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.

Goodness me we’ve had 36 pages of these unfounded claims, then we’ve had a bit of a breakthrough and now we’re straight back to it 😭

I wasn't talking about surgery; however, it would be an interesting comparison. Studies seem to show that only 60% of people who have undergone surgery regain all of their weight compared to over 90% of people who stop WLI.

It'd be interesting to see how much of that difference is down to the ongoing support you get after surgery, or if there are other things going on.

I used to work with someone who had bariatric surgery, and her attitude to food appeared to be much healthier than everyone else I know, including those who are now on GLP-1.

I don't think anyone should be prevented from re-accessing GLP-1s if they do start to regain weight despite accessing proper support, like those who go down the surgery route. I just don't think continuing on it for life should be the end goal.

I guess the other difference is unless there is a cost issue, no one has to stop weight loss injections, they are recommended for long term usage,and of course we know all tne health benefits they bring.

you don’t even need to stay on, if you start to regain you are allowed to buy another pen, as as long it’s within a year of stopping. So you never need to get obese, or even over weight again. As said up thread, you can maintain at 20, feel it slipping say 10 months later , go to a bmi of 22, and you can order another pen or two and knock your weight back down.

so the regain is only for those who come off permanently. So unless you can’t afford it, or are one of gnr small minority with side effects, them maintaining is very easy, and regain really not something to be concerned about.

It definitely is harder to keep it off, versus accessing and then either staying on or going back to WLI. 90% of people putting it back on after stopping WLI isn’t exactly a convincing number, it suggests that it doesn’t do anymore to change long time lifestyle choices without it than “the old fashioned way” does, so realistically you’d have to likely rely on it forever.

I appreciate some people are happy and able to commit to potentially lifelong WLI - I’m just not one of them.

What I was (perhaps unsuccessfully) getting at was that if getting it off and being more likely to keep it off was the main goal of those on WLI, wouldn’t a more successful and therefore more obvious choice be surgery?

I completely get the desire to keep the weight off - I’m hoping I never see my start weight again. I actually have no intention of getting to a healthy BMI, the top end of mine would put me back at a weight I haven’t been since I was 14. I appreciate… medicine and science, but I’m not 14 years old and don’t want that body back. I’m comfortable with being a “just” overweight woman rather than an obese one.

But if I was going down any avenue, I’d take the recovery from a gastric band over injections.

@ChunkyMonkey36

I know two people who have had band surgery. it's gone very well for one - I seem to recall she's had skin removal as well - but not so well for the other. In the latter case, however, it was complicated: she was in an abusive relationship and was being force fed by her jealous now ex.

That’s interesting, I’m the polar opposite, I’m staying on for all the health benefits like reduced cancer, cardio vascular health , anti ageing etc and don’t want to live my life battling with the scales any more. I love eating healthy, no cravings, irs so freeing.

id absolutely take that over having my body cut into and the recovery. And then wanting to eat, still having the cravings, and being restricted. It sounds awful to me, utterly Brutal.

@WearyAuldWumman

I only know one. She lost 17 stone, and has had a complete personality change during that time. She went from being essentially on the sofa with pizza to various sports clubs, teams, etc etc. A real new lease of life.

One of the people I know who came off WLI ate 3 cakes and a LOAF of dry bread on the drive home from work the week she stopped taking them. So definitely one for the “return of food noise”!

I guess I see both of them as restrictive - in that for most people the cravings come back if they stop taking WLI.

So if I was going to do something medically preventative, I’d rather it as a “one and done” thing than doing it every week, probably forever.

But again you don’t need to come off, and we know they bring huge health benefits. And the ops are not once and done the majority regain it all.

It's not really an equal comparison because WLIs are so much more accessible. In the UK, as things stand, lots of obese people won't have the choice between the two- I wouldn't have even at my heaviest.

Being obese doesn't mean you meet the weight requirements to have surgery. An obese person may not be able to lose the weight to qualify, or could be obese and still too light. It's not going to be an easy ask to get a surgeon to do it if you're BMI 31, yet your obesity will nonetheless be a health risk. I also haven't been able to find any private surgeons at all who'd do it at BMI less than 30, admittedly only in a quick search. But we know lots of people take it with a starting BMI of 27-30.

If you can't access bariatric surgery on the NHS either through being too light/heavy or simply because the waiting list is so long, paying privately for WLIs is much more financially accessible than for surgery.

Then, once a person has got to a healthy BMI with WLIs, bariatric surgery will no longer be an available option without significant weight regain. Whereas long term WLI use is.

The only time that I can keep weight off is when I'm able to exercise. Life got in the way for me for a while - I was working full-time and caring for three adults at one point.

I keep joking that the gym was a lot easier when I was only in my 40s. (That's certainly true for my patella alta. I knew that my knees had a tendency to 'give' but I didn't have the grating and pain at that point.)

However, now that I'm in my mid-60s my time is my own (not necessarily a good thing) and I at least have the patella alta diagnosis which means that I have a better idea of how to work round my limitations.

Weight loss is normally quite slow with me (apart from the sudden drop caused by bereavement trauma and that left me with wasted arm and thigh muscles). I'm relieved that I've managed to get those back up to normal.

I said above that I would have considered the drugs were it not for my pre-existing health conditions. I've been told that I have to take lansaprazole for life because of the possibility of gastric reflux causing cancer (as happened to my aunt - always very slim, by the way - it was nothing to do with eating habits) but lansaprazole is implicated in osteoporosis (which runs in my family).

The reflux means that I'm not allowed biphosphonates, so I'm on HRT as part of my osteoporosis prevention regime. (There's a definite family history of osteoporosis and I had two fractured elbows in my 30s.)

I can't risk exacerbating the reflux and I certainly don't want to exacerbate my IBS, so I'm taking the advice of my doctors and avoiding the weight loss drugs.

I knew two people who were prescribed amphetamines for weight loss in the '70s. It worked well for one but the other died of a haemorrhagic stroke.

I'm aware of the risks associated with the lansaprazole and HRT but I'm stuck between a rock and a hard place, so I'm trying to eat sensibly and building up my exercise regime while I'm still able to do that. Fortunately for me, the council leisure centre runs classes for oldies, so if I become unable to use the gym facilities, I have the classes to fall back on.

I was originally referred to a senior class by my physio and the exercise there is what started to take the weight off me. One of the women in the class has lost more than anyone else on Mounjaro and now seems to have stopped attending the class, though she might be exercising elsewhere.

It's a slow process for me, but given what happened when I accidentally lost weight rapidly, I'd rather take my time.

My GP has been adamant all along that the weight loss is slow because I've been building muscle and my recent scan seems to bear that out.

I understand your thinking about the 'one and done' process of surgery, but I think I'd hate not being able to enjoy a meal out. The acquaintances who have had the surgery seem to be on a very restricted diet.

The problem with the idea that continuing for life shouldn't be the end goal is that there isn't any other way that's more likely to keep a formerly obese person a healthy BMI. You talked about needing support, but you've not identified what that is, nor explained what these 'other ways' are and why they're preferable.

An obese person who gets to a healthy BMI with WLIs won't be able to get bariatric surgery, lots of us wouldn't have qualified for it in the first place, and waiting until people start regaining the weight comes with health risks.

Many global health organisations believe staying on for life is the end goal , and I think it’s for the reasons binus raises. What’s the alternative.

thr world is getting fatter. Obesity is a killer/, 80 percent of people regain all the weight lost, we know a lot of that is due to metabolic issues, not just stupid, fat, lazy. Insulin resistance, poor blood sugar management, high cortisol. The drugs resolve this.

if it was just people were stupid or lazy, the drugs wouldn’t work. Because you can push through. Unless you’re on too high a dose. I could sit and eat a three course meal, followed by a tub of Ben and jerrys. no issues. I don’t. Because my metabolic issues are now corrected and working properly. So I make healthy choices. I serve a health portion. I stop there. And I don’t think about it. I am not still hungry, I’m not sitting thinking about the chocolate in the cupboard, or the bottle of wine in the fridge.

for very few people is it about lack of knowledge, greed, laziness, it’s about their biology, which is why regain is so common and why the drugs work.

and for those who use food as a comfort, or it is uncontrollable greed, then the drugs don’t work. Because you can push through.

But how do you know how much support and supervision is provided if you haven't taken them?

I can't ignore the food noise long term.

I can do it for stints, but not for long periods and definitely not forever.

I didn't always have food noise. The food noise came on pretty suddenly about 12/13 years ago and my weight ballooned. I'd had a BMI of 21.5 and held steady for 12 years, all my adult life. I was also a healthy weight as a child and teen.

My weight ballooned and all efforts to stem the ballooning worked for a period of time (6months max) but I only once in 10 years got back to a healthy BMI before ballooning again. The food noise was constant and unrelenting.

I then found ozempic and within 48 hours it went away. I felt "normal". Like the previous 12 years had been a dream. It was like a miracle. The weight melted off, admittedly fairly slowly (about 0.5-1lb a week) but it was constant, steady loss, even over Christmas and birthdays. I felt hungry again, I had hunger cues that weren't just thinking I was hungry, it was easy to stop when I was full. I felt full, which is something I hadn't experienced in a very long time.

I was very worried when I came off that the food noise would return, but thankfully it wasn't and apart from a small increase immediately after stopping (3lbs) I've maintained my loss since.

For me, the risk of side effects were worth it and I'm incredibly grateful the medication worked for me.

I could never have afforded surgery (well I could if I didn’t use WLIs and saved all that money for years before someone says it). But the idea of a gastric band has never appealed to me. For a couple of reasons.

Firstly as far as I understand, with a band you can often need to go back for further readjustments etc & I likely couldn’t afford that even if I managed to find the money for the initial surgery.

But mostly, it wouldn’t change my food compulsions. Yes I’d lose weight becuase I’d be able to eat far less, but it wouldn’t alter the way my brain thinks about foods. And only eating when I was hungry or stopping when I was full weren't things I was doing before, I’d quite often eat past the point of pain. So I’d just be miserable and obsessed over food still.

From what I’d read foods like crisps chocolate etc can still easily be tolerated after the initial period and permanent success is less than half and I have pretty much no faith id be in that half 😂

I also don't understand the issue with being on it for life if needed. I'll be on my thyroid medication for life, because my thyroid will never improve.

We need to start seeing that being fat is a SYMPTOM of obesity, which is a disease.

Obesity is a disease, that needs treatment, and like for many diseases, possibly for life.

Yes, I've yet to see anyone set out a logical rationale for why it's not a desirable outcome given the unpalatable reality of what formerly obese bodies tend to do.

Appreciate that some people who use them can't afford it long term, but there's also commentary from people who don't even take WLIs themselves but nonetheless feel the urge to tell others what they should be doing.

i also find the desire some people not on tnem have to tell folks on tnem not to take them long term very curious, especially given the fact regain is used as a weapon to beat those on them with.

the convo is like this.

you shouldn’t use them you learn nothing ,
well no, they force you to eat healthy as you get gastro effecfs if you don’t
we don’t know the long term effects
well no, we have 4o years of human use, and we know the risks of obesity, and that’s enough for me.
you will pile it on when you stop,
well, no again, I shall stay on so won’t regain.
well you shouldn’t stay on either.
well tough I am, are you taking them, do you habe experience.
no, I’m just here to give you advice you didn’t ask for as I’m concerned
well no, no you’re not concerned, you’re jealous /resentful.

@Flushitdown

We need to start seeing that being fat is a SYMPTOM of obesity, which is a disease.

I agree with this, but also believe that obesity is not a single condition. There are multiple factors which contribute to it.

Insulin resistance is one…. that’s partly genetic and partly environmental. The environmental causes are many, but the one which IMO is the big change over the last 50 years or so is the food environment. Partly the food itself - the increase in UPF’s - but also the increase in frequency of eating. It used to be 3 meals a day, possibly a snack but not always, and “pop” was an occasional treat. Nowadays many people snack and graze their way through the day and consume large quantities of sugary drink - and that leads to chronically raised insulin levels, which in time produces insulin resistance, which raises insulin levels even further. The higher the insulin, the easier it is to lay down fat, and the hungrier you are likely to be.

The there is compulsive eating/emotional eating/binge eating - overlapping conditions, which are very common. Most people eat tasty food for pure enjoyment some of the time. But while some are able to control that hedonic instinct, others really can not. And the UPF’s add to this, because they are inherently addictive.

I keep on hearing how WLI’s quiet the food noise. For me, treating my overeating as an addiction and removing the foods which were particularly triggering has turned the food noise way, way down. Not gonna lie, it’s not zero. But it is manageable. I saw a video about ways to increase GLP-1 levels without medication, and it was things like eat real food, less sugar and processed carbs, more protein, intermittent fasting. A lot of the same things that people on GLP-1’s are encouraged to do. Presumably, the more you switch to that style of eating, the smaller the maintenance dose you would need. And clearly some people are able to maintain the loss without a maintenance dose.

Yes, I've yet to see anyone set out a logical rationale for why it's not a desirable outcome given the unpalatable reality of what formerly obese bodies tend to do.

Firstly, let me be clear, I have no objection to anyone on this thread or elsewhere being on WLI, for however long. I have no dog in this race. It's a discussion forum. This is a chat thread. I am neither fat or jealous. I can discuss Artemis 2 without being an astronaut.

In real life, I only know one person who is on them, though I could hazard a guess about a few others. It's none of my business. Though my one friend on them is looking alarming, has lost 7/8ths of her hair, and should never have got her hands on them as she has a 30 year history of severe eating disorder.

That aside, the issue with being on them longterm is, as I understand it, because of the potential over time for any of the serious adverse effects associated with them to occur. Also, because there are no longterm studies for the use of GLP-1s on weightloss specifically. There is realtime data for diabetics over say 20 years, but we won't know the cumulative effects of GLPs on other subgroups until we do. So many doctors with broader knowledge have urged some caution, but their voices tend to be swallowed in the swell of understandable enthusiasm.

Many drugs have unforseen longterm effects. So PPIs, necessary for millions, have been shown to have negative bone effects with longterm use, particularly with hip bones. Ditto, a surprise longterm effect of continuous use of SSRIs is bone loss, I've read.

Apart from financial reasons, I expect many people just don't want to feel nausea or adominal discomfort, if they have those side-effects and they have not really abated, over a long period.

A level of muscle mass loss, and bone loss that might lead to future osteoporosis, care of unsufficient nutrition intake on WLI has been put forward, as discussed earlier in the thread. Recently I read that some scientists have found there is an increased risk of some arthritic disorders with GLP1 drugs, which I found surprising. An old age full of sarcopenia, inability to get around, and with crumbling bones, would not be something to look forward to.

If, for example, some risks increase with longterm use of WLI, say muscle loss or pancreatitis or kidney problems, and the weightloss results of continued use start to plateau out after three or so years, as some studies have suggested, then the risk/benefit ration might change for an individual. I don't think anyone really knows the longterm safety or longterm benefits of these drugs used for weightloss. These things come out over time.

You could google these things, if you were interested. You could google the question, if you seriously wanted an answer. That's what I do.

@icecreamflowers "Also, because there are no longterm studies for the use of GLP-1s on weightloss specifically. There is realtime data for diabetics over say 20 years"

I continue to have difficulty with the notion that the body knows the reason why a drug was prescribed, and can choose to react differently.

You clearly do have skin in this game, you’re almost obsessed. It’s misinformation, negativity, no balanced or reasoned argument. Whay you say doesn’t even make logical sense, you appear to think scientists can’t understand the impact of a drug on tne body of it is taken for one thing and not an other.

so I think it’s clear you’re not going to admit whay you’re issue is. And I suspect jf we could see you we would know exactly what the issue is.

Your googling is very selective. You could read up on the studies showing numerous health benefits for obese people. Or you could carry on only reading those reporting negative effects, if you prefer, but I wouldn’t bother trying to present this selective reading as some sort of objective assessment of the current scientific knowledge of risks and benefits.

https://www.england.nhs.uk/2026/04/million-people-offered-wegovy-cut-heart-attack-stroke-risk/

https://www.medicalnewstoday.com/articles/weight-loss-drug-helps-heart-regardless-of-amount-of-weight-lost

https://www.theguardian.com/science/article/2024/aug/31/weight-loss-drugs-ozempic-slow-down-ageing-process-study

https://www.alz.org/blog/2025/glp-1s-and-alzheimer-s-what-you-need-to-know

https://www.nature.com/articles/s41587-025-02932-1

https://www.theguardian.com/news/ng-interactive/2025/may/17/weight-loss-drugs-altering-views-how-body-brain-work

I don’t think you can compare the use of semaglutide like for like though. The dosage for diabetes is far lower - on a par with a maintenance dose for weight loss. Dieters are taking far higher doses so it stands to reason the long-term impact of that isn’t actually known yet.