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!

I was responding to her hopeful glee that there would be fallout, vs my thoughts on whether there would be.

And yet so many on these threads extol the virtues of the WLI they are on as they "are learning to eat in a healthy way" - so clearly, and realistically, most people who become significantly overweight and at risk of XYZ in the future are not eating what I would call a healthy diet. YMMV.

I didn't read any hopeful glee into her tone.

But it’s important to note that not all the weight lost is fat. Research shows that up to one-third of this weight loss is so-called “non-fat mass” – this includes muscle and bone mass. This also happens when someone goes on a diet, and after weight loss surgery.

From the linked article. So regardless of how you lose weight, the chances of losing some muscle and bone mass is the same ? It does mention getting enough protein and doing regular resistance type exercise should help reduce the impact of muscle loss though.

Whatever you wish to call a healthy diet, you may wish to consider how you speak with people, as you were quite rude in your response to the previous poster.

Most of the people I've met on these medications have spent years trying to lose weight, including eating what most people would consider to be healthy diets and eating highly restrictive unhealthy diets out of desperation. Some of them have said they're learning to have a healthy relationship with food again because they can see food as a fuel rather than an enemy. Some people have spent years battling against the appetite stimulating and weight gain inducing side effects of other medications. Many of them have spent years battling to create calorie deficits in their diets, but it can be really hard to diet your way out of the effects of high doses of steroids, for example.

There's no need for your previously expressed judgement and rudeness, actually, towards people prescribed these medications for valid health issues. People are taking prescribed medications for clinically indicated reasons. If you don't want to take them or prescribe them, you don't have to, but perhaps rather than judging people who do need to take them, you should appreciate the circumstances which mean you're fortunate enough to not need them.

I wonder if weight training would also reduce the impact on bone mass loss or help recover any loss ?

No, it's not the same.

Per a 2024 article in The Lancet Diabetes & Endocrinology, studies suggest that muscle loss on GLP-1s ranges from 25 to 39 percent of total weight loss over 36 to 72 weeks. In contrast, non-Rx caloric restriction studies have shown only a 10 to 30 percent reduction in fat-free mass. The authors also add that the decline in muscle mass on GLP-1s is several times greater than what’s expected from natural age-related muscle loss.

I weight trained 3 times a week pre taking Mounjaro, and continued to weight train 3 times a week while taking it, so I’d be interested to see what my muscle loss is like. I certainly don’t feel any less strong.

I'm a registered nurse and podiatrist. I couldnt lose weight for 30 years. Went through loads of diets. I've been on mounjaro for 4 months and lost 3 stone. I have 2 stone to go. No side effects at all and feel great.
I feel better than I have in years.
Emotional bingeing was my problem.
I've had counselling for that since and I'll be on a 2.5mgs maintenance dose when I've lost all the weight for as long as I need to while I work on my emotional eating problems.
I've had no side effects.
So many of my patients and friends are on it. But anyone who is thinking of doing it should seek medical advice first. It isn't suitable for everyone.
I'm 63 and had to lose weight for joint pain and osteoarthritis.

There looks to be an increased likelihood of muscle and bone loss with weight loss injections, which is something people should receive advice about and it should be one of the factors considered in prescribing decisions. Risks can be mitigated though, through diet choices, vitamins, and exercise (really important).

@pirateshirt That Lancet article suggests that it is the amount of weight lost that is the critical factor, which makes sense, if you lose 10 stone you will lose more non fat mass as opposed to if you lose 2 stone ?
It would be interesting to see a study carried out where people are given enough protein to eat and do weight training, whilst using WLI and see what the difference would be ?

But what's the muscle and bone loss compared to eating any other calorie deficit?

Or what's the muscle and bone factor for someone at 9st who's never been overweight.

Compared to someone at 9st who's lost 4 stone on a diet vs on a WLI diet?

This muscle and bone loss does worry me. A few years ago I lost on a diet and going by my scales I seemed to loss a load of muscle rather than fat.

Also don't people who are obese tend to have a larger amount of muscle mass anyway ? So as they lose weight the necessity for that additional muscle mass is reduced and so it isn't as much of an issue ? As long as they exercise so strengthen the remaining normal amount of muscle ?

As it said:

on WLI, 25 - 39% of total weight loss
with regular dieting, 10 - 30% of total weight loss

It's just something to bear in mind. Especially, as people have been shown to regain when off the WLI, so presumably would go back on them, and round and round, and it could lead to premature sarcopenia.

As a registered nurse who is on Mounjaro with 20kg to lose I would advise speaking to your GP before you start; this is especially important if you have other medical issues and/or are taking other medications. At the very least people should consult their local pharmacist.

For me personally, not far into the process, I think it’s a brilliant drug. It’s calmed down the feelings of being constantly hungry and deprived I get while dieting. You can eat healthily if the dose suits you but you’ll probably get some gastric adverse effects if eat oily fatty foods. I feel better, all my bloating and longstanding IBS has disappeared. I’ll accept the low risk of later effects if it improves my cardiovascular risk, which to me is far more imminent a concern.

I think some of the sceptics are people who won’t grasp the complexity of food dependency, which is an addiction like any other and should be thought of as such. Those of us who yo yo with dieting our entire life are rarely going to manage our weight long term with the tried and tested methods.

It feels like the research is comparing apples and pears. Someone losing a couple of stone on a traditional calorie deficit diet loses 10-30% non fat mass, someone who loses six stone using WLI loses 25-39% non fat mass. Do you see what I mean ? the fact that they mention it is most likely attributed to the larger level of weight loss as opposed to the mechanics of the medication, means they are unlikely to be comparing like with like ?

@Icebreakhell can I ask what my GP would be able to say about a private prescription that is nothing to do with them? The online prescriber has my full medical history, that’s reviewed by a doctor, so what would be missing there that a doctor at my GP surgery would pick up? My GP surgery don’t even want to see me for the prescriptions that they issue, so I can’t see why they’d be prepared to discuss a private prescription.

I also don’t have a “local pharmacist” and also can’t see why talking to someone at a pharmacy would be any more helpful than the process carried out by the online pharmacy.

@Dymaxion I need to look more into it but at the moment with this morning info it does feel a little bit like sour grapes.

@Icebreakhell Thank-you I will totally take on board what you are saying about contact GP first.
At the moment I'm nervously toying with the idea. I'd love to be able to drop 3st and get back to a healthy weight. For the first time in years

Hope I've not lost too much muscle - some is inevitable with any weight loss, you can't purely lose fat. My muscle tone has never been an issue though, just that since I had kids it has been hidden by a load of fat which wouldn't shift. I always knew the importance of weight bearing exercise. I first joined a gym with my dad when I was 18, 31 years ago and remember him telling me about how beneficial weight training was for women long before I read about it online. I intended to have a private Dexa scan in a year or two anyway even before I heard of mounjaro. And I might take HRT, am seeing if my periods have definitely stopped at the moment.

What sort of ongoing support do people get from the private companies prescribing this medication ? Do they get nutritional advice, such as a minimum amount of protein you need to be eating ? Advice on exercise ?

Some do, some don’t. You can ‘shop around’ and choose an approach that’s right for you.
Personally I didn’t want any of that… as i said above I already strength trained 3 x a week (and ran 5k twice a week) so had the exercise side covered, and I knew the theory behind eating well, it was just the ravenous hunger/food noise meant I ate too much. MJ helped me to reduce my portion sizes.

@Dymaxion it depends, the level of support varies according to what people want. Some companies offer coaching and lots of other access to varied support. They all will give out detailed information about the medication and how to support taking it with an appropriate diet and exercise.

No, it's to do with the rapidity of loss (also occurs in bariatric patients). If people have the right support and information, it can be minimised, but so many people do not have much support or information, judging by these threads.

Thank you @MereNoelle , you sound similar to me regarding appetite and portion size. I am considering using it to reset my appetite, whilst eating a healthier diet and starting to exercise. I do know if I remove the rubbish carbs from my diet, my appetite does reduce so hoping a combination of the two might be the key to a more sustained weight loss. Have a lot to lose, around the 10 stone mark !

@pirateshirt could you explain what information we are not getting if you think that would be helpful to people? What is it that we are not being told that we should be being told? Thanks.