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!

They have been widely used in the US for over fifteen years. Yes, there might yet be longer term side effects, but equally there might not. What we do know a lot about are the dreadful side effects of obesity.

Mounjaro can be taken long term at a maintenance dose. You wouldn’t stop taking antidepressants because your mood had stabilised. Mounjaro is the same. It’s a medication for a serious health condition.

I would disagree with this, a lot of people living in deprived areas will be relying on calorie rich food for nutrients. Increasing the cost wouldn’t help them.

I did it for 8 weeks. It gave me a huge hoof up the backside. I lost 2lbs a week. What I did do though was absolutely change every single thing I needed to. Protein intake, water intake, exercise every single day. I started in July last year and now I've lost 2stone and 2lbs but 90% of this is will power, commitment to exercise and food control. I was only a size 12 but I'm short. I never went up a dose. Stayed on 2.5mg so can't really say I had much in the way of side affects. I see it as a tool to reset your Lifestyle changes. Honestly wouldn't know what my go thought. I know a lot of people on it that have lost stones and stones but once stopped it's come back on once they eat normally again. I had to force myself to eat and it wasn't nice. But I've kept the weight off and I train every day. I feel great.

The NHS/dieticians/Gp's are mostly not up to date with the latest thinking on what's actually a healthy diet. They are still recommending the Weight watchers style diet. My Gp's knew nothing about using injectables when I first started on Saxenda a couple of years ago. It's interesting That Michael Mosley's son has just now written a book on how to eat healthily on GLP medications. It's also very worth following Zoe ( Professor Tim Spector ) on Instagram.

With regards to putting on weight after stopping Glps this happens with all diets. Not just with the medicated weight loss. There is evidence that the body has a set weight it will return to. So the majority of Slimming Magazine club winners used to go back to being rather large. There are very few exceptions.

Thank you.

I hadn’t realised there was specific training related to GLP-1 prescribing. That’s really helpful information and gives something specific to look for in a private GP.

Everyone is different, If I was in your position I’d definitely use weight loss injections.

I think they're a useful resource for patients who need them. I don't think there should be stigma or criticism around people using them. Like many useful resources, there is a potential for abuse, but the majority of people I've encountered who are prescribed them have been prescribed them for a genuine clinical need. As with all medications, there are risk: benefit calculations needed by and for individuals. I've seen people slash their cardiovascular risk factors, get diabetes under control, become pain-free after years of chronic pain, and have life-changing benefits from them. No medication is without risks, but for some people these medications have changed and potentially saved lives.

Unfortunately obesity rates are significantly higher in more deprived groups in the UK. Rates of childhood obesity have soared whilst the rate of children being underweight has (happily) remained extremely low. Obesity is increasing health inequality. I would like to see much higher VAT on calorie dense food of low nutritional value. There would be exemptions for staples like bread, milk, cheese and so on, and 'negative taxation' on healthy food including healthy ready prepared options. I'd be astonished if supermarket and ready meal manufacturers weren't already planning how they would respond to this sort of approach.
I'd also like to see more rules about what proportion of a small supermarket can be booze and snacks - the gov should force them to give more space to actual food, and subsidise food shops in poorer areas & 'food deserts'.

Well, they certainly work, but like most things they aren't perfect. Have seen around 5 or 6 hospital admissions in the last 6 months due to severe side effects. A weekly injection for the rest of your life sounds horrible and I wouldn't want that. I have seen quite a few posters on this site say they struggle to even eat one proper meal a day on it. Whilst obesity is not healthy, that isn't either. They may be a false economy for the nhs if people regain all the weight when they 'come off' them. Time will tell.

I guess if you think of it like that, then legitimately it’s true, compare the long term side effects of raised blood glucose, ingesting seed oils and large amounts of carbohydrates/sugar and you have a recipe for all the metabolic diseases currently causing much harm. If you can reduce the ingestion of these poison’s it may at least balance out the risk short term and cut it massively if you can reduce your expose to them long term.

a&e nurse here - it works, but only if you are prepared to make life long dietary changes. suppresses cravings so you can reset eating habits. Not promoting it but personally I know lots of medical professionals on it

is it sustainable? not sure and will only know after stopping the injections. Studies suggest weight gain in 1-3yrs after stopping if you don’t change eating habits

Bad press re gall bladder & pancreatitis - not encountered any patients with an issue

Patients presenting to A&E on it concerned about side effects - Stomach cramping/diarrhoea, yes but blood work fine so rehydration and reassurance only needed, discharged from A&E

If done properly it’s not a short term fix, but supports a calorie deficit to weight loss with high protein balanced diet approach to eating

Couldn’t lose baby weight, now aged 49 5’2, went from 73kg to 61kg in 4 months on Mounjaro, no gym, no pre existing med conditions. Stayed on starting dose throughout, have plateaued at target weight so doing 1 more month. Not for everyone but worked for me. Will see how I’m doing in 12 months…

I think as long as you don't expect it to be a miracle drug, and do it along side a diet that encourages GLP-1 production as a long term eating pattern, so protein, fibre, good fats, lots of veggies and limit shit/processed carbs, increase your exercise, then it is a win/win for anyone obese.

Nurse here who admits to not being completely up to date with all the evidence for them at the minute. On the face of it I think they seem amazing. Obesity contributes to SO MANY health conditions. Heart disease, high blood pressure, strokes, type 2 diabetes, liver disease, kidney disease, too many cancers to count, mental health issues, arthritis and other joint conditions the list is endless. It’s probably the biggest contributing factor to poor health today. While the body positively movement is great, I don’t care how many people tell you I’m fat and healthy, it’s just not true. Obviously the best case scenario would be for everyone to just move more and eat a healthy balanced diet but if it was that easy we wouldn’t have the obesity epidemic that we currently have which is costing millions every year. Obesity is complex and telling people to just have more self control doesn’t work. Weight loss injections seem convenient, easy to administer and most importantly as it stands at the minute with the current evidence, a safe way to help people get to a healthy weight.

there also seems to be a growing body of evidence that suggests they may be beneficial for people with other addictions in curbing cravings.

I sometimes wonder if we will look back at bariatric surgeries like gastric bypasses and gastric bands and be shocked that we used to actually partially cut out people’s stomachs to aid weight lose, similarly to how we now view lobotomies preformed in the past for mental illness.

I ended up in hospital after two weeks with an inflamed pancreas and the doctor told me I had to come off it. Another surgeon said she thought there would be a lot coming out about it in the next year - but two of the nurses were using it.

What are the risk factors to someone who has a lower bmi?

Why so nasty and bitter?

Given they’ve been around for two decades plus why did the surgeon think that?

Don't forget UPFs, for their impact on the microbiome and thus inflammation and thus <gestures at the physical and mental health crisis>

I wish GPs and other HCPs would push themselves to be up to date with the impact of UPFs overall. It doesn't map directly on to high calorie/low nutrient foods; a tax on the latter would be fiddling around the edges, at best.

Obesity is classed as a chronic disease that is multi factorial. And it really is. It’s simply not the case that everyone who is obese is a lazy and greedy whatsit that just can’t be bothered. I could list several factors that hugely contribute to obesity.

These drugs are literally life changing and life saving.

Oh yes, a weekly injection must be awful. Compared to a future of type 2 diabetes, high cholesterol, high blood pressure, stroke, cancer, heart disease… I know which one I’d pick!

People that are so concerned about long term effects really need to look at the long term issues that are directly concerned with being obese and having high levels of visceral fat. Literally life limiting and ending.

Thinking about obesity as a disease rather than a choice is helpful. It may well be that permanent medication is needed- and if it is- so what?! It is a chronic disease that could require long term treatment.

I’d be interested to know whether the people that have struggled with awful side effects have been to see a reputable physician who has prescribed appropriately or whether they are just buying online and dosing themselves…

I know 2 who have collapsed with kidney issues recently, one has rightly come off and one is continuing despite her being a healthy weight

I've been qualified for 25 years, so I've seen a good few safety problems in that time, which makes me cautious.Honestly, I am on the fence. There are plenty of examples of drugs where the side effects done become apparent for years, or until enough people have used them.

GLP1s have been used in diabetes for years, but Mounjaro is not just a GLP1. It's a first in it's class GLP1/GIP inhibitor, and has only been available in the uk for a year or so. (However I have never seen any drug take off as quickly as Mounjaro, so it's getting pretty widespread exposure).

If nothing nasty comes out of the woodwork, then you would kick yourself for not starting at the earliest opportunity. But you need a crystal ball.

One thing I will say is that the benefits are going to be greater if you are more obese, or have other obesity-related problems. Think about your wider health, not just your weight.

I’ve lost over 6 stone and feel better than I have pretty much my entire adult life. I no longer require anti hypertensives or reflux medication. My relationship with food has changed massively. My GP has been supportive. I felt I could no longer ignore the risks and effects of obesity and wanted a kickstart. I’m now on a maintenance dose and working on increasing my fitness in order to stop using the mounjaro. I work in healthcare and know lots of colleagues who are also using it. My side effects have been fairly minimal and any queries have been answered quickly by my provider.

One concern I have is that women are using this medication but not changing thier lifestyle. You are not only loosing fat but also muscle mass too if you don't incorporate strength training which directly impacts bone health. I was listening to a podcast last week about a woman who had developed osteoporosis and was trying to sue one of the producers. I think we are potentially swapping one problem for another. I have known 2 people who have used them and both have put all the weight back on when they stopped.

You could say the same about Weight Watchers or Slimming World etc.

Most of the people I know who take Mounjaro are intending to stay on it at maintenance level long term, same as any other medication.

Aren't you lovely