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.

The point about her not understanding nutrition is that I would expect someone on WLI to be given an idea of what macros they should be aiming for based on their current weight and goal weight. At the very least, advice on calorie and protein intake. She got nothing, zero advice. Just an email about what to eat to manage nausea and a few recipes.

She was utterly convinced the WLI alone made her lose weight (or not in her case) because that is what the ad said. She's not a stupid lady; she's very smart in other areas, she's just never had any interest in nutrition, so she believed the ads.

She is considering macros now. She seems to be trying to emulate the way I eat after that conversation, but she doesn't weigh her food or count her macros because the WLI provider told her it works without counting calories, and yes, we have had that conversation and she is now aware she needs a calorie deficit but she seems convinced she can get this by simply cutting out pasta and cheese, which maybe she can. IDK. IDK how much pasta and cheese she ate during a typical week.

Also, why would I want her to stay fat? She is my best friend. I love her and want her to live a long and healthy life. She is the one and only person I will talk to in depth about diet and nutrition in rl because I want her to succeed, and I want to help her even if it does risk being triggering for me.

Okay, I can see I've got them muddled but my initial point still stands – data exists about the impact of using semaglutides for diabetes long-term, but there isn't data yet for taking them at the highest possible dose long-term just to lose weight.

To be fair, I did refer to T2D being prescribed it, and I didn't say my T1D godson was – we were just talking about the doses.

@Frequency you might say she's not stupid, but the evidence of what you're reporting about her behaviour says otherwise. At the very least she seems completely incurious and strangely passive. I think it's reasonable to assume she has missed information, not read it, or not understood properly.

I have used many different suppliers and they all send information about diet and nutrition, have it available on their website and so on. No one has to care about "macros" in the sense that current social media obsessives seem to bang on about them, but you can simply be aware that you should prioritise protein and otherwise eat a balanced diet. It's not rocket science and it's pretty darn obvious if you are trying to lose weight, via any means, that you need a calorie deficit to do so. Even the patient information leaflet included with every pen explains how it works and that it goes along side a calorie reduced diet - you might want to check that your incurious friend has actually read it!

Gosh some folks really are panicked about these meds aren’t they. It’s such a shame for them. And I wish them all good luck in their weight loss journeys.

I can only speak for myself and those I know . I feel amazing. From the first jab my energy levels soared and my stomach started shrinking back. No side effects, all my blood tests now smack bang in the middle of the healthy range, look years younger, size 18 down to 8, workout 5-6 days a week. High blood pressure now normal and off the harsh meds for that, sleep apnea gone, cholesterol now optimal, cortisol levels which were very high, now normal.

been maintaning for about 14-15 months on a maintenance dose, for me that’s 5mg.a maintenance dose is what works for you. Some people seem confused on this. Weight completely stable, diet very healthy, any lose skin has shrunk back to the extent you’d never know I’d lost weight, body looks toned and fit and I’m in my fifties.

Husband the same, my bmi is 20, his is 25 now, all his blood test results came back last week, he started well after me when he saw the results, all incredibly healthy, his asthma and mild excema resolved or reduced.

we also have 4 friends on it, all having similar results, two other friends, can’t use it, one due to cost, the other due to contra indications. Sadly both still the same weight or heavier, with the same health issues getting worse, even though they have tried very hard.

i understand the cost restrictions I don’t really understand the fear, ive always been comfortable to take prescription medication for the purpose its prescribed to me, and dont suffer hypochondria/health anxiety etc. but i dont understand some people do feel fear from this thread, and as said, i feel thats a shame for them to be missing out, and wish them luck.

@Passingthrough123 "just to lose weight" is pretty darn important if you are obese or overweight with a weight related health issue. There seems to be this underlying suggestion that using medication to lose weight is somehow a frivolous use of a medication. Using it to treat T2 diabetes is fine, because it's a valid disease, but obesity is not considered something that should be medically treated as it's not a valid disease, it seems.

The trials for semaglutide for T2 diabetes used the same maximum dose, 2.4mg, that is typically accessed for weight loss. Not everyone on Wegovy gets to the highest dose and then stays there for a long time, people work up the dose levels and stay on the one that works for them. You're not forced to get to 2.4mg and then stay there long term. There are ongoing trials for all GLP1s and there is no evidence emerging from them that using them for weight loss and for longer amounts of time has a different safety profile compared to long term use for T2 diabetes.

I tried. The side effects were absolutely unbearable for me. Constant headaches and nausea. I tired several different types on glp-1s and they all made me dreadfully ill. Im seeking therapy at the mo to try and address the underlying causes of my overeating.

She showed me the ad, and it does say she doesn't need to count calories. "Are you sick of counting calories? Are you fed up with being told to eat less and move more? It doesn't work! Try Juniper!" It's an ad I was constantly bombarded with when it first came out, so I knew it anyway, but that's where she got the idea from.

She never went with Juniper because it was too expensive. I think she uses MedExpress or some other online pharmacy.

She also showed me the emails she gets from the pharmacy when she was trying to prove her point, which, to be fair, did mention protein and lean meats, hence the steak and veg instead of pasta and cream, but nothing about a calorie deficit, exercise, or reading and understanding nutrition labels.

She's not stupid, she just has no interest in nutrition and was brought up to believe home-cooked = healthy. She's also from the era of the food pyramid, low GI diet, and carbs = good. Fat and red meat = bad. I'm not entirely sure what she thought cheese was, but she did point out that she uses low-fat cheese.

I have researched it (I have used WLI so it's in my interest) and there is nothing in the literature that makes me think long term use of them is any worse than long term use of other medications which are used to treat chronic conditions such as statins, thyroxine, some medications for heart dieases or anti depressants. Yes, there are potential risks, but those risks need to be weighed up against the risks of not taking them and the benefits of taking them. We DO know the long term risks of obesity and we also know that obesity is a chronic disease. Makes sense to me that some people will need to be on medication form life. Like depression, there are steps people can take which lessen the risks or improve the outcome and not all people need medication for life, but some do. And taking those medications needs to be weighed up against the risk of not taking them.

The point about her not understanding nutrition is that I would expect someone on WLI to be given an idea of what macros they should be aiming for based on their current weight and goal weight

You can easily access all of that info on the same internet you use to order the drugs, if your provider doesn’t offer it, which many do.

By the same token, when people claim “just eat less and move more”, who’s providing the nutrition info there? Anyone can go on a non medicated calorie defecit diet & the macro requirements would be the same as with medicated weight loss.

I’ve done both and managed to source my own info when I needed it. Plus if she’s made no change to her eating habits, and you’re happy enough with her macros to eat her food, she’s not got an issue has she 🤷‍♂️ Not knowing the terminology hasn’t made her unhealthy.

Um there is only 2.

@Frequency your one friend and her odd incurious behaviour and her willingness to take adverts at face value is really not representative or indicative of anything.

Having said that, being fed up of counting calories, as that advert apparently says, is clearly meant to indicate that dieting alone is difficult and usually unsuccessful. Which it is. It isn't the same as suggesting that you can lose weight without being in a calorie deficit. How you achieve a calorie deficit is up to the individual and doesn't depend on calorie counting, although lots of people do. I have lost 11st plus on Mounjaro and I don't calorie count. I use other methods to have a calorie reduced diet.

MedExpress, as you mentioned it, have a section on their website about WLI and healthy eating/exercise:

https://www.medexpress.co.uk/wl-guide

The information is there, the fact that your friend doesn't know it is down to her and not relevant to anyone else.

Don’t need to count calories becuase you’ll naturally eat less. That doesn’t change the scientific law of cals in vs cals out for weight loss 🤦🏻‍♀️

im sure she’s not stupid as such, but I’d seriously question the common sense of someone that doesn’t know you have to be in a calorie defecit to lose weight

Anyone else finding it surprising and rather unfortunate the scared posters all appear to be friends who peo-oe on them who either en masse suffer awful side effects, or take it too far and look awful or continue to eat shit and don’t understand how weight loss works.

none of them seem to know anyone having success even though statistically it’s the overwhelming majority of people , maybe that’s where all their fear comes from, which is really unfortunate for them. But I get that.

Well, yes, you and I know it means that, but she didn't. She knew she needed to eat less, she knew what a calorie is, she knew how to count calories and had done it in the past with varying degrees of success, but when the ad told her she didn't need to count calories, she assumed the meds did something magical, and she didn't need to concern herself with calories. The thing, they don't make her eat less. They have zero effect on her appetite, but she has still been trying to make changes. She refuses to give up on them because she said that will feel like she's wasted thousands of pounds for nothing. She has now switched from Mounjaro to Wegovy to see if she gets better results there and is now considerate of calories, if not actively counting them.

She's admirably dedicated to weight loss, even though she is bafflingly clueless about the mechanics involved in it. Apparently, the only reason we are friends is that she knew I'd lost a lot of weight, and my answer when she asked me outright how I'd done it was unsatisfactory, so she decided to try to befriend me to gain more insight into my eating and hopefully get a better answer the next time she asked me how I did it. She does assure me that it is not why we are still friends, but it is why she went out of her way to become my friend (and here's me thinking she just liked my hair and taste in music).

No I don’t recognise those scenarios at all within my own circles anyway and I certainly don’t find it unfortunate that people are researching medical evidence as it stands today and are making measured choices for their own bodies, as everyone should with medications which profoundly alter the digestive system. And I certainly do not see that as scared but judicious.

What I do find very sad though is that people seem hell bent on commenting negatively about those who choose differently to themselves.

Did you quote the wrong person or did my post touch a nerve, if you take a few deep breaths and calm down, no one, myself included said it was unfortunate to research or make measured choices. Your comment doesn’t link to what your quoted

if you’re upset, and it feels like you are, upset, take a step away, nothing is aimed at you 💐

Hang on she’s spent thousands??? So she’s years in? And nothing, and STILL taking them?

and just to add, I actually would use the word stupid at that point. To be years in (even months) on a medication you know is not having the desired effect, while
possessing the knowledge that eating less would help her lose weight but blindly ploughing on because she believes it to be magic…and not once in that time contacting your provider, or anyone else (even someone on social media running a WLI account) for advice or support? I’m not sure there’s another word for it.

But…even if all that were true, and I can’t jazz it up - I don’t personally believe it… none of that demonstrates that WLI are dangerous, quite the opposite, she’s been taking them for years without any effect at all!!

A discussion about one one weird friend is really irrelevant to anything.

The original question from @Donteatmychips has been answered well, across the thread. Cost, being medically contra-indicated, and people's individual circumstances resulting in different conclusions to the benefit/risk analysis being the actual reasons.

I hope that people are able to filter out the misinformation and misunderstandings about the risks in order to be able to accurately make their own benefit/risk decisions.

I also hope that the NHS can progress quicker through their rollout of Mounjaro so that cost is less of an issue going forward.

It sounds like she might be one of the people WLIs just don't work for? That possibility is information she ought to have received, I'd be interested to hear whether the supplier told her this and if not, who they are.

Different dosages. Different risk profiles. But mostly it's the dosages, and also the lack of supervision for many people blithely taking them for weightloss.

A diabetic under the care of a GP or a specialist is monitored periodically, and perhaps knows a few warning signs - such as to pay attention to changes in their vision. Diabetics already risk kidney disease and eyesight changes. But it's only been recently that optometrists and eye specialists have been sounding the alarm about an observed rise in cases of NAION, involving sudden blindness, with patients who are on WLI - just one example.

In the US, there are now 70 plus lawsuits from people who experienced blindness while on a GLP1 drug for weightloss.

GLP-1 weight-loss drug lawsuits allege serious side effects

Possible lawsuits in the US are no indicator of anything other than the US's very different legal system and healthcare model.

It must depend who you are with. I swapped around providers a lot, had about 8 in total, and every single one of them offered advice on nutrition and exercise. I didn't take it up as I'm very knowledgeable about nutrition (crappy eating wasn't my reason for obesity).

Admittedly it isn't mandatory but it was certainly pushed - some of them it was one to one video calls wth a coach, others it was webinars or online support groups/ videos.

I don’t need to take deep breaths thanks because I read your post and responded in a perfectly calm and reasonable manner!

If, speaking very generally, you don’t want people to reply to what you have written, in response to you labelling lots of different individuals under the category of “scared” then perhaps a discussion forum isn’t for you?

Yep, I agree. I was just trying to answer the question.

Surely, also, some of the people the OP writes so disparagingly about are on WLI and just partway on their "weightloss journey."
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Edit to add, as the thread is now full:

Possible lawsuits in the US are no indicator of anything other than the US's very different legal system and healthcare model.

Actually, they are an indicator that more than one person has gone blind as a result of WLI. In this instance, more than 70 Americans, though you are right, we can't yet know the incidence of sudden complete blindness experienced by those on WLI, worldwide.