to feel uneasy about what this means long term rather than surprised by the weight regain itself?

[HazelMember]

I’ve just read a BBC article about research into weight loss injections like Ozempic and Wegovy showing that people who stop taking them tend to regain weight quite quickly.

I’m not shocked that weight comes back. That happens after most weight loss attempts whether they involve medication or not.

These drugs are increasingly talked about as something people might take for years or even indefinitely. That raises questions for me about what happens when someone cannot afford them anymore, when supply changes, when side effects become an issue or when a person simply does not want to stay on a medication for life.

If stopping leads not just to regain but to a fairly rapid rebound, it feels less like a temporary aid and more like something that is very hard to step away from once started. That sits oddly with how casually they are sometimes discussed.

AIBU to think the real issue here is not that people regain weight after stopping, but whether we are quietly normalising a treatment that may be difficult to discontinue once begun? Or is this simply the reality of managing a chronic condition?

I think there are still a lot of questions about these drugs - which is very often the case with new drugs or when they are being used in a new way.

How will they work for people long term, and what the best way to prescribe and use them will be so they will be successful and not just part of a loss/gain see saw.

Could there be long term effects revealed when they are being used by many more people?

Will there be abuse, like we are seeing in places like Hollywood? How will that affect attitudes to weight loss, especially in younger people?

Will there be a shift in social attitudes around weight? How will that intersect with wealth? Will people start to see it as a "right" to have access to drugs like these to stay slim?

We do know about contraception, it affects it, women are advised to ensure that they take alternative methods as it makes the pill less effective.

So does St John's Wort and some other medication.

But isn’t the issue here that people have to pay for it, unlike other long-term medications which we get on NHS.

I recently started WLI and it’s a huge stretch for me. There’s no way I will be able to do more than a few months so every time I read something about how it really should be considered a forever medication I die a little inside. That’s just not an option for me.

I wonder if it's understood what morbidly obese means here? BMI 40. You can be very obese indeed and not clear that bar. A 5 foot 5 white woman would have to be more than 17 stone.

The poster would be looking for a loooong time for any evidence that a 17 stone woman of five five would be best off with the eat less move more route.

Great post and thoughtful questions 👏🏻

I think sometimes people don't always think critically or outside the box when they're considering things like new/off label medication. 🤔 (I'll probably get flamed for saying that though!)

Obviously most people can take medication and not have any serious adverse effects, but believe me when i say the lifelong and even devastating injuries that have a huge impact on health make you more wary of how these things work.

I think it’s another fad diet and will always maintain that. My Mum is the sort who has done pretty much every diet going over the years and constantly yo-yo’d as a result. She’s never been unbelievably massive but I’d say she’s been low level obese at her biggest- maybe BMI in early 30s.

She’s just tried everything over the years- constantly back and forth to weight watchers buying all of their crap merchandise, slimming world, 5:2, Atkins, special k, cabbage soup for heavens sake. Never known her have a healthy relationship with food, it’s always been worrying and tracking calories or ‘points’, living off crab sticks, WW bread and skimmed milk 🤢.

Now she’s using these. Just another thing in a long line of fads. No idea why she’s never just taken up running or the gym long term instead, it would be far more beneficial for her long term health. She just had a hip replacement, she’s only in her 50s. You can’t tell me that doesn’t have something to do with the way she’s mistreated her body over the years.

@Sartrepeople like your mum who buy into fads might use WLI in that way. It’s one example and not at all sufficient to generalise from. It’s not my experience nor that of the many others on the long running support thread for WLI that I post on.

This is why they should be prescription only though. At that height and weight you definitely do not need them.

Those papers say "The causes of obesity are manifold and cannot be attributed to one single cause, such as overeating. In most cases, including polygenic obesity, the factors causing obesity are modifiable". They also say those factors are "physical activity environment, food consumption, food production, individual psychology and social psychology".

People's relationship with food is complex, so saying "eat less, move more" is like saying to an addict "why not just stop". When I was a 1990s smoker it used to make me very cross that the govt message was simultaneously "just stop smoking, it's so bad for you" while also tobacco advertising was absolutely everywhere, and fags sold on every street corner. Eventually I did quit, and it was a whole lot easier when advertising was stopped, non-smoking areas became the norm, and fags were hidden away behind counters.

Junk food is sold everywhere, promoted everywhere, cheaper than healthy food, and physiologically highly addictive, yet people are just supposed to say no using willpower alone, despite being completely surrounded by messaging that says more more more.

It's definitely not just a case of "eat less, move more", and I agree it is unfair to blame the behaviour of individual people for a global public health issue.

No idea why she’s never just taken up running or the gym long term instead, it would be far more beneficial for her long term health.

While I don't disagree that exercise is great for your health, exercise has surprisingly little effect on weight loss. I've been fat while working as a fitness instructor. I didn't lose a single kilo while intensively training for half marathon.
And of course it is not so pleasant to exercise when she has a BMI in 30s.

In my opinion, WLIs are not comparable to herbalife shakes or some weird restrictive cabbage soup and an egg diets. And believe me, I've done them all as well, I didn't know better. I hope your mum gets some support and nutritional advice alongside, and yes, joins a gym as well - this could be an opportinity for her to significantly improve her life.

One would think that exercise would help keep you in calorie deficit though.

I think how much exercise can help with weight management would vary greatly between individuals.

yes absolutely exercise helps. But only moderately. And ironically, fit people actually utilise fewer calories on other tasks - they become more efficient.
Pontzer et al., Constrained Total Energy Expenditure and Metabolic Adaptation challenges the classic idea that total daily calorie burn increases linearly with physical activity. Instead, after a point, energy expenditure plateaus, meaning the body adapts by reducing energy spent on other physiological processes so total expenditure stays within a narrower range.

Or see Exercise Paradox (Herman Pontzer) - People with extremely high daily activity (e.g., walking many kilometers) don’t necessarily burn more calories overall than sedentary individuals. He studied the hunter-gatherer tribes that are very active the entire day, but didn't actually burn more calories than a random office worker.

I find this topic quite fascinating.

Just to be clear, definitely not saying people shoud not exercise. Quite the opposite and I myself pretty much live at the gym. But an obese person won't become a slim one just by starting C25K, if they don't sort out eating.

Loose skin isn’t going to put you at risk of a heart attack, stroke, diabetes or cancer.

I know that. It can cause some severe psyochological issues in some people. It may very well be limiting. Not all ailments are physical.

If I do more cardio my bodyfat melts away and I have trouble eating enough to keep myself over 8 stone. Running especially makes me shed bodyfat.
This has always been the case for me and it remains so at age 60.

I think it’s true that you can’t out-exercise a bad diet, but if you’re already eating close to weight loss amounts of decent whole foods, then exercise actually makes a lot of difference. Even walking burns enough calories to make a noticeable difference for me.

Absolutely this. It makes a huge difference if diet is healthy and body fat is low. I see my muscles grow daily and it’s very satisfying

Find this fascinating also. I exercise a lot but the calories I burn daily are pretty average and probably not loads more than people who live a much more sedentary lifestyle, unless I run 10+ miles etc. you also don’t burn masses more calories running than walking, but I prefer to run for the other benefits. My weight remains steady and I don’t really loose or gain more than a few pounds.

you definitely can’t outrun a bad diet, you have to adapt your food intake along side. A lot of people actually gain weight while marathon training as you need to fuel your body for the exertion you feel but you don’t always burn as many calories off.

that said, you do burn more calories when you first start and so for someone starting a weight loss journey exercising alongside will likely be beneficial both in terms of burning more calories and just generally feeling better in yourself. But you do need to keep increasing the intensity or you do just plateau as you adapt to the level of activity. You have to learn to enjoy the exercise for the other benefits rather than just doing it for wait loss as the gains aren’t always particularly impressive.

I think how much exercise can help with weight management would vary greatly between individuals

this

even when i was at the gym for an hour and a half a day 6 days a week in my 20’s i didnt lose an ounce

friend of mine runs so she can eat what she likes, in her case the exercise balances out the food intake…and wine 😀

here's an article about the exercise paradox: https://today.duke.edu/2019/01/living-caveman-won%E2%80%99t-make-you-thin-it-might-make-you-healthy

I love the loose skin posts.

Because some loose skin is much much worse than being 20 stone.

I literally cannot understand the thought process of someone who would remain dangerously, unhealthily overweight, just so they didn’t have loose skin. I’ve got some loose skin on my stomach. I’ve carried 4 babies, all c sections and have been overweight for years so it’s going nowhere. I look good in clothes and ok in undies and my body is healthy so who cares?!

There are people who have a lot to loose and the loose skin will need managing. It won't be just a bit of loose skin. No point risking the effects of obesity but for some the loose skin issue won't just be purely cosmetic. This in itself can have challenges and I don't understand why anyone would dismiss that.

I’ve lost 11 stone. I don’t have loose skin that needs managing, I’ve got a bit of crepeyness on my inner thighs, a bit of a stomach roll but it’s no longer an overhang as it’s shrunk back, I’ve also had two large babies and two c sections so it’s never going to be flat. I’ve got a bit of bingo wings going on but that seems to be improving a lot recently. It’s nothing like what you see on social media, of people who have lost multiple stones and have hanging sagging skin. It’s obviously a possibility but it’s not a reason to remain obese, or to fear losing the weight. Try and lose weight at a steady pace, and try to exercise and eat well, but that’s good advice generally not just to minimise loose skin.

It just sometimes seems like the “threat” of loose skin is used as a way to needle and poke at obese people, to say that even if you do lose the weight you’ll still be “unworthy” and just have swapped one health issue for another that’s just as bad. I’m sure it’s not meant that way but that’s sometimes how it seems.

Managing in what way?

I lost 10 stone and have loads of loose skin, I look like a pelmet and my skin was very stretched and not elastic and Im old so it was inevitable. Im a big wrinkle

It doesnt bother me, I find it fascinating in a way that it used to be all full of fat.

I look great when dressed but I didnt do it for that anyway, I did it for my health.