Severely obese, 2 miscarraiges, should I go on ozempic before TTC again?

[Helpneeded719]

Hello everyone, name change for this post as it is very personal.
I am 34 years old, I have had 2 miscarraiges - one chemical at 5 weeks and one mmc at 9/10 weeks there had been a heartbeat previous to the loss, I sadly have no living children.

Myself and DH are DESPERATE for a baby, all blood work came back as normal in regard to the pregnancy losses, we didnt do any further investigations. I dont have any underlying health conditions, however I am extremely unfit and morbidly obese (BMI of 46 I think).

I am only just 5 foot but weigh 17 stone and honestly eating what are "regular" portions of food for most people make me gain weight, I have to starve to get to a healthy weight, I then struggle to keep it off. Have a generally ok diet each loads of vegetables, fruit etc. But weight just does not come off easily for me at all, I do have quite a large appetite and I do struggle with emotional/boredom eating too. My doctor has said the whole eat less move more just simply does not work for people with genetic predisposition to being heavier etc. So its just not that simple for me unfortunately (trust me I have tried)

My dilemma is do I try to get maybe 2 stone off over the next 3 months by myself via eating a banana, a healthy oat cereal bar and a smaller portion of a homemade, healthy & nutritious dinner every day - will be a struggle to stick to it but this is all I can eat to actually loose weight, and then try again for a baby ASAP, BMI will still be well into the severely obese category

or do we take a break from trying for 9 months, I start on ozempic for 6 months, loose weight, stop for 3 months as recommended and then TTC again when at a healthier weight? This option seems so tough mentally as we are so desperate to have a child of our own. But I need to think about what is best for both my own health and that of a future pregnancy.

How much of a struggle would pregnancy be for me at my current weight? 5 foot and 17 stone, I do have hip pain and am very out of breath walking up a stairs. What are the chances my weight contributed to my miscarraiges?
Other side of the story is waiting another 9 months at my age to TTC ill be 35/36 when baby is born.

Really struggling with the decision, my GP hasn't brought up my weight and just said I shouldn't find reasons to blame myself for the miscarraiges when I asked.
Has anyone any advice? What is likely to be worse being obese or being older when TTC?
I had no issue falling pregnant but both pregnancies have sadly ended in loss.

Thank you if you've gotten this far xx I am terribly ashamed about my weight and fitness levels, it is something that causes me a great deal of emotional upset and shame. But I have my reasons of why Im here so I really dont need any lectures or shaming, please, as I really have beaten myself up enough over it for us all,
Thank you x

Echoing what has been said about getting some blood tests done, particularly HbA1C and thyroid. It is not normal to need to eat a tiny number of calories to lose weight. At your current weight, height, age and assuming a sedentary lifestyle you should be able to eat around 2000 calories a day and stay the same weight, so 1500 calories a day should see a steady loss of 1-2 lbs a week, add in some basic exercise like a brisk 20 min walk 3 times a week and you should definitely lose weight, if you don’t lose weight eating less than that then there is something not working quite right.

I was diagnosed with PCOS but told no treatment I just needed to lose weight - eat less, move more. That didn’t really work. I was able to lose weight but only by starving myself, eating no carbs, doing loads of exercise and feeling hungry and in pain constantly. I did manage to lose 10% bodyweight that way though, and I got pregnant, and I got gestational diabetes. Was put on insulin during pregnancy and the weight fell off. I was 2 stone lighter at the end of my pregnancy than the beginning. As soon as I had the baby they stopped my insulin telling me that giving birth cured my GD and I was never tested or treated for anything again, just kept getting told all my problems were due to being fat and I needed to sort myself out.

2024 I was diagnosed with T2 diabetes after buying myself a continuous glucose monitor and presenting the incredibly high sugar readings to medical professionals.

At that point the diabetes team started prescribing me insulin and metformin which didn’t work so moved on to Mounjaro which was miraculous, blood sugar levels fell to normal range within weeks and the weight fell off. I’m now 9 stone lighter, in the healthy BMI range for the first time since primary school, BP is normal, cholesterol is normal, muscles/joints don’t ache constantly and I’m wearing size 10/12 clothes.

A banana, oat cereal bar and dinner isn’t going to help you lose weight for a start OP.

you need to cut down on carbs and focus on lean protein and healthy fats with clean carbs. Work out your macros and use my fitness pal and weigh your food.

it’s a big dedication and may involve you having some very honest conversations with yourself but much healthier then WLI

So sorry to hear about your miscarriages.

I would definitely have further testing for you and your DH as you don’t want to assume it’s you and not have your DH try to improve things if it’s him. I would also put ttc on the back burner to try and get into a healthy weight but that won’t be within 6 months if you lose at a sensible rate. If you lose too quickly, you will lose muscle which means you’ll pile it back on and more in no time. You’re also at higher risk of gallstones as someone else said. You don’t want to lose more than a couple of pounds per week after the first few weeks when you may lose a bit more. In this time, I’d also try to exercise to improve your lung function and lift some weights to mitigate muscle loss.

If you don’t get back into a healthy weight and get some level of fitness, as soon as you’re pregnant, it will pile back on and that does put both of you at higher risk.

I personally think the risk of waiting a year or two is lower than not addressing the health issues. As I said, use the time to both have tests so it’s not wasted time at all. Make sure your DH is eating healthily even if he’s a healthy weight (and to lose weight with you if not). It’ll make his sperm healthier.

Weight loss and fitness will make pregnancy, birth and afterwards so much easier. Good luck x

Ive been there. Ive done it all, unfortunately my case is not as simple or straight forward as others. My GP has said that weightloss is not a 1 size fits all and the whole eat less, move more, reduce carbs doesnt just work for everyone. Especially when genetics is involved. She also said because of my height I am severely restricted in the amount of calories I can consume. My job is 13 hour days, very sedentary, very stressful, add in my commute and im gone from 5am to 8pm, live in the countryside so dont have paths/safe areas to walk and im also too tired/mentally exhausted from the stress of work all day, all I can do is shower and get to bed. So this adds to my problem. Im quite active at the weekend, get walks in every chance I can but it obviously doesnt make up for the sedentary lifestyle during the week.
Ive done low carb, high protein etc 100 x times but it just doesnt work for me long term at all, ill loose some weight but then it just totally stops and no matter what I do i wont loose any more. Im also one of the rare people who protein absolutely does not fill up at all, I'm starving after eating a high protein meal (chicken/steak/salmon with eggs just doesnt fill me - I need a carb source to avoid stomach grumbles all night)

Its possible there are thyroid issues at play as my TSH has been elevated and then just about within normal range in recent bloods. They were also considering checking me for PCOS but didnt go ahead with the testing then (I do have some symptoms) which I guess would explain the weight loss.
Im not afraid of trying/admitting it to myself etc at all, im quite open about my struggles. Ive paid a nutritionist at my local gym before and I wasn't even loosing weight on her plan (and yes i was 100% sticking to it) i lost for 5 weeks and that was it so maybe there are some hormone issues at play

So sorry to hear your story, it must be very painful.

Gently, I would remind you that your GP is not a specialist in this area and their advice may not be helpful here about it being harder for some people to lose weight. I’m not saying this is completely untrue but it removes some sense of agency and hope. Oat bar and a banana is a terrible choice for the first part of the day and will lead to you feeling very hungry, it is high sugar and will leave you wanting more very quickly. I know you have done it previously but you need to religiously track your calories, protein and fibre.

Consider having a look at the glucose goddess and reading/watching some guidance from Tim Spector about ultra processed foods. There is currently a tv programme available on C4 ‘what not to eat’ and one by Joe Wicks about UPFs.

I have had problem ttc and all four of my children were conceived when I was dieting and restricting calories to lose weight, so anecdotally it can make a huge difference.

Hope that you get your baby this year.

Thank you so much, this is so helpful I will be sure to take a look
Sorry I should have said the oat bars are homemade, I dont tend to eat a lot of UPF's as I have health anxiety to add to the mix so I tend to buy organic and cook homemade where possible.
Open to all recommendations on a better breakfast option,
Ive tried eggs in the morning previously but for some reason it makes me very nauseous and doesnt fill me up at all - this may be down to the fact that I need to eat them at 5am as im running out the door as I dont have anywhere at work that I can cook food. When having the banana ill have my first bite to eat at 10am so I suppose I am intermittent fasting which may be adding to the fact that this works best for me?
Ive also tried Greek yogurt which I love but it gives me chronic stomach acid issues if I have it on an empty stomach.
The banana and homemade oat bar are "handy" for me as they dont need reheating as depending on the day I dont usually have the opportunity to reheat food until evening at work.
For dinner id have salmon, chicken or steak, a baked potato, and a mix of veg so it might be peppers, onions, carrots, brocolli, garden peas and an egg - I have tried cutting the potato out but I need it to feel full, I then usually have a kiwi afterwards x

Even though I am drastically overweight I am concious of what I consume and where it has come from, when Im not dieting/am emotional eating etc I will absolutely spend my weekend baking breads, lemon drizzle, shortbread biscuits and more and consume them within a couple of days but I rarely buy UPF's and my dinners/main meals are all nutritious and full of veg, but I do have a big issue with portion control as I have a really big appetite.

If it were me, yes I’d take a year off to focus on getting healthy. Mounjaro has been life changing for me and I’ve lost 3 stone (another 2 to go). If you go that route, make sure your contraception is bullet proof as there’s clear warnings on weight loss drugs that you shouldn’t take them if you’re trying to conceive.

I’m not an expert but wonder whether cutting out all added sugars and refined carbs might be the way to go. Instead eat lots of vegetables (including root vegetables roasted in healthy fat , which are very filling and full of fibre, some lean protein and dairy (especially LIDL’s full fat Greek yoghurt), and fruit.

However, I’d also try and find a specialist nutritionist - someone who is very experienced in dealing with unusual cases like yours.

Given your extremely long working/commuting day, is there any way you could find a less challenging job, or at least one that is closer to home? Or move closer to work?

ETA just saw your update re. Yoghurt - maybe try cottage cheese instead?
re. Eggs for breakfast making you nauseous - could you perhaps delay breakfast until you get to work and have some boiled eggs and fruit

Yes.
It's not just about being able to conceive a pregnancy, its about having a healthy pregnancy, a safe delivery and a postnatal period where you can be healthy and recover well enough to care for a newborn.
It is also about when your child gets older and being able to give them an active childhood with a mum that can run after them. Speaking from experience here, as someone who's mum died when I was in childhood from obesity complications, you want to be around to see them grow up.

The ‘stomach grumbles’ are a good sign that your body is adjusting to the reduction in food intake - try to see it as an indication that you’re losing some weight as opposed to a sign that you need to eat more.
Out of interest, is your DH also overweight? If so, is he dieting with you? If he’s not overweight, what’s his take on you trying to lose weight? Is he encouraging, or does he unconsciously sabotage your efforts?
Ultimately, being lighter will reduce strain on your body, so your hip pain will lessen. It will also mean you’d be more actively engaged with your baby, be less likely to develop illnesses linked to obesity and generally fell better all round. In your position I would use WLJs to lose weight then attempt to conceive once you’re down to a more healthy weight.

@Helpneeded719 Insulin resistance can definitely make it harder to lose weight but nobody is destined to never be able to. Because excess adipose cells are hormonally active they cause a circular problem, in terms of further driving IR, but it's possible to disrupt.

Re hunger pangs - it's completely normal to have to go go through several days of light cramps when transitioning away a from high carb diet, as it's your stomach physically shrinking. I get this after eg a big takeaway or post christmas splurge. But they are a good thing and pass. There are also a few days of frequent urination as your body releases retained water/ bloating.

I think the injections for a few months would give a boost to morale, because you'd start to see results fast and not feel effort was all for nothing. They'd also get you used to smaller portions. You could alongside consider following an online weights or stretching tutorial on youtube or even just dancing around your house for 30 minutes - anything to help the joint pain/ breathlessness you've described, as pregnancy is a major heart strain.

Longer term, if you can find one or two healthy meals you love it will never be a chore to eat them. Or just try to cut anything like biscuits during the day, which are a killer for blood sugar, drink a lot of water and then eat your usual but make half the plate different coloured vegetables or salad.

@Helpneeded719
Why do you have to work 13 hours a day and how will you combine that level of work with children?

Have you ever kept a food diary?

Thyroid - optimal level is a TSH of 2, especially in pregnancy. GP's are poor at optimal thyroid, dietary advice and pregnancy. Please see an endocrinologist for advice.

Miscarriage: I had 5 pgs that reached the 2nd trimester, 3 the third. I lost count of the early ones - which 30 odd years ago we shrugged over and viewed potentially as a late period. I have two DC. I was 30s and a normal weight. However, there is more and more research indicating links with thyroid and sub-optimal pg experiences.

I'm 5'6" and to keep my weight at 11stone (was 9ish in my 30s), I eat no refined carbs, no sugar, little red meat, no wheat, no saturated fats. Breakfast is typically 2 tbs greek yoghurt, 6 nuts, 1/2tbs all bran, half a dozen raspberries, tbs blueberries. Lunch is typically a salad of lettuce, pepper, cu, tomato with a little virgin olive and wine vinegar, half a can of tuna and a tbs cottage cheese. Dinner is typically chicken or fish with the equiv of 6 new potatoes, salad or veg. Daily fruit: 1 apple, 2 satsumas, small lunch of grapes. Glass of wine (or 2) Friday and Saturday. If I want to lose one pound I have to cut out breakfast, lunch or dinnernfor two or three days and have no wine.

I think you need to be very very honest with yourself about what is going in and get yiur thyroid sorted out.

Currently trying to find another job but unfortunately cannot afford a huge paycut due to commitments, but I have done quite a few applications and got through to aptitude test on one so far so hopefully something will come up. My self esteem is so low so I did mess up 2 interviews I had the last year which is a pity as I would have loved both jobs.
Yeah i could bring boiled eggs and have them cold at 10am that would work for me and it would be less work than making the oat bars too.

That's a good take on it to look at it as a positive. What i was previously told by a nutritionist is that I should never be going to bed hungry so I suppose I was looking at it from that perspective but changing my mindset on that will be a good start.
He is not overweight but he is very tall, so he has an absolutely massive appetite but can afford to eat what he wants really. He is not what would be considered slim but BMI is nowhere remotely near mine.
He is very supportive, has been my rock through the miscarraiges to be honest as I was extremely down after both. He is also very upset over the losses and finds himself emotional eating too but the difference is he doesn't gain weight like I do...so I suppose in some ways yes it probably is unintentional sabotage. He is a good cook and likes to bake too so he will bake cakes/buns/biscuits. Again he has a pretty varied diet as in he will eat lots of fruit, veg, protein every day, take conception supplements etc but he will also devour any cakes, biscuits that we make. He came from a farming background so he is also very concious of where his food comes from so does tend to avoid UPF where possible.
Yes I think my head is a little clearer after all of the advice on here and I will push TTC out and focus on loosing the weight/getting fitter and begin trying again when that happens, it is so difficult as I want a baby so badly but I likely do need to get more in depth tests done in regard to possible PCOS or thyroid issues too. Thank you x

Thank you so much. Yes I think my head is so much clearer now after reading all of the advice and I feel I absolutely have to loose the weight and get fitter before trying again. I do exercise at the weekend I will walk every chance possible, and I do pilates but its the 5 days im working that I have a major problem with but yes maybe something I can do at home is the better option. I just have no energy or interest by the time I get home. My job is very stressful, very toxic, mentally draining, and I absolutely hate it if im honest, I am trying to find something else but the miscarraiges have knocked my self esteem so much so I am struggling with interviews etc
Thank you

I am so sorry for your losses that is so tough xx

i am in quite a high level position that requires me to be on site 5 days, the industry that Im in everyone lives to work, my manager who is in his 60's never shuts off and is sending mails at 3am etc its just expected, I am probably lucky in that once I walk out the door I do totally shut off from it and dont answer any calls/emails outside of working hours but I still hate it. I used to love my job, but since my first miscarraige I have just lost all interest in it and resent it.
I am absolutely trying to find something else but I have commitments for the next 4 months (family related) that I cant afford a massive paycut in the short term. Ive been trying to change jobs a while but I am lacking in self confidence so I struggle with interview.
I wont continue in the industry once I hopefully have a child, my role pays full salary sick leave for 1 year and full salary maternity pay for 6 months so I would have looked for something else after maternity. I wouldn't be stuck in the commitment with family only I agreed to it after the miscarraiges when I didn't think I would be trying again any time soon due to grief x

@Helpneeded719 my DC are 31 and 27 now. Very, very early on I pragmatised the losses. If they hadn't happened, I'd have neither of the wonderful children I have.

If it helps I did 12 hour days pre dc and when pg with DS. I had no difficulty giving it up, partly because I was burnt out, partly because ds wasn't v well as a baby. On the plus side, working in such a full on and stressful environment meant being at home with a baby and small dc was far from arduous. I have 7 wonderful years playing and parking.

At your age, still under 35 at the moment and you know that you can get pregnant, if you can afford Mounjaro then I would do that and give myself a year to get in the best health I can. Find a sympathetic personal trainer and really work on my physical health and then go for TTC.

Definitely would be good to take some serious steps to losing weight - for your own health as well as making it better for TTC.
I wouldn't say your MCs are definitely down to your weight, but it can increase the chances of them ofc. I have 1 child already, no losses when having him. However, trying for our 2nd (at 34 too!) I've had 3 losses (1 was a chemical). I am in the overweight catergory - BMI of 28. I'm now 15 weeks into a new pregnancy and all seems to be going well.
Good luck OP!

I would look into further investigations for both you and your partner. I would also go on WLI for 6-12 months then TTC at a healthier weight.

It sounds like you have been doing the opposite of intermittent fasting if you eat at 5:30 am and never go to bed hungry.
How about trying to eat only within a 12 hour window of 8-8 in the first instance and having a main meal at lunchtime with a small meal when you get home .
There seems to be lots of baking going on which needs to stop.

Just wanted to say that its not pregnancy so much you need to be healthy for, its having a baby and a toddler. You can rest when pregnant as much as necessary. Having a small child is absolutely exhausting and asks a lot mentally and physically. Get yourself in a good a spot as possible first. Best of luck xx

I would definitely look at loosing some weight, either by wli or other means. It’ll make pregnancy a lot easier and more importantly delivery and recovery. Good luck