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.

This is how I live.

constantly restricting, overeating, swearing I’ll start again tomorrow.

i’d give anything to get rid of the “food noise”.

but I lost most of the weight several years ago prior to the availability of the wld. Fucking hard, but I got down from an obese BMI to bordering on normal. I still have two stone to go to get to a healthy weight for my build, only now I don’t qualify for wld.

it’s frustrating as I think my mental and physical health would benefit hugely- I’m still to big to do impact exercise without ruining my joints.

i see people using the drugs to sail on past down to a goal weight and lower- if it’s too risky for me to be on wld, why isn’t it for wld users?

there doesn’t seem to be an “end point” where wld users are told to stop or have their dose tapered to maintenance. Possibly because it’s new and not been used in this way before so it’s a “side effect” no one’s thought about.

yes the wld are amazing and will massively reduce other health complications of obesity, but it is possible we will see increasing morbidity and mortality if end points aren’t monitored more closely. It is so easy to tip into disorder territory when you start with weight loss.

Out of curiosity, what would stop the person you quoted from getting prescribed the drug privately?

I was on Mounjaro through Voy and although there was a question about whether you had ever been diagnosed with an eating disorder, I don't believe they actually check whether the answer you've given is correct?

It worked brilliantly for me, minimal side effects and completely suppressed food noise, I'm now about half a stone from my goal weight but I'm going the rest alone as I believe I can follow the dietary changes and exercise plan I put in place whilst I was on it.

I'm glad to hear there are very few side effects for many people.