To worry about friend's weight loss?

[Annabel28]

I'll try to keep this as brief as I can - keen for this not to descend into a pro vs anti-weight loss jabs type thread but I could really do with some advice.

I have a good friend who I've known since school. We both went separate ways (geographically) after university but have always stayed in touch and I really like her and care about her. She's had some difficult experiences in life and I'm glad that I've been able to be there for her in the past.

In the last few years she gained quite a bit of weight - always assumed this was related to having kids etc. but it was a substantial amount, she told me her BMI hit 40 and she was starting to avoid walking places because it was becoming uncomfortable. In April she decided to start weight loss jabs privately which she gets from an online pharmacy. She started to lose weight rapidly and would send me a lot of photos of her journey/progress. I was initially really supportive of this journey because I've seen so many people (including family members) struggle with the health consequences of obesity and traditional diet/exercise methods just haven't worked. However she's 9-10 months in to treatment and to be honest I'm a bit staggered by the amount of weight loss. She's gone from a BMI of just over 40 to a BMI of 20 in this period (don't know in kg because she only shares her BMI with me). She is still taking/accessing the weight loss jabs and says she needs to continue them. She seems happy but almost hooked on losing more weight.

Slight disclaimer here - I am a mental health professional by background and if anyone had lost this % of weight over that time period by dieting I would be assuming they had entered eating disorder territory (this is an area I work with and know a lot about). Although my friend is delighted by her weight loss she still seems to view herself as "a fat person" and still seems driven to lose more. I really don't know where this is going to end and she's reluctant to talk about the more emotional aspects of the weight loss.

Is it normal/reasonable for her to still be on medication even though she's a normal BMI? What would be the standard protocol?

For people on this medication, how have you coped with the psychological affects of so much weight loss and is there anything I should be doing/saying to support my friend?

TBH I'm a bit disturbed that so many private companies sending these medications out don't seem to offer concurrent psychological support but I suppose there are cost issues and ultimately their first priority is profit, not the consumer's wellbeing.

It forces a lifestyle change. Certainly eating habits anyway. It's how that looks when people come off it. People who I know who have came off it have kept up the good routines and are maintaining or still losing. It helps mindset massively.

The work that poster is referring I assume is overhauling diet to healthier options, eating less generally long term and addressing emotional eating patterns. Rather than simply relying on undereating and a jab to take away the hunger pangs.

I've been referred for weight loss jabs via the NHS and yes they do offer psychological support with the programme

@baileys6904 what form does that take, out of interest?

If you don't mind me asking, what was your BMI and do you have any weight related health conditions? It is so very rare to hear of anyone who has actually been prescribed WLI on the NHS, specifically and only for weight loss. Also, what previous tiers of weight management did you go through?

I have a BMI of 20
I weight 123 lbs
Im 8.11 at 5ft 6
Im not skinny I’m actually quite curvy with ass thighs and boobs

when I was ill a year ago I dropped to 8 stone and was underweight at a BMi of 18

Ive Struggled for over a year to get back up my orginal weight of 9 stone

But I don’t look ashen or like a skeleton
maybe your just used to seeing her fat and over weight

You get hunger pangs.
You have to overhaul your diet, if you don't, that's when you get the much mentioned symptoms.

As to adressing future behavior. Of course you have to, like you do with any diet. If you don't you fail. Like with any diet.

I still think it’s relevant though.

@Agix points out that people can stay on the jabs past healthy weight and down to an unhealthy level. To a weight where if you weren’t on the jabs you’re treated as having an ED.

there seems to be a mentality that because people are using jabs to lose weight, it’s ok. Whereas if they lose the same weight without the jabs, it’s ED. Surely if your organs are damaged with an ED they will be with jabs, there isn’t some magical protection against being underweight.

i think we will be seeing an increase in ED’s soon where people on the jabs continue past healthy.

Name changed for this, but I've recently started Mounjaro.
My aim is to steadily lose around 20kg over the course of a year/18 months.
I don't want to go nuts with the weight loss and become obsessed with the scales.
I'm doing alongside a steady plan, which is gradually changing my eating habits as well as what I eat.
I've upped my walking and my plan is to join a gym in 2 or 3 months.
If I do everything at once, I don't think I'd be able to sustain it.
I see people gushing about how much weight they've lost in a short time and it IS exciting - I get it - but I can't allow myself to get swept up in rushing the pound shedding.

Ooo it’s a been a couple of weeks since we had one of these!

In order to stay on the medication into the underweight territory, you'd have to be actively lying to your provider and providing fake photos and incorrect information. It isn't something that is allowed or accepted, that prescribers are ok with. It's not something that Agix has any evidence of, or has seen happen. It's just her assertion that it's happening. It's also not what's happening with the OP's friend, who is in the healthy weight range at a BMI of 20.

Agix's weight has clearly been in the underweight category (BMI less than 18.5) for long enough to be a serious issue and to cause damage. That's not at all the same as someone who is losing weight from the obese range to the healthy range and then staying there.

Actually, on the WLI threads you'll find that many people are eating 3 smaller meals each day. They are not snacking inbetween meals (because the medication makes people feel fuller and slows the travel of food through the digestive system). They are often eating much healthier food because they no longer crave sugar and because very fatty food can exacerbate any digestive problems. Some people are meal planning (healthily) when they've never done that before, some have stopped buying crap food, or stopped having takeaways so they can fund their WLIs. Many have cut right back on alcohol, and drinking much more fluids.

Many people post that they are learning to serve themsleves smaller portions, that they don't have to finish every morsel on their plates, to recognise feeling full and to stop eating when they do.

All those are patterns of someone who eats healthily. There are threads where people are sharing how they are managing after they've reached their goal weight - either with reduced amounts of medication, or none at all. They are sharing the good habits that they developed and how to maintain them

Of course there will be some who have (or who develop) disordered patterns.

Well I don’t think the jabs are ok I think they’re crazy. Some people have been seriously ill with them.

But how many people abusing the jabs already had a ED that had resulted in being overweight? I’d think a fair few.

@20bloodypounds thank you. Yeah, I'm sure plenty of people don't get addicted or misuse the meds. I don't have anything against them really. It just sounds like OPs mate is going quite far. It could be she had ED in the past and OP wasn't aware. Or I guess weight loss itself can trigger ED in some people.

On the WLI threads there are many who have felt able to resume exercise, exeercise they felt unable to do at their starting weights but which they now enjoy. One of the threads has spawned a C25K offshoot thread. Those people have found it life changing and life enhancing. They are becoming robustly more healthy not pale and sickly.

Several people post their weekly losses, and in general those are 1 - 2 pounds per week. That is the suggested healthy weight loss for someone of WW or SW. The difference is that many people of wieght loss drugs can sustain their 'diet' over a longer period to get to their weight loss goal.

There are quite a lot of people on WLI threads who are not even sure they will lose weight beyond a BMI of 26 (which is still slightly overweight). They are making those decisions based on their body type and what they think will suit them and is sustainable for their lifestyle.

Of course some people have been seriously ill, that is a risk with all medication - did you know that about 3,000 people in the Uk die every year from taking asprin (not overdoses)?

But there are well documented health problems associated with being obese, not to mention massive costs to the health service and the economy. For the general population of people with obesity the risks associated with taking a weight loss drug is much less than the risk of being very overweight.

Apologies, I am distracting from @Annabel28 's OP and her concern. If OP's friend is still trying to lose weight beyond BMI 20, or if they have become 'addicted' to the achievement of another pound off, or if they are struggling to regain a sense of their new slimmer, healthier self, or if they are lying to their medication provider, then yes that is something to worry about. But I'm not sure OP knows whether that is the case. Certainly none of the rest of us do.

And I hope that the anecdote of OP's friend will not be interpreted as 'data' and misquoted along the lines of 'people become addicted to weight loss and are still taking the injections at an unhealthy BMI of 20'. I'm sure no-one would do that...

Not all medication, no. Some is riskier than others.

For obesity it makes sense, but for everyone else I think it’s crazy.

You make a variation of this post on every discussion about weight loss jabs.

Your situation is different. You have a severe mental illness. You would never be prescribed these jabs and they would not be safe for you because of your mental illness. You shouldn’t use your situation as a comparison for someone who does not have an eating disorder.

I hope that you are able to heal and be well one day.

You must know that with anerexia there's laying to others and lieing to yorself. My friend told me she had all sorts of possible GI issues etc and she was forcing excess food down herself all day but couldn't gain weight. That was her narrative to everyone. Family, NHS etc. She weighed just under six stone and everyone was telling me she was fine.

I don't know what you can do. No one seemed to see it. My son weighs two stone more than my friend did and four inches taller and I'm constantly being asked if he has a ED.

Not everyone, I’ve had zero side effects and it’s definitely helped with my IBS.

I've been on Mounjaro for 3 months.

Started with a BMI of 39.5.
Now have a BMI of 32.7

I expect to lose more slowly over the next year or so, but hope to be in the 24/25 bracket within 7 or 8 months.

No side effects for me other than tiredness. Eating around 1300-1500 cals a day at the moment,

Food noise was making me crazy. If you haven't lived with the psychological effect of cravings, over eating and binging or just the constant turmoil in your head around what you can or can't eat you'll never understand why WLI are helping millions of people.
I'm 2 weeks on mounjaro and it's honestly a miracle. I'm eating pretty much like a normal person. Tonight I've felt hungry and over eaten...well I say that as it feels more than my recent normal but the difference is I've now stopped! My brain isn't craving more...I can just stop. No feeling guilty etc

Well one of the problems is a lot of providers are like the Wild West and have ZERO maintenance plans so I can see why she'd want to get all the way to the smallest HEALTHY bmi (which is 18+)

If I was you I would ask what bmi she has in mind and if her prescribed is offering maintenance plans

Personally I'm aiming for BMI 23. This would be 7 stone 13 pounds. I'm very short

However that's because I'm with Boots and they have maintenance plans. I've also only lost half a pound average a week.

I think it’s obvious from the many posts on here that companies aren’t offering any psychological support alongside the drug. Why would they? They are selling a product.

Well if they offered maintenance plans then they would keep people on the drug longer