To think that if people can take Mounjaro forever for maintenance (which I support FAOD)

[Fragmentedbrain]

Why can't everyone just buy it when they feel the need?

Basically this means that people who lost weight in a different way are denied this long term amazing support tool while those who started off on it can keep using it. But if you purposefully regained a bit of weight to become "eligible" for the injections you could take them and then have Mounjaro available for life.

This seems very unfair to me.

Yes, this would be good for someone like me. Was BMI of 32 at one point, have lost quite a bit and now down to 23; this is not the first time though, and have always ended up gaining it back. it's been miserable losing it, and miserable trying to maintain - constant hunger, cravings, planning, so restrictive and almost unsustainable amounts of exercise. But now that I'm back in the normal range, I wouldn't be eligible, even though I was almost pre-diabetic (HbA1C of 42 at one point, even when restricting carbs), had hypertension (unclear if I still officially do), high cholesterol (still, despite the weight loss), and a big family history of weight issues, type 2 diabetes, demetia, inflammatory conditions etc.

I would think I'd have been a good candidate for the injections had they been more easily available and affordable when I was at my highest weight, or if the NHS had just been able to prescribe them to anyone with my weight/conditions. It would have made losing the weight less awful, and might help now with the misery of trying to maintain like this, as well as with the other conditions/risk of conditions.

I hope that in the future this would be considered. I wouldn't be surprised if I end up putting some of the weight back on, and this could be used to help prevent that.

There’s a big gap between being slim and being eligible for Mounjaro.

What about the was slim but now slowly gaining person? The person who in 3 years time could be obese and gaining?

People are rarely born fat. If prevention is better than cure, shouldn’t someone who is gaining X per year and struggling to lose be able to have access without meeting the obese threshold?

I've never taken WLI myself - I'm lucky I don't really think about food much - so maybe I shouldn't be commenting, but I think you make a good point about people who've lost the weight naturally. They should be able to get a maintenance dose the same as people who've lost on WLI. The tricky part would be proving it, but I suppose if their previous obesity is noted on their medical records, that should be fine.

For overweight people and people who want to avoid getting overweight, I think it's a bit trickier. So many people don't seem to realise that obesity changes your physiology significantly, and those drugs act to counteract that (not a very scientific way of putting it). That being said, if they do trials and it's deemed safe for people who aren't obese/don't have other conditions that affect their physiology, then I would have absolutely no problem with them being able to take them if they want to.

My only slight reservation would be how we would gatekeep them so that people with serious eating disorders would not be able to access them.

The thing is, I used to be obese. You’d probably not have thought I was at the time because of the way I carried the weight, and the way I dressed, but I was. The reason I was obese (which is the same reason 100% of obese people are obese) is because the number of calories I consumed was more then the number of calories I burned.

I lost the weight through changing what I ate, and how much I ate and exercising more (which obviously whilst very important was not the key to weight loss). It was HARD. I had to rewire my brain.

Now I’m a healthy weight. But my brain still screams at me every day and I have to fight EVERY DAY not to give in to my cravings.

Now imagine if I’d actually lost the weight through weight loss injections. I’d potentially still be on them and from what I read I’d not be getting the same cravings etc and maintaining would be way easier than it is. Feels a bit unfair.

Congrats on your weight loss.

Why is it unfair? Surely you can recognise how hard this is mentally and therefore, be grateful other people get that support? As I’ve said before, I do think those who have lost weight through the conventional methods should be given the opportunity to take a lower maintenance dose to aid that maintenance of weight loss.

That’s the point I’m making. People look at me and see a thin person. They see someone who says no to the slice of cake, who doesn’t finish their food in a restaurant, who always eats fruit for breakfast. What they don’t see is that I have an internal battle every time someone offers me cake, that I freaking love croissants but haven’t had one in 2 years, that I have to eat something healthy before I go to a restaurant so that I don’t eat too much, and that when I say I’m too full for desert, I’m LYING!

i still obsess about food two years after i lost the weight. I wonder if I was on a WLI, maybe it wouldn’t dominate my thoughts so much.

I agree 100%. It's almost a disincentive to change up your diet and try and get more healthy, because if you do that you'll have to potentially struggle forever. You may as well just not bother and go straight for the MJ.
And those saying you still have to work on MJ - I'm sure that's true, but you obviously have to work LESS than without it, or nobody would bother, would they?

Is it due to double in price in Sept for those on it privately?

On every WLI thread someone says that you don’t just lose weight with the injections, you have to eat healthily and exercise. You have to work hard to get to goal weight.

OK, so once you’ve reached your goal weight why do you continue to need thousands of £ worth of NHS supported WLI? I’m sure it takes many months, maybe a year or over to drop that much weight. By that time surely someone has learnt how to exercise and eat healthily?

Why is this different to other NHS procedures who help or cure someone then sends them on their way?

I don’t agree with the NHS paying for maintenance WLI once someone has lost all the weight unless they have a medical issue that directly blows up their weight.

If someone has done loads of exercise and learned to eat healthily then why can’t this just be carried on with to maintain it.

Weightwatchers costs me £8.99 a month. I’m in maintenance mode having lost 2,5 stone through diet and exercise. I think about food all day every day.

The NHS can’t fund WLI forever. There needs to be some personal responsibility for maintaining weight once you’ve reached your goal.

I can see where you’re coming from op and I do think that we will see the availability of WLI’s widen over time.

Losing weight is hard, even more so as you get closer to your target weight. Once you get there, it takes significant effort and consistency to maintain it. I rarely take my eye off the ball and track my food/macros/weight daily, even when I’m on holiday. Exercise is also an essential part of my life and I rarely miss a scheduled session. It would be nice not to have to be so strict, but for me at 55, i need to in order to stay healthy and fit.

i have no doubt a maintenance dose of a WLI would make my life a lot easier.

Private prescriptions aren’t NHS supported.

I think we’re aligned then - I do think that if you can prove (via medical records, old photos etc.) that you were obese, you should be able to access 2.5 or 5mg to maintain your loss.

Because obesity changes your whole physiology, and it is just not as simple as eating right and exercising. Obviously, that's a big part of it, but the WLIs help with the rest. People think it's just an appetite suppressant, but it is so much more than that.

Oh, and the vast majority of people using it aren't getting it on the NHS.

People haven’t “learnt how to diet and exercise”. That isn’t the problem. Fat people aren’t stupid and eating vegetables doesn’t require a PhD. Everyone knows how to diet and exercise.

For some people, mild hunger is physically painful. It hurts. For some people, being in a even a small calorie deficit causes a lot of symptoms - being very cold, dizziness, palpitations, headaches, nausea… For some, their bodies don’t regulate their blood sugar properly causing cravings, dizziness and hunger when there’s no need to eat. Those symptoms are eased or stopped by medication. All those things reappear if you stop taking the medication.

Think of hunger thresholds like pain thresholds. Some people say having a smear really, really hurts and they need to have lots of pain relief. Others say it doesn’t hurt at all. If someone with a lower pain threshold were in pain all day every day from daily life, would you begrudge them painkillers just because life doesn’t hurt for someone else? Then, after they’ve been on painkillers and been able to get back to a place where they can go to work and socialise and exercise, would you say they’ve “learnt how to work/socialise/exercise” so we can take away the painkillers? Or would you think they still need those painkillers?

For many, hunger is like pain and an appetite suppressant is a painkiller.

Your comment is like stopping treatment for someone with anorexia once they’re a healthy weight because they’ve learnt to eat now. Or stopping antidepressants if someone is happy because now they’ve learnt how to smile and could just keep doing it.

GLP-1 Agonists are serious medications of which there are no long-term studies of, for obvious reasons. However, there are very, very serious side-effects showing up, sarcopenia being most common, with osteoporosis increasingly showing up. Sarcopenia, especially alongside osteoporosis, is one of the three leading causes of death in older people. It's not a little thing to brush off, losing muscle and bone density is incredibly serious. There is also the issue of cardiac shrinkage in animal testing, which is incredibly serious if we see it in humans.

These medications really need to be used sparingly, in cases where the risk of side-effects is the lesser risk to the patient, not for people who don't feel like making the effort to look how they'd like. As for the cravings and having to weigh up whether or not we should eat something. That's life, the people who don't feel like that are rare. Most people love delicious food, and the social side of eating and have to weigh up whether of not they'll have x now, versus y later. Tall, naturally lean people, especially men, and/or is they are very active, are the only people who can eat whatever they want, whenever. There are also some people who just aren't especially food motivated, but that comes with it's own drawback of never getting to derive great pleasure from food.

If the drugs can be adapted so side-effects are mitigated, and they possibly could be if used as a tool in a multi-pronged approach, where resistance training is done to ensure muscle and bone loss don't happen. Alongside other measures, and everyone could take them and maintain a healthy weight, that would be fantastic. But until we can be sure that 'the cure isn't worse than the disease,' it would be foolhardy to roll them out as some here think they should be. Already there is a huge class action lawsuit happening in the US, with over 2k litigants, as of the start of this month, claiming serious side effects. This is without doubt going to grow massively in the coming years. It's possibly that GLP1 agonists will become more widespread a decade from now, but it's equally possible that they will be looked back on with horror.

It's interesting that you think that way. I'm on Wegovy and what you described is exactly what I go through. The WLI makes it easier to make the right choice, but those choices are still there. All day, every day.

Do you have a source for this? They have been in use for years.

A source for what? The sarcopenia issue has been well know for quite a while now. The osteo issues are increasingly common. The cardiac shrinkage in mice is well documented - though hopefully it's not happening in humans, we aren't mice after all, but it does warrant caution until we know for sure. And the class action lawsuit is common knowledge too, with some of the litigants suing due to vision problems.

Any of your claims?

the vision issue is due to a temporary worsening of diabetic retinopathy.

All medication carries risk and has costs associated (private or public purse) why should we be encouraging those who don’t need it to line the pockets of drugs companies? The message is that you are failing somehow if you don’t want to pump medication in your body to get thinner.

personally I’d qualify for it but I don’t use medication unless absolutely necessary - eg no hrt for me, didn’t have drugs in childbirth either

But what we are saying is that there are some of us who probably do need it - those who have (possibly temporarily) lost weight through other means, but really struggled both with the losing and still with the maintaining. And who potentially still have some of the conditions associated with obesity, as well as the physiological changes. If the drug would help us keep the weight off without yo-yoing back up again, that could be healthier overall. Or even if it just helped mentally. it's not just about making choices, which everyone has to do, but the constant cravings, hunger, planning, working out how to occupy the brain until you can have 200 more calories for your lunch or whatever. Running 2 hours in order to have a nice breakfast. The levels of restriction that some of us need are quite high, and it's very difficult to control the cravings and thoughts around that. I don't think the choices that people of normal weight have to make are at the same level or of the same intensity.

And yes, there are potential side effects, but so are there with obesity, and with conditions that caused the obesity in the first place, even if it's not currently there. There are also benefits that the drugs could have on these other conditions, rather than on weight loss, and I think those could be considered as part of the balance, especially as further research is done on them.

I have a BMI of 26 but I am relatively fit (enough). I’ve always struggled with my perception of my weight when compared to others, but there’s no way I’d put on more weight and have to go through the rigmarole of getting WLI and injecting myself with all that stuff, and the side effects.