To wonder what happens when you reach a healthy weight on Wegovy etc?

[Milsonophonia]

I have three friends who were mildly overweight who've used Wegovy. All are now looking very slim - one looks a bit frail - she's lost 3 stone. Two of them lied online about their weight to get it. Anyway, they are happy with their new thinness and the new reasrch that it's a potential wonder drug.

What happens when you stop? Do you get the anti inflammatory benefits forever? Or does everything on your body return to how it was - hunger back, no anti inflammatory benefits?

I'm constantly tempted - have a bmi of 29 and need to lose a good stone and a half - but can't seem to find anything about people who have stopped the drug.

Also I'm slightly worried one of my friends is going to disappear, as she's already thin but still taking it. Can you just take it forever?

My partner has been off it for 3 months. He had a BMI of 36 when he started and it’s now 32. He’s just started binging again in the evening, he ate a bag of crisps and four muffins after eating 3 normal meals in the day. His obsession with food had gone away but now it’s returned. He started 112kg and went down to 99kg. I can imagine he’ll be back up by Christmas.
The most worrying thing about his experience with Wegovy is he has lost muscle mass and is now very weak.

As soon as you stop and it’s out of your system (not very long), then all of the food noise will be back the same as before. Unless you make serious life-changing diet and exercise changes, then some/all of the weight will come back.

I’m not sure if it’s possible to be on a lifelong maintenance dose, if there is a pharmacy doing that then maybe someone will come along to say.

You do need to use the time on Wegovy to improve your eating habits and fitness. I started Nov last year, so I’m coming up for a year and almost at the point Boots will stop prescribing (I’ve used Boots all the way through). I’ve gone from 117kg to 73kg, and they’ll stop prescribing at 70kg. So that’s pretty soon.

I’ve not noticed increased bingeing as I’ve gone through, and I’ve gained muscle rather than lost it as I started going to the gym regularly. I couldn’t have exercised at my start weight, I was too big, but once I was about 15kg down, I had energy to start, and I’ve kept going.

At the end, it’s not a magic bullet, you still have to do the work of eating sensibly and exercising, and if you can’t/don’t want to do that then it is maybe a waste of money.

Obesity causes some inflammation- that should be reduced long term, but won’t stay reduced if you regain the weight - or it’s suppressing inflammation caused by something else.

Will it all go back on… I don’t know. Something like 90% of people on any diet put the weight back on, and doctors seem to say that people need to be on it long term. But no one’s prescribing it long term, at the moment.

Still feels better to me to lose the weight and give myself the chance of keeping it off. I am glad I did it. I started many diets over the years, and the difference this time is that I’ve been able to keep going to (very nearly) target weight.

My friend has also experienced loss of muscle mass. Tbh she's very slim now but looks as though she's been on bed rest for 6 months - no muscle tone at all. Presumably if you work on that though you can mitigate it.

Thanks for your reply and it sounds as though you've taken it seriously and done really well!

I'm going to have to stay on it at a reduced dose forever as I'm highly resistant to losing weight

I gain weight on 1000 calories and maintain on 800

I will never be able to cope with the food noise at 800 calories, I will literally feel hungry constantly and know I will gradually put it on

I eat chicken breasts or salmon and veg every day for two meals on Mounjaro. And that's it - never hungry, never think about food

I'm going to have to stay on it at a reduced dose forever as I'm highly resistant to losing weight

Is there such a system in place that is doing this? Asda for example have said they stop prescribing at a healthy bmi.

Yes this is what I wondered, although my friend just buys it through an online place

Weight loss drugs are meant to be aimed at people who have no other options & have exhausted all other alternatives. People who are so fat that the damage their weight is doing to their health is worse than the risks associated with the drug. If you only have 1.5st to lose you would be absolutely mental to risk your health for that imo.

Thank you for sharing. Do you mind me asking how old you are, that you gain weight with 1000 calories? I was wondering if it's a menopausal thing. How much weight have you lost on it?

I've thought about using it, but the possible side effects worry me. And I also worry about putting the weight back after short term use. At the moment I'm doing intermittent fasting, and it's been working, albeit slowly. I've become used to managing the hunger during the fasting window, and I worry that if I used the drug, I'd get used to not feeling hungry, and then it'd be a shock once the hunger started again.

Your example of people who lied to get this is what I find really worrying about this injection. I understand its use for morbidly obese people, but this isn't the first time I have heard about people managing to obtain it by lying.

In all the concern surrounding obesity, I think the other end of disordered eating is in danger of being forgotten.

Most of the research I have seen suggests that people do put the weight back on. For some people, being on semiglutide gives a chance to regulate their natural eating habits. Most people don't necessarily eat because they are hungry, they eat because they can. My partner struggles with weight loss and we had this conversation the other day, he said he very rarely actually feels hungry which I was not surprised to hear. He is constantly munching, then "diet starts on Monday" where he eats very little. Come Saturday, he is having "cheat days" where he eats everything in the fridge and the process starts again on Monday.
Muscle loss happens with most diets - muscle is a non-essential tissue and unless you are working out to mitigate the loss, the body will prioritise other tissues and organs. I am aware that quite a few bodybuilders in the US (where semiglutide is more affordable and common) use it to cut for the show with very little muscle loss.
For most people for whom the drug is prescribed, it will likely need to be more or less a permanent feature in their lives. They will lose access when they reach normal BMI, gain the weight and then be in the bracket to be prescribed it again, I guess.

Everyone I know who is on it is on it for vanity reasons. I have a BMI of 28 and could get it easily online.

https://podcasts.apple.com/gb/podcast/zoe-science-nutrition/id1611216298?i=1000660424275

This podcast features a doctor involved in the trials who discusses your question at length. Well worth a listen.

I’m taking Mounjaro. I started off with a BMI of 31, which is obese, but only just. I was advised by a doctor to lose weight as my liver function tests suggest Non-alcoholic fatty liver disease.

I have lost 10lbs in 6 weeks so not drastic but significant. BMI is now 28, still overweight but I would not have got Mounjaro if I had applied for the first time at this weight.

I would like to stay on it until my BMI is in the “healthy” category, which means losing another stone, more or less.

Each time you renew your order with med Express it asks for your new weight. My last order gave me a BMI under the threshold of 30 and that was fine. I have no idea if it will reach a point where they stop prescribing.

I have read and listened to all the information that suggests that the weight will go back on again but I do feel that I will be able to control my eating and lifestyle better when I am less heavy. I figured that losing the weight but with a risk of regaining it is still better than doing nothing at all. Time will tell I guess.

@Milsonophonia when you say "Everyone I know who is on it is on it for vanity reasons. I have a BMI of 28 and could get it easily online." do you mean from a reputable pharmacy registered with the GPhC, and you could acquire it easily by lying about your weight and providing fake photos, or similar? Or do you mean from an unauthorised illegal supplier of vials of what may be insulin or other drugs?

Your friends are making extremely poor and dangerous decisions, and I don't think I'd be basing my opinion of Wegovy for weight-loss for obese people on what your friends are doing.

I'm on mounjaro with a starting BMI of 36.

I have to provide weekly weigh in and a photo every 6 months. I am using a reputable online pharmacy and am aware of other people who have been rejected for prescriptions due to their answers to the medical questions or because their photos have been rejected.

Obviously there will always be people who are willing to lie but on their own health they risk it.

What happens when I reach my target weight - then I will go onto a lower maintenance dose until I feel confident that I can keep on with changed diet and exercise.

Hi I just looked the other day and monjorou has biggest weight loss as a percentage compared to the others but on the website I am looking at buying from as seems reasonable can’t really see many of the side affects. What are they did you get any as I am curious about trying it. I am much bigger bmi than you but the other thing if you start off with 2.5 mg and then every four weeks it gets increased up to 15 mg don’t they keep you back on the lowest if you have lost all your weight to just maintain

So by 'maintain' you mean on it forever?

The current thought is that it could be like medication for essential high blood pressure, people need to take it permanently to keep their BP down. Research is going on to find ways to make tablet versions of these medicines that are as effective as the injections.

The largest studies looked at people on semaglutide for 4 years and found no unexpected side effects, weight loss maintained and many other benefits around cardiac health. So, if that can be converted into a simpler tablet, then perhaps that's a long term solution.

Or effective ways of maintaining weight loss when stopping taking these medicines may also be found. The issue of maintenance is a problem for any weight loss method, whether that's dieting alone, all the various bariatric surgeries and other weight loss drugs.

The issue of maintenance is a problem for any weight loss method, whether that's dieting alone

Yes agree, but no side effects with diet alone!
I am no conspiracy theorist, but if you wanted a drug to make money with, then a drug that makes people slim with ease but you have to take it forever...surely that's the holy grail?

Hi. I can’t comment on the maintenance dosage but on side effects I have only had one, which is increased acid reflux. I suffered from that anyway so just increased my medication to deal with it. It’s because it makes the stomach empty more slowly.

Other than that it’s fine. The main thing to get used to is just not getting excited by food and having to force meals down a bit. I’d describe it as feeling constantly the way you do when you’ve been mildly unwell and have no appetite so just don’t really fancy anything. That gets pretty boring if, like me, you are a food lover.

I have gone from a BMI of 38 to a healthy weight. I use a responsible online prescriber with regular weigh ins and photos. They can keep prescribing until I reach the lower end of a healthy weight, so I am now reducing my dose to just enough to maintain but no longer lose. They can keep prescribing because I am not at risk of becoming under weight.

I think the prescribing guidelines will evolve to be more explicit about maintenance doses. I am eating well and exercising but I know I have lost weight because the food noise has been turned off and I need it to stay off to maintain.

Injections aren’t very complicated at all from a user perspective. It’s only once a week, very fine needle and you’re not having to find a vein or anything, it just goes into any fleshy bit of the body. The pens control the dosage without much risk of getting it wrong. Having the medication in your subcutaneous fat makes it release slowly.

Lots of tablets can have a bad effect on the stomach eg ibuprofen, so injection administration is better for the body overall. I think perhaps tablets would be simpler from a storage and production perspective.

Well, dieting alone is also not as successful, as the studies have shown. That's why there needs to be a trade off between the risks of obesity and the risks of side effects. I'm using Mounjaro, which is tirzepatide, a similar drug to Wegovy (semaglutide) - side effects are usually mild and are gastric related. There are things you can do to mitigate them usually. The risks of long term obesity are obviously much more severe than some possible gastric upset. Hence it being worthwhile for me to use it at the moment.

Of course drug manufacturers are looking to make money. Those who make BP drugs, statins, blood thinners, etc etc will also make a fortune from people who need to take them permanently. When drugs are able to be made generically, then the prices will drop due to competition. The manufacturers of these drugs have done the R&D and all the drug trials and have an opportunity to make their money back and have a period of exclusivity.

Goodness knows the diet industry get enough of obese peoples money, for less outcomes.

I have lost weight consistently for the 8 weeks I've been using Mounjaro so far and have not found it hard to stick to. I have not had any serious side effects and find that the ability to stop thinking about food all the time to be exceptionally freeing. Perhaps it's going to a bad decision in the long run, I'll let you know.