Doctors/Nurses/Dietitians/healthcare professionals, what are you real and honest beliefs about the whole weight loss injection moment we are having?

[Banrockmystation]

A genuine thread for me who is too afraid to ask in real life. For context I’m in my 40s with pcos, at least 2.5 stone overweight and despite exercising 4 times a week and calorie tracking etc for the last few years my weight issues continue.
I don’t have an opinion on other people being on the injections. My reason for asking is because despite probably being a candidate for them and knowing how hard I try to control weight, there’s something that stops me.
I worry that there is more to it than what is being shown by the media and that there isn’t enough research done on long term effects etc? Aibu? Is that just fear or an actual possible concern that others in the industry have too?
Despite my weight, I’m heart healthy and fitter than I’ve ever been.
Thanks!

One of my frustrations is that NHS (rightly) manage their use of resources, and any private company seems to be out to sell you a product from their supply range. Getting unbiased advice seems impossible. Or maybe I’m just looking in the wrong place

I’m a HCP but my line of work only really had a passing knowledge of these. I couldn’t see an issue myself but wanted to see if there was anything I was missing or hadn’t considered, in the context of myself taking it. I saw an endocrinologist who had expert knowledge and could do an unbiased benefit/risk for my personal situation. That would be my suggestion.

You Didn’t say too low. You said 22/23. Which is a perfectly healthy BMI and appropriate fur a maintenance dose.

A TIME article isn’t evidence. We are in the territories of anti vaccine scaremongering.

Fuck me, I am sorry for trying to post easy references. How unforgivable. Did you bother to read the article? I am guessing not, as you would have seen the scores of links within it.

Sorry I dropped out of uni and never completed my medical degree, shame on me for having an interest in health matters, and double shame on me for posting on this thread when unlike every other poster here I am not a doctor.

People do become very punishing on these threads. Now I'm an antivaxxer!

Actually, there is a nice venn diagram demonstrating the cross-over of antivaxxers, for whom there was not enough data and not enough time in development of the vaccines, and those who have leapt onto these WLI, despite there being not enough longterm data on the saftey of usage for weightloss, particularly the adverse effects of longterm use.

Did you read it? And click through to the research which pretty much says it’s extremely rare and further research would need to be conducted to establish an actual link. And even then you need to consider the rare side effects versus the common risks of obesity. I don’t want to take this drug because of a tiny remote chance I might get something that is incredibly rare and unlikely to actually kill me versus likelihood of obesity related conditions / death.

I believe the Germans call this “Schadenfreude”’! A little part of me feels the same, obviously I don’t want anyone to suffer, but I feel like I’ve put the work into exercising and calorie counting, it’s annoying that other ppl can just have an injection and lose weight easily. Maybe I should jump on the bandwagon and give the injections a go, but that fear of future side effects is too scary for me.

It’s not easy with the injection.

Do you feel like this about all medication? My heart works a bit better so it’s wrong you get it? I manage my depression better?

I believe the British call it being a right cunt.

@LavenderFields7 having been on mounjaro for 3 weeks now it’s not as simple as that - it still requires a very low calorie diet to get results- in my case it makes me feel sick the whole time and gives me a constant ‘off’ feeling - so I am doing a month and that’s it and going back to strict calorie control as I’ve got good willpower - in other people’s case it just makes them feel full very quickly so they end up not eating much either - it doesn’t simply make the weight melt away and you won’t lose if you carry on eating what you want when you want if you were naturally overeating. . Personally for me the side effects aren’t nice at all and I can calorie control if I put my mind to it and am consistent - others clearly though need a bit of medical assistance to not overeat because their body works differently - where it does work well for many is those cases were they are on medication that causes a lot of hunger and an inability to burn fat or process carbs well - insulin resistance isa real biggie as you get older -

It is part of their “wellness” approach to menopause. It is seen as part of the solution to perimenopause. Despite HRT many women will gradually gain weight, sometimes because of HRT. They introduce micro dosing of GLP1s to help with insulin resistance and increasing cholesterol ( alternative to statins). For the menopause industry in the US it is the solution to the thickening waist line that most women experience as estrogen declines however healthy they are.

https://theharperclinic.com/microdosing-of-weight-loss-drugs-for-women-in-menopause/

A friend of mine was very very ill in hospital with Pancreatitis 🫤

Im on mounjaro, i have lost 37.5kg, just short of 6 stone, in 7 months. Its been life changing. Ive tried all sorts over the past 25 years, never been sucessful until now. Its not been plain sailing, ive had some side effects that i have managed to control for the most part. I researched them heavily for 6 months before taking the plunge, discussed with my own GP and with Dr's i know at work.

Im also an A&E nurse, and have seen a rise in admissions from WLI use. Mostly side effects that are poorly controlled, some more serious. Alot of the side effects i have seen is from people increasing doses to quickly. Some of the more serious have been sudden with no history to show they were at risk, some have history and clearly have lied to get the injections. However, in comparrison to how many people are on them, the risks of more serious side effects are still very small. Its a risk you take. I see people everyday with reactions to all sorts, every day we have patients with allergies to antibiotics, analgesias, statins, blood pressure medications etc etc. These are no different, people will react differently and theres no telling who will suffer long term more serious effects. The injections themselves work for so many people, but they need regulating better. Prescribers need access to medical history, people taking them need better education than the 1000's of "tiktok influencers" who claim to know what they are talking about when in reality they are clueless. I do believe it is a ground breaking mediction that is going to have a positive impact on teh overall health of people, but at the moment its too easy to get and not enough clinical supervision for users. I hope the day comes when it is more supported and available on the NHS with guidance from specialist dr's and nurses.

I know all of this. I'm not sure of the point you're trying to make to me as you keep telling me things I know.
Lots, but not all, of the online pharmacies are happy to prescribe a maintanance dose providing BMI does not drop below a certain point - usually 23 BMI. They have set this as the lowest weight they are happy to prescribe at. I am not saying a BMI of say 20 or 21 is too low, or unhealthy, just that it is below the point the pharmacies are happy to prescribe for maintanance.

Actually thinking about it I don’t think it’s pleasure in others downfall, because like I said I don’t want others to be harmed, it’s more like relief that my instinct was right (they are dangerous drugs).

@LolaLouise have you come off them? Very well done by the way - that’s a fantastic achievement

although they don’t really suit me , it does annoy me when people seem to think it doesn’t require a strict control of diet - I’ve yet to find anyone on them who has lost significant amounts who hasn’t radically reduced/changed what they eat - be that because (like me ) they feel sick or that they simply feel full much quicker- I personally don’t agree with maintainance doses unless for T2 , unless something comes along with consistent and proven less side affects to essential organs - that may of course happen

I feel that using WLI as a first line to constantly suppress appetite when a perfectly healthy weight isn’t really how it’s intended and has a big risk of being used for those who are actually now pretty slim but have developed an eating disorder- surely in most cases we need people to be eating a normal amount of calories to maintain weight and use the habits they have learned via WLI to keep ata stable weight ( weigh every few weeks minimum , drink more water, eat less junk etc)

Insulin resistance is quite complex and very much depends on your diet. The body basically goes into overdrive when you eat carbs. I was diagnosed years ago ( complex endocrine problems, the result of a pituitary tumour) and it can be overwhelming.
I have been using calorie deficit and low carbing to successfully loose over a stone since Christmas. And in the past have had long periods of healthy weight maintenance.
Basically if I cut out carbs I function better. My insulin stabilises and it then naturally doesn’t crave carbs.

If I now eat anything high carb I crash.
it was my birthday last week and we always do cakes at work. I made one of my legendary coffee cakes and decided to have a small piece for lunch ( calculated into my daily calorie allowance). The effect was profound, after 3 mnths of low carb my body released a massive amount of insulin and I became so drowsy that I fell asleep at my desk within 15 mins of eating. In the past I would have reached for more sugar to stave off the drousyness. But knowing the mechanism I now just wait until my insulin drops back down to normal.

Until I was diagnosed I spent a lot of time struggling to stay awake after a carb loaded lunch and would always have a nap after my evening meal.

I have actually used carbs to help me go to sleep in the past, a bar of chocolate at night was my solution to insomnia. But then I would wake up starving in the middle of the night.

I can understand why so many people become obese when insulin resistant. If you don’t understand what is going on you reach for sugar to keep going. Continually eating to keep your blood sugar at a functional level becomes habit.

Greed is totally different. With insulin resistance you eat to keep your blood sugar normal. You don’t over eat but tend to snack continuously to top up but crave high sugar since that instantly relieves the low glucose. The diet content is more about high sugar than quantity. You reach for a high calorie snack rather than a large meal. My DH once commented that he couldn’t work out why I put on weight since I didn’t eat enough. It’s just that my body is super efficient at converting carbs rapidly into storable fat.

Once I start to low carb then my body stops craving them. Weight loss and management becomes easy. If my glucose levels are normal and not fluctuating wildly I don’t crave food. I was in our local M&S cafe recently around closing time when they hand out unsold cake for free. When not low carbing I would have happily accepted a free cake but had no problem refusing a cake when my blood sugar is normal.

It is a lived experience and at times difficult to follow a healthy diet in a world where UPF is easily available. However once I’m off carbs life improves across the board. The brain fog lifts, my energy level increases. It has become so much easier since I retired.

I love food but have finally accepted that not all food is good for me as an individual. Recent health problems mean I have to address the problem. And the insulin resistance has become more of a problem while taking hormone blockers post breast cancer. I lost my younger sister to pancreatic cancer last year so GLP1s are a no go area for me. I want to see my DS graduate, marry and maybe have children of his own. And although I am not obese my health issues ( long standing) mean that being a healthy weight will improve my chances.

@Angrymum22 yep I am very similar, if I go low carb , decent fat but lowish calorie I do lose weight albeit slowly without WLI - ( I’m 63 and was pre diabetic( just) but reversed it in 6 weeks. it’s not that difficult for me as I don’t have food noise or a lack of willpower, I just have to be consistent and cut out wine too. I’ve done 3 weeks on mounjaro but decided it’s not for me (1 more dose to go) - as I feel sick most of the time even at low dose and get tummy ache - and it’s making me miserable even though I’ve lost half a stone. I did lose 2st 4 18 months ago in 8 months low carbing but also used herbal berberin appetite suppressants intermittently and I’m going back to that as the results were similar but no side effects apart from feeling a bit full at times. I just didn’t ’keep It up’ past the 8 months and went back to drinking wine ( half a bottle twice a week) and more carbs and it crept up again - around 6 kg in 18 months , which isn’t huge- but I still need to lose 3 to 4 stone to be at the high end of an ok bmi . i do think it’s ok to say though - mm I really don’t feel great on this , what have I learned though to keep me on track - but obviously I am pleased it works for others with little SE or the SE to them are worth the weight loss

You said no legit prescribers will prescribe with a BMI of 22/23. They will as a maintenance dose.

I dont know what your issue is! Perhaps you just don't understand what I've written.
I said 'None of the legit prescribers will continue to prescribe if someone's weight drops below a BMI of 22 or 23'. Which they won't. That's the level pharmacies (to the best of my knowledge, obviously I've not checked all their ts and cs but this appears to be the overarching headline) are happy to prescribe for maintanance AT, they are not happy to prescribe BELOW that level.

Actually the leading maintenance providers say they will prescribe under 22, tailored to individual circumstances.

Oushk: ‘Anyone with a BMI of 19-24.9 will be considered on a case to case bases and will need to provide their weight loss history during the consultation process’

Cloud: AFAIK from being in MJ maintenance communities, they will continue to prescribe maintenance doses within healthy BMI range

Pharmulous: Same as above.

IQ Doctor: Same as above.

A lot of pharmacies are rapidly changing their maintenance policies to be nearer the above, as those pharmacies tend to be well in the lead in tailored prescribing of weight loss medication.

Certainly when I had my maintenance call with Oushk, I had mentioned I’d like to stay around the 21-22 BMI range and that was no issue.

I think it’s absolutely fine to discuss the side effects. I had a friend who didn’t do well on them and got diverticulitis. I was sympathetic.

People are just responding to your seeming enthusiasm for it to go wrong for them.

Im still on them. Im currently a few kilo away from my goal weight which will put my BMI at 23, but im titrating back down now by dropping 2.5mg each month. I went up to 12.5mg and planning to go down to 5mg and stay on that for a few months whilst i learn the art of managing my weight

They are. They will prescribe a maintenance dose as long as you are within a healthy BMI.

18.5 and under is unhealthy.

Accidentally posted when my phone rang before id finished - oops

This is what i mean about better education and clinical management. They are a great tool to get a person to a healthy weight, however, they arent teaching the person much. Having researched myself, and had discussions with people, i feel titrating down and slowly increasing appetite etc and learning how to manage weight is necessary and the best way to stop using them. Using them as a tool to hit a goal is all well and good, but long tem use isnt ideal, especially as we look towards funding them on the NHS more and more - we want people to be successful off them as we dont want the cost of them to be forever. I feel guidance is needed for this, theres very little information from providers out there about how to manage coming off them.