I'm so huge and fat, I'll be dead in five years

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In my early 30s, 5ft4 and last time I got on the scales, I weighed 26 and a half stone. Currently on the antipsychotic Aripiprazole (15mg daily) and Fluoxetine (20mg daily). Before that, I was on Olanzapine and Paroxetine. Before that I was on Sertraline. Before that I was on Mirtazapine. Before that I was on Citalopram. Got a parent who has hypothyroidism. At the beginning of the year, I had blood tests after a stomach bug and got told I am deficient in Vitamin D and B12. I was prescribed some Vitamin D to take twice a week, but I have not been taking it consistently. My face is puffy and I get hairs on my chin and a few on my chest. Periods are irregular and when I do get them, they get quite heavy. I'm tired all the time and the house is a mess, but I just have no energy to do anything. I barely manage to get up for work. Got left pelvic pain and left hip hurts when walking. Ankles seem swollen and feel sore when I lie down in bed at night. Get out of breath going up the stairs and too fat to reach my toenails to cut them. I want to lose weight, but just feel hopeless.

Sounds like PCOS thrown in there as well, have you been tested for it? You might need metformin to manage it

I ballooned when I was on SSRIs over the years, although I am just fond of food as well so it wasnt a total reason but they dont help

Can you afford WLI?

You would probably be a candidate for mounjaro or similar on the NHS? Could you speak to your GP?

Bummer. As you know, Olanzapine's notorious for metabolic side-effects causing weight gain. Aripiprazole's supposed to be better from that point of view (and others).

It sounds like you may have PCOS. Can you ask about a scan of your ovaries?

You probably won't be dead in five years, that's your depression talking. This will pass. Hard to believe perhaps, but there are better times ahead

Very unlikely to get it on the NHS, you need about 4 comorbidities, cant remember what they are, possibly diabetes, high blood pressure, perhaps PCOS counts as well?

If someone is 26+ stone, they will likely qualify on the NHS (unless you get fatphobic GP who thinks it’s just a case of pulling yourself together). You’re correct about the criteria but with a BMI of at least 60 in this case, that would likely be enough.

I’m sorry that sounds really hard. I’d be asking your gp and psychiatrist to start you on metformin for weight loss at the very least - there is new international guidance on this for antipsychotic induced weight gain. But Ideally a glp1 if you can get it. Then add in the usual lifestyle measures but I think a medication is indicated here and evidence based (although psychiatrists and GPs only just getting confident with this for antipsychotics so you may needs to be persistent, show them the papers)

Well I only know there is a big poster in our GP surgery warning not to ask for it unless you have 4 conditions, cant remember what they are and obviously the BMI has to be over a certain amount.

Being on a metabolic worsening antipsychotic should be more than enough on its own and is in other countries but the nhs is behind on this

Very much sounds like PCOS (now PMOS) is a factor here OP. The hirsutism and irregular periods point to that. It's a metabolic disorder that causes hormonal imbalances and pretty serious weight gain. It also causes fatigue and brain fog.

You are not going to die in the next few years but you do have to take action now. It's not easy, I know...I have PCOS too but even 15 minutes of walking a day can start to balance your insulin levels and help you manage it. WLIs are also an option.

Please be kind to yourself 💐

BMI has to be over 40 plus 4 co-morbidities. A BMI of 60-70 or more would be considered on that alone.

Do you like your job? If not, can you afford to quit it?

I'd be buggered if I'd work if I thought I only had five years left. I'd pack it in. Maybe join a slimming world and a gym and commit to serious weightloss too with all the free time.

You might find all the stress has been a big weight gain cause too.

Please please please talk to your GP about what weight loss pathways there are available to you.

About 7 years ago I spoke with my GP who helped me access a publicly funded weight loss clinic (in Australia) the process was slow and frustrating but 7 years later I am almost half my size. I feel so much better more like myself. It was not easy. It's start hard.

Honestly if it affects you physical mental health souch it may be worth it to try to by WLI privately.

You can turn this around, but you have ti really want to.

I would suggest making an appointment to talk to someone - chat to the receptionist to find out if that is best being your GP or (most likely) a practice nurse. Ask for some up to date bloods including thyroid and HbA1c but they should be able to support you. Its also worth recognising that there is also likely to be a significant psychological element at play too, and its not going to be as simple as just eat less". It may be possible (depending on your current MH conditions and support) to get psychological support via a bariatric referral.

Ultimately, it's doable but it won't be easy. I lost 50% of my body weight (was 28st) and it was totally life changing.

OP, my story is similar to yours, I was older, as I'd just let it go on for so long. I got to the point where my weight was going to kill me, one small thing after another going wrong, including diabetes. I'd already had radiation for my thyroid condition and then what really frightened me was a scare with liver cancer.

I saw a random GP at a health centre (I'm not in the UK) and he gently asked if I'd ever considered weight loss surgery. I hadn't. I'd seen TV shows with weight loss stories, but somehow, not connected the dots to me.

I was 117kg and I'm only 155cm if I stretch a lot. I used to plan my days around meals, where to park and how little I could walk as everything hurt. My whole life I had been hungry, crazy hungry. I know I was eating too much, but sometimes after even what I knew was a huge meal, I was still hungry. I knew that wasn't right, but didn't know what to do about it. Like most big people, I'd tried every diet. I'd maybe lose a little and then put double back on.

The day the GP mentioned weight loss surgery, I knew it was the lifeline I needed and I knew I had to make it work, or die.

I came home and cried, talked to my supportive husband and cried, phoned the one friend who I know had surgery a few years before and cried and I found the weight loss surgery threads on Mumsnet and read every word (they were at the end of Thread 2 back then).

The day I saw that GP, he started me on Metformin and it helped a little with controlling blood sugar and I waited to see the weight loss surgeon. She was amazing, never made me feel bad, she was just supportive. She said if I had surgery I would probably lose around 30kg. That would have left me still seriously obese, but not in the 'going to die' range. So I booked a date four months later for surgery. It could have been sooner, but that's what fitted in with work and time off for me.

Surgery has been nothing but life changing, in all the best ways. I lost 53kg and have maintained that relatively easily. Also, for the first time in my life, I'm not hungry! This sounds silly, but it's quite a revelation not to feel hunger (at least, not often). The surgeon explained that the part of the stomach they take away during Gastric Sleeve surgery is the part where the hunger hormone, Ghrelin, is produced. All those years of diets, Weight Watchers, special programs, I'd never even heard of Ghrelin. This annoys me as I feel like the sooner obesity is treated as a medical issue and not a laziness issue the better.

The rest of my family were all pretty normal sized and we did a lot of socialising around food. I made a conscious decision that this wouldn't change. I had my first lunch out with a group of friends just 9 days after surgery. I checked the menu ahead as I was on liquid only for the first two weeks (then puree/soft food). I made sure there was a soup I could eat and had apple juice over ice to feel like I was having a festive drink. I had a great time and went home tired, but feeling so good, it was a hurdle and I'd cleared it.

Now, four years later, I sit very happily at 65kg. I can eat pretty much anything I want, just smaller quantities of it. I can stop when full and if I'm not hungry, I say no thanks to food. And it's not even hard! I don't count calories or anything else, it feels like freedom after dieting for so many years (and failing). I am mindful of what I eat, I do make sure I eat some protein at each meal. If I've had a couple of big days, I might make sure I'm a bit more careful for a few days afterwards, but that's it.

As an example, I rarely eat pizza (just never been a fan), but last night had three decent sized slices of meat lovers for dinner. No regrets. I may have had a couple of small Easter eggs too (I still have a stash), but I didn't then have the biscuits that were offered to everyone. Today, I've had a bacon and egg roll for lunch. I am mindful of carbs generally and also a bacon and egg roll fills me up, so I didn't eat the top bun and I'm typing feeling very full. Some people who have weight loss surgery can't eat this much, but then, there are those who also get into competitive under eating.

Since committing to surgery, I am also a member of a couple of bariatric surgery groups on Facebook for my county and these have been very supportive.

I'm not saying you can't lose weight alone or with drugs (that all appeared after my surgery). Just giving my experience and what worked for me. I just can't imagine that I would have been successful with the new drugs, while still having the part of my tummy producing ghrelin.

I do exercise as well, but not crazily. I have become the annoying person who is happy to walk everywhere and I walk over 15000 steps per day (nobody needs to do this but it suits me) and go to Pilates once a week.

Wishing you all the best with finding something that works for you.

Edited to add: All the body parts that used to hurt no longer hurt! I'm not on metformin, that ceased the day of surgery. Life is great!

I'm sorry I don't have any advice OP but I just wanted to send you some love and I hope you get some useful information from this thread and manage to find a way through x

I know they are doing studies on GLP-1s specifically to counteract the weight effects of antipsychotics. Mirtazapine is also a known culprit for weight gain.

It really ought to be qualifying to have BMI over a certain amount plus taking these drugs as a qualifier, without diabetes, especially as olanzapine is known to trigger T2DM.

There are specific weight loss boards on here like weight loss chat where there are threads you can join for support or start your own to document your journey and get support. I and many others post regularly and the accountability and kind words make it easier.

I don’t have knowledge of your conditions but I would echo speaking to the doctor about your weight to see if they can help. If you decide to try injections either privately or on the NHS there is a board on here discussing those and you will have support and can read other people’s journeys.

I would start by speaking with your GP and keeping a food diary for a week to see what you are eating and then review it thinking about what do you want your diet to look like it, can you add more veggies and fruit. If you are drinking alcohol can you cut that out etc. Maybe use this as a reason to try new foods or recipes. You need to take your vitamins especially if you are deficient and start trying to do things for your mental health.

I suffer from chronic pain and it’s hard. It doesn’t stop me exercising but I have found loosing weight helps lessen that pain. Do you have a step tracker as that is something else you might want to track and then look at gently increasing.

Please don’t do this on your own. The weight loss chat section is incredibly supportive, it’s really handy to be able to track your progress and writing your thoughts down will really help x

How are your finances? Could you afford to go private? They do take these things more seriously if you're paying them I find. Although I realise not everyone can afford this. Sometimes seemingly complex problems can be solved in only a few sessions though. The right thyroid meds might really help.

To be honest op, even if you have to buy Monjaro it’ll probably end up cost neutral because of what you must be spending on food. I know mine was and my BMI was 30.

I lost a lot of weight, and I mean a lot of weight, by reducing calories only.

If you can't afford the GLP, which some don't recommend anyway for various reasons, just drop those calories. You will have a lot more energy and self-esteem and a lot of the issues you mention, which could be associated with inflammation, could actually rectify through weight loss.

Vit D and B is normally low in obese individuals because of how absorption works, diet being low in these things but higher in sugars etc.

Make sure you are getting protein, fibre and then topping up calories with good, healthy fats (where needed for taste) and, lastly, carbs. You can go no carbs, and that will help with appetite, but I've lost weight both ways so up to you what you think you can manage.

I've been where you are so I know it feels hopeless. But, you can do this!

Start with a journal, good intention and drinking water!

No other advice to add, but I can feel the pain in your OP. You are not defined by your weight. There is so much more to you. Please be kinder to yourself.

I would highly recommend WLI - if your doctor approves - yes it is expensive but I don’t comfort eat or buy nearly as much more crap so I think it’s so worth it

OP you sound really down and I am sorry things feel so bleak. As others have said, brighter times are around the corner. WLI been a godsend for me but if they are not viable, committing to a walking programme is a positive step too. Doesn’t have to be much and you can be your own champion (or competitor!), helps with mood and perfect time of year. definitely worth a wider check in with GP for a meds review to generally support you?
You are just as deserving of happiness of others, always remember that. Today can be a positive first day - it sounds like you are a warrior already x

How much do the weight loss drugs cost? I am just wondering if people are eating less food, maybe they can then afford the drugs? Or are they really expensive?