People who think weight loss injections are cheating

[AuntieDote]

I've seen this viewpoint over multiple threads recently, and I'm just really curious to understand it a bit more because it makes no sense to me whatsoever.

What do you think people using the injections are cheating at?

As in - what's the competition and who are they gaining an unfair advantage over? What do you think the rules of being allowed to lose weight are/ should be?

Is it more important to you that overweight people/ those struggling with obesity lose the weight, become healthier, reduce the burden on the NHS, stop taking up more than their allocated amount of space in the world, or just stop doing whatever it is that upsets people so much about the existence of fat people -- or is it more important that they struggle and suffer whilst doing so?

Or would you secretly prefer them to remain fat so you can feel superior?

Is it that you feel you've worked really hard to either lose weight, keep it off or never put it on in the first place, so nobody else should be allowed to achieve this without the same amount of struggle?

What do you think the weight loss injections actually do, and do you not recognise that those on them are also doing all the usual things people who are trying to lose weight e.g. modify their eating, exercise etc? Does it not count that they're doing these things because it's made easier in some ways by the drug?

What types of weight loss support or tools are not 'cheating'? e.g. I used hypnosis once and it worked for a bit, to the point that I felt pretty much the same way I do with the injections i.e. reduction in food noise and compulsion to snack etc. It didn't last anything like as long, but it worked for a time - was that cheating?

Would it still be cheating if they weren't as effective as they are?

FWIW, I really couldn't care less if people think I'm cheating - who cares? Who does it impact only me and my bank balance? If someone said here, press this button and you'll be a healthy BMI overnight and stay there forever I'd press it with both hands and not give a shit about how anyone felt about it.

But it's just the logic of it that baffles me - I've never seen it as a competition and have never felt like getting to or being a healthy weight only counts if it's done in a certain way - I suppose I'm not much interested in what size anyone else is or what they do to get that way, so I can't imagine for a second ever thinking another person was 'cheating' - only ever being happy for them if they're happy and hopefully healthy too.

So your evidence is that someone said this is a “risk”? Of course it’s a risk.

They are the manufactures of ozempic/wegovy, not mounjaro.the former can only be used for two years and yes the risk is proven. The latter for life and limited risk proven.

Not sure why anyone is arguing with the evidence, that if you suffer from obesity, when you stop taking GLP-1 receptor agonists the weight goes back on for 85-90% of patients. It happens over time, and sometimes not all the way back to the starting weight, but obesity is a chronic condition and the odds following any sort of weight loss are that you regain.

Imagining that everyone who takes MJ can come of it and stay slim is delusional.

It does make the use of this class of drugs for maintenance very, very interesting.

I say this from the standpoint of welcoming the availability of this class of drugs for weight loss for people who are obese. But let's not pretend they are something they are not.

Here's an extract from NICE's Evaluation Committee, which draws on the manufacturer's research and modelling:

Weight regain after stopping treatment
3.17 In its submission, the company's model assumed that after stopping tirzepatide, the weight that had been lost was regained at a steady rate over 3 years. At 3 years after stopping treatment, weight was aligned with where it would have been had treatment not started (in line with the diet and exercise support arm endpoints). The EAG explained that the rate of weight regain seen after stopping semaglutide treatment in STEP‑1 (see section 3.11) suggested that the time it takes for the treatment effect to be lost is closer to 2 years. The clinical experts explained that STEP‑1 provided relevant data to estimate the time that treatment benefits would be lost after stopping tirzepatide. They explained that for semaglutide, around two thirds of the weight lost while on treatment is regained within the first year after stopping. Some other benefits gained, such as reduced blood pressure, are also lost by this time. But they noted that there is no long-term data for what happens to weight after stopping tirzepatide. After the first committee meeting, the EAG updated its model to assume that weight would be regained in 2 years after stopping tirzepatide. The EAG noted that assuming either 2 or 3 years for time-to-weight-regain did not have a meaningful impact on the ICER. In response to draft guidance consultation, the company also updated its model to assume that weight would be regained in 2 years after stopping tirzepatide. The committee concluded that it was uncertain how quickly the benefits associated with tirzepatide would be lost after stopping treatment. But it preferred to assume that weight would be regained in 2 years after stopping, in line with the evidence for semaglutide.

So, the calories in, calories out theory is correct. GLP 1 regulates hunger pangs and satiety after eating. Certainly, drugs can be used to aid in breaking old habits. We also need a social conversation about the idea of three meals per day. Is this necessary, especially in our partially sedentary world?

The information below describes patterns of weight regain following the cessation of treatment. It does not discuss the mechanisms responsible for weight regain.

No one forces anyone to eat 3 meals a day. Plenty of people don’t, with many foregoing breakfast, I am unsure why a discussion is needed . We don’t live in some form of prison state where we are forced to eat.

the reason behind 3 meals a day is due to the time it takes for food to pass from the stomach to small intestine, meaning people feel hunger.

but again. How much you eat, how often, is a personal choice. There is no rule, and no one forcing anyone.

This data is out of date, I’m afraid. PP’d above I think is the research link that looked at 420,000 users of these medications (published earlier this year) that indicates that 56% of people keep it off for 12m; and that a further 22% keep off at least 25% of the weight over that period. The incidence of NOT regaining correlates with those who have lost the most, so the more you have to lose, the more likely you will keep it off. The stats show that only 18% regain it in full, vis a vis 80-90% of traditional dieters.

This is not arguing with the evidence - it is relaying on more recent, more extensive research.

but obesity is a chronic condition and the odds following any sort of weight loss are that you regain

I think this will certainly be true for some people (but by no means all), in which case medication should be available long term in my view. Surely it is for diabetes?

Maybe using the word forced isn't appropriate. We're certainly socialised to think we need at least 3 meals per day, snacks etc via our food manufacturers. Marketing and advertising is a powerful tool to create a synaptic pathway between producer and consumer.

Ah, no, far from being 'out of date', I cited NICE's technical guidance which I think was published today.
https://www.nice.org.uk/guidance/ta1026/chapter/3-Committee-discussion#clinical-evidence

Do you want to give the reference for the chart you dropped in?

Misread the date as dec’23. Will go and have a read.

The reference for the chart is in the image - epic research. (Not sure I appreciate your tone btw - this is an informal forum, not an academic symposium. Perhaps you can google per the reference in the chart?)

Good grief. What’s happening here, it’s now turned into some faux pretentious academia discussion. Do people really resent the we are getting slim on the drugs that much. It is so resentful and envious in tone.

I feel really sorry, genuinely, for people who have such significant issues with their weight, they haunt forums furious about these jabs.

Overlooking the grumpiness in the spirit of Xmas.

NICE's assessment is an important resource for people on the thread who want to understand the evidence base.

Have actually read some of this now - including skimming the 920pp report submitted to NICE by Eli Lily detailing their evidence. I’m not clinically trained so much of it is over my head.

As far as I can see, NICE’s remit is to reconcile the evidence for use of medication or medical procedures against the cost and efficacy of them (ie they are about looking at how we spend monies from the public purse, and therefore have an agenda here). They have, consequently taken a cautious approach in deciding to actively support the prescribing of these medications for those with BMIs over 35 with at least one co-morbity on the NHS. Ie they are not about discouraging the private sector’s participation, or even about denying access to those under 35BMI on clinical grounds, but suggesting a rationale under the NHS for prescribing it - because the cost of doing so (there are pages and pages on the costs in supplementary evidence spanning 158pp, allowing for supervision, monitoring, not just the drugs themselves) mean that they are simply prioritising those with over 35BMIs. Given the state of the NHS I am not surprised that a line has to be drawn. This is a ‘guidance’ on prescribing, not evidence that it should not be prescribed, or even a delimiting instruction that they cannot/should not be prescribed to other groups.

I note also that the SURMOUNT trials /evidence were carried out from 2021/May 2023 so although the NICE publication is recent, the data relied upon is not actually as recent as the report I cited earlier (pub’ed Feb 2-24, I think) but that is neither here nor there because, really, unless you are a relevantly qualified clinician (I am not) you are unlikely to wade through the 1200pp of data to understand the ‘evidence’ base. The NICE data is purely about local NHS trusts decisions to fund the use of these drugs in the clinical setting - it is not about the evidence of the safety/efficacy as far as members of the public/users.

So, I’m happy to reply on a wide range of research studies that my prescriber has studied (in fact, mine actually takes part in those studies as a prof of endocrinology). The NICE report is only interesting if I’d hoped to get it on the NHS, and clearly at the moment acc to this guidance, that is unlikely to be on the cards.

I have prediabetes, confirmed by repeated blood tests. I do not want to end up with diabetes.

Previously, the only thing that bought my blood sugar down was doing Dr Hyman's "Blood Sugar Diet" but it was ridiculously restrictive and completely unsustainable.

Not all of us are using these injections for weight loss. Controlling diabetes or prediabetes (so we don't end up with diabetes!) is the original intended use.

But with the stigma surrounding these medications I do not tell anyone. I just can't be bothered with the judgement. I think that's unfortunate and annoying.

Controlling diabetes was just the first approval, as it was the easiest. Not the original intended use. Weight loss was always intended, it was just next up, and after that is cardio vascular and kidney disease.

you write original intended use like that’s in some way more important, it isn’t, there are many successful drugs that control diabetes.

As an aside I have friends who don’t experience hunger in the same way as others. They are generally of small build & eat like birds. They’re not particularly active & if want choc etc will have a small amount.

What triggers hunger as ‘wild animal’ hunger isn’t the same as greed and is bound to eventually scupper any diet etc. Insulin reg gone awry? Some, even those of small build, predisposed to a much larger appetite?

It’s interesting how people think these treatments are cheating some how. That they’ve been ‘good’ but the fat people haven’t and don’t deserve to have better health or be slimmer if they haven’t done it like they have.

I could care less what anyone thinks, and I certainly wouldn’t judge anyone else using medication, It’s not an easy path, the fat doesn’t disappear into the ether somehow.

like the saying goes dimming someone else’s light won’t make your own shine brighter…

It’s not just taking a jab though, is it? It helps but there still needs to be a complete overhaul of diet and lifestyle, no sugar, no refined food, no caffeine, no or little alcohol, and exercise.
And the side effects aren’t great, really bad for anyone straying from fruit/veg/lean protein/ no sugar diet. Partly why it works suppose, having awful cramps, bloating, nausea, diarrhoea etc if the person using the medication isn’t vigilant with their food.

What are you talking about?

Imo it’s similar to how some people feel about the ‘poor’ whilst being quite well off.

They deserve to have what they have, because they work soo hard and don’t seem to count inherited factors into it whilst not realising that some people have additional struggles and actually work harder than they do but to no real avail.

I have caffeine. I can drink alcohol and eat sugar on the injections without side effects. I've only had side effects when increasing the dose, not related to food. I am certainly eating a healthy, balanced diet and the medication is enabling me to do that successfully but I'm still drinking coffee every morning like always and a glass of wine or a slice of Christmas cake doesn't pose any problems. The difference now is that I can have one slice/one chocolate/one spoonful and it doesn't trigger binges and I don't feel deprived stopping at just one/just a bit. I'm not avoiding those foods because they make me ill - they don't make me ill - I'm able to have them as part of a diet that makes me feel nourished and satiated and energetic and well overall.

Good for you. I know several friends who can’t abide caffeine because their stomachs are feeling delicate, and suffer side more side affects when they have refined sugars etc.
You don’t, ace.
my point was, it’s not - use a weight loss injection and behave as. Efore and the weight falls off. It still take effort, a lifestyle change, a focus on healthier living. At least that is the case for the overweight people I know who need to lose a lot of weight to have a healthy BMI.

I've not found this at all. Admittedly my diet has always been good, just far too much of it all. But I can literally eat or drink anything I want. I don't get side effects and don't need to be vigilant or careful.

I've very much found that people who talk a lot about the negative side effects have either not been on the medication themselves and ate reiterating what they've read in the (sensationalised) media or have not been on another medication long term. I've yet to find a medication I've taken long term (anti-depressants, levothyroxine) where there were a couple of weeks of side effects before it settled down.