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!

@Crikeyalmighty
I'd agree, there is also a heck of a lot of people weight gain has been very slow. Maybe 3lb a year gained over holidays and Christmas. But do that every year over a lifetime and end up 3st heavier than they should be.

Not everyone seems to be able to lose pregnancy or fertility treatment weight either. Throw PCOS into the mix too.

We aren't all complete piggies

Have seen one unwanted pregnancy and 2 with major side effects due to unexplained interactions with other drugs, one who was hospitalised. All in 1 month.

Most GPs do not prescribe these and therefore are not in a position to counsel anyone. One of the patients above HAD actually asked their GP if it was safe, and had been told, yes probably.

Yes there was experience of these drugs in diabetics. Different dose, different indication, and different drugs now (Mounjaro). There is no evidence to show that they work longterm. There is some concern about the effect of such rapid muscle loss (doesn't happen at this rate in standard calorie controlled dieting). I think there are too many stories of silver bullets that turned out not to be for me to feel comfortable with these meds.

For these, and similar reasons to PP re the insnity of medicalising our terrible food culture, I feel very nervous about the drugs.

I get frustrated when people claim that Mounjaro has been around for years, therefore is safe.
Firstly it is slightly different from previous drugs used in this class as PP has pointed out
Secondly it has only been tested on Obese and morbidly obese patients, initially for type 2 diabetes and only recently as a weight loss drug.
We are making a lot of assumptions about its short term and long term safety. It is all about risk. The co morbidities associated with obesity and type 2 diabetes out way the currently known side effects, but we have no idea what side effects may emerge 20-30 yrs down the line. We also have no idea what the side effects are when used by patients who use it for maintenance. We know that obesity is the result of imbalance in GLP1 pathways, by adding extra into the body will it switch off natural production, making weight gain rapid when we stop using it. It’s an expensive drug not everyone will be able to continue on it indefinitely.
There are a lot of drugs that have been withdrawn or have cautions attached because side effects have come to light many years after they started using them.
I really hope it is the miracle drug it seems to be. It is a lot safer than gastric sleeves or bypasses. And we do appear to have a massive obesity epidemic which is seriously stretching the NHS. Let’s hope that Mounjaro doesn’t stretch it further.

Why? What a weird thing to say

I was on Ozempic a few years ago but had side effects of nausea and just feeling pretty rough. I came off it after two months, having lost 20 pounds. Anyway, I had a scan last year for another ailment and was told I have gall stones, these don’t give me any bother. I would really like to go back on injections again but I’m not sure what with the gallstones. The case of the nurse in Scotland who died while taking them last year is really scaring me too.

So true. I put on weight after treatment for endometriosis ( many do). I didn’t gain weight during pregnancy but after breast cancer and ongoing hormone treatment I gained weight. I’m now on calorie deficit and have lost a stone over 2mnths, steadily, without going on an exercise kick. Just dog walking and general day to day activity. I don’t want to lose muscle mass or bone density so concentrating on healthy diet with minimal UPFs.

It has a warning that it stops absorption of the pill. Also I imagine affects absorption of other drugs

3% of people have mental health issues when using it - not sure if that’s generally or whether those people were already suffering with anxiety or depression.

and most importantly for me, it’s generally not being monitored - you’re not being monitored. What might be a game changer for an overweight diabetic where the risk of the injection is less than the risk of illness then great. Might not be worth the risk if you want to lose a couple of stone.

You are both right: people are only as greedy as they've ever been, we haven't fundamentally changed as a species in the space of 50 years. What has changed is our food. And I don't mean eating more cake, Macdonald's, crisps, chocolate or booze (though maybe we do eat more of those things).

It's that nearly every single type of completely ordinary, basic food excepting raw ingredients (but even then, many fruits and vegetables for example are now cultivated with a higher sugar content), from bread to ready made lasagna to baked beans, has now changed in a way that makes it more palatable, less satiating and harder to stop eating, with who knows what minimally regulated synthetic ingredients added for various reasons that have nothing to do with nutrition and everything to do with sales and reduced production cost. Most people are now overweight or obese. Most people clearly aren't eating anything unusual, only what most people eat.

The pervasive idea that solving obesity is about eating less cake or doing more park runs, has been manufactured by big players in the food industry to avoid accountability for the public health catastrophe their under-regulated products have caused/are causing. Its getting harder to blame "piggies" now that it's so obvious this issue is affecting nearly everyone, in particular (perhaps more so for me), so many very young children.

Definitely ensure you're being prescribed and monitored by a HCP who knows what they're doing and is thorough.

My SiL told me last week that she's aware - because of the experience of a friend - that people such as beauty therapists have got themselves into the business of selling what they CLAIM is Mounjaro.

Research bone density and osteoporosis for women on them.

like everything they have good points and bad points. For some they’re a lifesaver for others they shouldn’t take them. But this is a concern and you should understand it if you do make the decision to go that route.

pcos - cut out all sugars ( inc carbs).

Well, I can't NOT wait for the side effects of uncontrolled diabetes and obesity that now aren't going to be happening to me seeing as I've resolved both due to mj.

I think for weight loss they can be worrying because they don't actually teach you healthy habits or change anything, you just simply eat less because you can't eat too much without feeling sick or just don't have an appetite to eat. What happens when you come off? Or do people really see themselves staying on this for life? That could be 50+ years for some people. Plus people are already abusing the system and lying to access them. The worry is people with eating disorders will abuse them.

I’m a GP and am very happy to see how my obese and diabetic patients are doing with these medications. I’d absolutely take them myself. Long term data - we’ll see. I’m also interested to see how the licensing changes for long term maintenance treatment.

Yes, these drugs are the same as any diet, and we know diets don’t lead to sustainable weight loss over the longer term unless major lifestyle changes are adopted too. Again, it’s easy to not eat whilst the appetite is suppressed and food is not a thought. How are people learning to identify and respond to hunger appropriately when their body isn’t sending cues? How are they learning to use other tools, not food, when feeling upset or stressed etc? What are they learning about nutrition and eating foods in balance for health and enjoyment?

I’ve been working with patients for years who’ve regained the weight because these drugs changed their physiological responses but not their behavioural or emotion triggers. Same for patients post-bariatric surgery who have changed the physical body but nothing else, and continue to eat to the point of illness and pain. The drugs are not the magic bullet many seem to believe by themselves unless the changes are holistic.

I think it’s the number of people taking it upping the number getting side effects.
For me it has led to a devastating diagnosis that wouldn’t have been discovered had I not ended up in hospital.

I think it's fab. But I do wonder why amphetamines i.e elvanse for adhd which is 1st line adhd and 2nd obesity.isnt given and aren't available for obesity that's something I do wonder unless it's mental health side effects maybe?

I’ve no skin in this game but why do you look forward to something like this? Are you a bit twisted or jealous?

they certainly complicate things a bit if you end up needing the services of my specialty (anaesthetics) and it's a concern that people are sourcing medication via non-traditional routes and not telling us, therefore putting themselves at increased risk of anaesthetic complications (applies more to people at the lower end of the overweight spectrum rather than people with significant obesity).

Personally, have been overweight/'just'obese for most of my life and, after having been a normal weight for a while but recently crept back up to overweight, I still wouldn't even think about taking them. For people with significant obesity/complications of obesity, the balance of risks & benefits appear to be clearer.

What reason did he give?

@Cityandmakeup have you ever considered therapy?

Largely, I'm in favour of appropriate usage. The risks of obesity are profound and I feel the risks of long term effects to be 'worth' the risk for people using appropriately alongside other measures e.g. dietician support, CBT for eating issues.
Largely, trust the rigour of the drug development process. (If not by the big pharma but the MHRA and local clinicians who support trials in the UK).
I also feel people tend to forget that drugs are literally designed to alter your body chemistry and will never be without risk. Is is unreasonable of anyone to expect to take any drug with accepting the risk of possible side effects. We all tend to turn a blind eye to this when the intended effect is desirable.
I worry about misuse.
It reframes various debates in my mind about appearance, mental health, social stigma of obesity and thin privilege.

It IS about calorie deficit not necessarily calorie counting.
It's a biological fact that to lose weight you need to burn more calories than you eat.
All dietary modification works on that, whether it's the NHS, WW, high protein high fat, low carb, paleo, Zoe, whatever.
You need to find the one that works for you and you can stick with for the long term.
And yes after 30+ years as a dietitian it still surprises me how little people understand about good nutrition. We aren't all low fat marg and diet yogurt fans you know, most of us believe in real food!

A question for those of you working with patients taking GLP’s, have you had much success with asthmatic patients who have gained weight due to steroids? and also what is the real risk for optical side effects

I have eosinophilic asthma and am being assessed for biologics which could finally lead to reduced steroid intake, my current intake makes weight loss and management very difficult and I’ve spent decades removing weight gain after prolonged steroid therapy

I’m also concerned about vision as I have Fuchs/ cateracts, thanks

What a weird and unkind comment.

That's one of the most horrific things I've read on this forum. That's just plain evil.