, etc. I made a mess of my body, and I should take responsibility for fixing that.

If cleaning was an impossibility, I’d get a cleaner. If losing weight was an impossibility, I’d consider WLI. But I don’t believe it is an impossibility for me to do that, so I don’t currently see any value in that help.

That is however a personal view - as I’ve mentioned, my mum has recently started Mounjaro for her diabetes, and I have friends and colleagues who use it. I don’t believe it’s right to impose the things above on others, just as I don’t believe it’s right for others to tell me I should use them where I evidently don’t want to.

I didn't say it made you have all those things. But there have been recent reports of a level of malnutrition in many people on WLI, that raises concerns of osteoporosis. If you're so low in calories and protein and other building blocks it is quite possible to be losing heart muscle.

The poster I quoted wrote: You cannot lose heart muscle with mounjaro - in reverse it will actually benefit the heart as the fat goes away.

That's a basic misunderstanding of anatomy and the effects of extreme dieting.

There was a recent study reported on the news that I heard. I don't know the details. I think it was this one:

Study finds nutritional risks in users of GLP-1 drugs

Inadequate micronutrient intake can put people at risk of a range of conditions, from hair loss, fatigue, and slow wound healing to an impaired immune system and osteoporosis.

"While GLP-1 RAs medications are transforming obesity care, we still know very little about how they affect eating patterns and nutrient intake," explained Dr Vinelli. "What's more, many people taking GLP-1 RAs receive little or no systematic guidance on diet quality, protein intake, or micronutrient adequacy."

Erm, feels a bit of a judgey post but I can't take them because when I took ONE dose of the lowest possible amount, I ended up in hospital with acute pancreatitis. I asked my GP about trying again with them and was advised to never try anything similar ever again....

I’m sure your doctor told you it wasn’t remotely related to the drug, right?

Surely this is the same for any diet? I can’t grasp the logic here.

I can speak to myself, my diet is healthier than it’s ever been, for the simple reason I don’t have any more cravings, so I have limited sugar, and very low alcohol, but also as if you eat too much fat or sugar, you get gastro effects, like nausea, the runs, burping etc.

there is what I eat in a day threads, and most people seem similar, lean proteins, fish, seafood, meat, veg, salads, fruit, eggs, yoghurt etc.

myself and many others are aware of the need to eat your protein etc,

compared to the diet of these people before, it’s way healthier, cutting out the excessive portions or too much fat and sugar.

unless you’re on too high a dose, it’s a personal choice whay you eat.

and studies are shown consumers are moving to much healthier choices.

https://www.supermarketnews.com/nonfood-pharmacy/glp-1-drugs-reshape-consumer-spending-eating-and-wellness-habits-report

“Despite lower absolute intake, macronutrient distribution (the proportion of daily calories derived from macronutrients) was nearly identical…indicating a proportional reduction in food intake rather than changes in diet quality.”

“However, weight-adjusted daily protein intake was critically low in GLP-1 RAs users (0.6 g/kg/day), with the majority (88%) falling below the Italian national recommendation for protein intake (of 0.9 g/kg/day). In non-users protein consumption was also below this recommendation at 0.7 g/kg/day, with 69% below the national recommendation, showing that inadequate protein consumption is a concern regardless of the weight loss strategy employed”

I don’t know if this “study” shows much of anything. They’re basically saying protein intake was low in WLI users and in non WLI users 🤷‍♂️

Very wise, sorry you’ve suffered and been judged, un needed.