Do you have questions around medicated weight loss and weight-related health conditions? Ask ZAVA’s medical expert - £100 voucher to be won

[CeriMumsnet]

Medicated weight loss treatments are a major topic of conversation on Mumsnet right now, with many of you sharing experiences and finding support across the talkboards. We’ve found that lots of you have questions around starting medicated weight loss treatments when living with weight-related health conditions like diabetes and high cholesterol.

That’s why we’ve invited ZAVA’s medical expert, Dr Clair Grainger, to answer your questions and share general medical insights around this topic.
Share your question on the below thread and Dr Clair will be online in a few weeks with answers. Everyone who posts by 12 August will be entered into a prize draw to win a £100 voucher. (T&Cs apply).

About the Expert
Dr Clair Grainger (MBChB, MRCGP (2017), DRCOG) studied at The University of Edinburgh from 2004 to 2009. She has worked in hospitals throughout Edinburgh and London before completing her GP training in North Middlesex Hospital in 2017. Clair is a Clinical Lead doctor and has worked at ZAVA since 2018. Her clinical interests include obesity management and women's health.

Hi @SquishyGloopyBum Maintenance is an important part of the service we offer. We don’t want people to feel like once they’ve lost the weight they’re on their own. We continue to supply medication and support to people who’ve reached or are nearing their healthy goal weight.

You can stay on injections long-term. The studies that look into the safety and effectiveness of weight loss injections cover periods of 68 to 72 weeks. But it can also be safe to continue using them beyond that time frame as well, provided you are not suffering with side effects.

Weight loss tablets exist as well, although they don’t work in exactly the same way as the injections do. Some tablets with the same active ingredients as injections exist for treating diabetes (Rybelsus and Victoza) but none are licensed for weight loss in the UK just yet.

If you’re ready to start weight loss maintenance, you can request treatment as normal and one of our team will check your consultation and approve your request as long as it’s safe. Maintenance prescribing criteria are slightly different to those for starting treatment.

Hi @MyNewLimePanda Many people find their side effects get better over time. Side effects usually occur when you first start treatment or when you move up to a higher dose, but they can go away again within about a week. For some people side effects may last throughout treatment. If they are not too severe, you may be able to manage them and continue treatment anyway. If they are severe or you feel you can’t manage them, you may need to stop and try alternative treatment instead.

You don’t have to stay on treatment once you reach your goal weight, but you do have the option to move into the maintenance phase of your treatment. This is when you continue taking your medication but the goal is stay at your current weight rather than lose any more. You can also stop treatment and maintain your weight using only diet and exercise instead.

If you suffer with any serious or unexpected symptoms whilst taking weight loss medication please contact your prescriber or another healthcare professional for review.

Hi @sharond101 Weight loss injections can interact with other medications. It’s important that you provide honest and accurate information about other medications you’re taking when you request weight loss treatment. If you are on any medications that interact with weight loss injections, a doctor would not approve treatment and would most likely suggest alternatives or would advise on any cautions you need to take whilst using both medications. As long as you continue to provide accurate information about your other medications and a doctor has approved weight loss injections for you, they will be safe to take. If you start any new medications always have a chat with your prescriber about any potential interactions.

Hi @Bowling4soup It is a possibility. There are currently a few tablets with the same active ingredients as weight loss injections that are available in the UK for treating diabetes only (Rybelsus and Victoza). If these tablets are trialled for weight loss and licensing is granted in the UK, then they could become available in the future.

Hi @StormyPotatoes You can taper off with your treatment. Rather than stopping altogether, you can reduce your dosage slowly beforehand if you prefer however this is not strictly necessary. This can help you adjust slowly to an increase in appetite while you maintain the lifestyle changes that have helped you lose weight.

There is currently only one tablet available for weight loss in the UK which also reduces appetite (Mysimba), but this is not offered as a ‘lighter’ form of injections. It’s a standalone treatment which you would take instead of injections.

Alternatively, if you’re worried about putting weight back on you could continue with maintenance treatment, where the goal is not to lose more weight but maintain your current weight while still on your medication.

Hi @BigDeanWinchesterFan It’s not clear exactly what the risks are when breastfeeding while using weight loss injections. For this reason, we recommend avoiding these medications while breastfeeding to protect the health of you and your baby, as advised by the manufacturers of the injections.

There is no evidence that using weight loss injections negatively impacts fertility long term. On the other hand, there is actually some evidence that they may increase fertility for people who are overweight or have polycystic ovary syndrome. But, like with breastfeeding, it’s not clear how safe it is to take weight loss injections while pregnant, so it’s recommended to stop taking Wegovy 2 months before trying to conceive and Mounjaro at least 1 month before trying to conceive.

The best way to reduce your chance of gaining weight back is sticking to your diet and exercise plan. As long as you maintain the habits you put in place during treatment, you should be able to avoid putting weight back on.

If you’re worried about putting weight back on you could also keep going with your treatment. This is called ‘maintenance treatment’, where the goal is not to lose more weight but maintain your current weight while still on your medication.

Hi @benjaminjamesandgraham There is some evidence to suggest that weight loss medications, like semaglutide (Wegovy), could improve liver enzymes and health in overweight people with non-alcoholic fatty liver disease. Although weight loss injections are not approved for this use in the UK, if you meet the criteria required to qualify for weight loss injections and have no contraindications that would make treatment unsuitable for you, then weight loss injections may help reduce the amount of fat circulating in your body.

Hi @lovemyflipflops Yes it is possible to restart treatment after you stop. However, if it’s been more than 2 weeks since your last dose you would need to restart treatment at the lowest dose again and increase using the same dosage schedule as before to reduce your risk of side effects. The BMI criteria for restarting medication following a gap in treatment can differ from if you were continuing treatment without a gap.

Hi @prawncocktailcrispss There are several things you can do to manage constipation and slow digestion, including increasing your water intake throughout the day, adding more fibre to your meals, such as fruit, vegetables, wholegrains, beans, and pulses, and making sure you stay physically active, even a walk after a meal can help stimulate your digestion and aid the movement of food through your stomach.

You could also speak to your pharmacist about trying a laxative to soften stools or an antacid for heartburn. If your symptoms persist or are severe, speak to your doctor for further advice, so they can rule out any other issues or recommend an alternative treatment, if necessary.

Hi @HansHolbein At ZAVA, patient safety is paramount, which is why we have implemented several steps, in line with UK guidelines, to ensure only those who qualify for weight loss medication can access them. To obtain weight loss medication from us, you will need to have an online medical consultation, which includes submitting photos to help our doctors confirm your body mass index (BMI). A ZAVA doctor will review the information you have provided and photos to determine if weight loss medication is safe and suitable for you. To avoid fraudulent consultations you are also asked to sign a disclaimer that the information provided is accurate and honest.

Hi @sunshinesky If you’re considering buying weight loss medication online in the UK, it is important that you are buying treatment that is safe, genuine, and legally supplied by a reputable and licensed company. Before buying any medication online, here are a few things you should consider:

• Is the website or company registered with the General Pharmaceutical Council (GPhC)?
• If you are requesting treatment from an online doctor service based in England, is it registered with the Care Quality Commission?
• Does the website have a physical UK address and phone number?
• Do you need a prescription for the medication? If so, will the company provide you with one following an assessment or consultation?
• Is the medication approved by the Medicines and Healthcare products Regulatory Agency (MHRA)?

If you answered no to any of the above questions, then there is a chance that the company you are buying from is not trusted and the medication they provide may not be safe or genuine. At ZAVA, we are registered with the CQC, our dispensing pharmacy is registered with the GPhC, and our team of doctors are regulated and registered with the General Medical Council (GMC). You can view our regulatory details on our website.

Thanks.

How do you confirm height?

Hi @Gingerkittykat Yes. While weight loss injections can directly lead to a small drop in blood pressure, the main benefit comes from the weight loss itself, which can significantly reduce blood pressure long term for people with high blood pressure.

It’s important to check with a doctor if you can safely take weight loss injections alongside any blood pressure treatments. It’s also important not to try and ‘swap out’ your blood pressure treatments for weight loss injections.

Hi @Gorondola Initial research shows weight loss injections have a complex relationship with autoimmune disease. While there may be some anti-inflammatory effect from the injections, it’s also possible they may exacerbate some autoimmune diseases as a side effect.

Weight loss injections would be unlikely to replace your autoimmune treatment. However, it’s possible you could safely take weight loss injections if you have an autoimmune disease, and even alongside autoimmune treatment. But since this is a broad range of diseases, you would need a doctor to advise you on your specific case and approve weight loss injections if safe for you.

Hi @Fancyquickthinker While temporary hair loss is a possible side effect of weight loss injections, it’s also possible to reduce your risk of this. This kind of hair loss, called ‘telogen effluvium’, is usually caused by nutritional deficiencies that result from rapid weight loss and poor diet while on treatment.

Making sure you eat a balanced diet that meets your nutritional needs while taking weight loss injections could remove the risk of hair loss entirely.

There are also treatments for you to consider to help with menopause-related hair loss, such as minoxidil. Talk to your GP about your hair loss and potential options if you haven’t already.

Hi @PedroPedroPedro If you have kidney disease, weight loss medications are not necessarily contraindicated for you, but contraindications and warnings will depend on the specific medication, your general health, and the stage of kidney disease you have. You should let your doctor know before you start any new medication if you have kidney disease, so they can assess if weight loss medication is safe for you, as not all options will be. For example, orlistat may not be recommended for people with kidney disease, while you may need extra monitoring if you choose weight loss injections.

Hi @Runningshorts Yes, there are some pre-existing conditions that mean taking medications like Wegovy, Mounjaro, or Nevolat may not be safe. That’s why a health professional must assess your medical history before prescribing them to you.

You must not take Wegovy if you are allergic to semaglutide or any other ingredients, if you are pregnant, planning to get pregnant, or breastfeeding. You also should not use this if you have heart failure or have suffered with pancreatitis whilst taking weight loss medications.

Mounjaro may not be suitable for you if you are allergic to any of its ingredients, pregnant, planning to get pregnant, breastfeeding or if you have severe issues digesting food, have had pancreatitis whilst taking weight loss injections or are using a sulphonylurea or insulin to control type 2 diabetes.

Nevolat is not suitable for anyone who is allergic to its ingredients, has severe heart failure, has kidney disease, liver problems, inflammatory bowel disease, or severe stomach or gut issues, is pregnant, thinks they might be pregnant, or is breastfeeding.

It is important to be open and honest with your doctor during your consultation, so they can determine if weight loss injections are safe and suitable for you to take. If they are not, they can give you advice about alternative weight loss medications or lifestyle changes you can make.

Hi @itsywitsy Great question! One of the common myths about weight loss injections is that they will help you lose a significant amount of weight on their own, when, in reality, you will need to make positive changes to your lifestyle to support their effectiveness. Staying well hydrated, eating smaller, more frequent meals, and focusing on a balanced diet with lean protein sources and fibre can help your body adjust and may be helpful with some of the common weight loss injection side effects, such as feeling sick, bloating, and constipation.

It’s also a good idea to make other subtle and gradual changes, such as increasing the amount of exercise you do, reducing your alcohol intake, and sticking to regular mealtimes, which can help support steady weight loss and improve how well your body responds to the medication. Although there’s no specific need to prepare your body for taking weight loss injections, making these changes early and developing them into habits can make the first few weeks easier and help you get the most out of your treatment.

Hi @pushchairprincess Absolutely! When you order weight loss medication from ZAVA, you’ll receive support from our team from day one. You’ll have regular check-ins with your doctor to monitor your progress and any side effects you may get. You’ll get free support materials and guides from our in-house nutritionist to help you with meal planning and choosing the right foods, and our patient care team will be on hand for any other queries.

We also have a range of guides on our website to help you along the way, including:

• Mounjaro diet plan
• Mounjaro side effects
• Wegovy side effects
• Weight loss FAQs

Hi @Cliffedge25 Weight loss injections can directly lead to a small drop in blood pressure, but the main benefit comes from the weight loss itself, which can significantly reduce blood pressure long term for people with high blood pressure.

This means you wouldn’t be able to ‘swap out’ your ramipril for a weight loss injection, but if you lost weight over time using injections, eventually your blood pressure could drop to the point where you no longer need your ramipril. This would be a decision you would make with a healthcare professional like your practice nurse.

Ramipril doesn’t directly interact with weight loss injections, so they can be safe together. The only thing is weight loss injections slow down your digestive system which can limit absorption or oral medications like ramipril. So, it’s important to keep an eye on your blood pressure on weight loss injections, particularly if you get any side effects.

Hi @Pugsy99 Ozempic contains the active ingredient semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist. That means it mimics the actions of GLP-1, a naturally occurring hormone, by binding to its receptors to regulate your blood glucose levels and promote weight loss. Ozempic does this by increasing insulin production, reducing the amount of sugar the liver releases, slowing digestion, and making you feel fuller for longer to reduce overeating.

However, Ozempic is not approved for weight loss in the UK, instead, it is a treatment option for type 2 diabetes. Although in the past, Ozempic has been prescribed off-label for weight loss, this has led to supply issues, meaning those who needed it to control their blood sugar levels could not access it or faced delays obtaining their medication. Wegovy, Mounjaro or liraglutide are the preferred alternatives for weight loss in the UK. They are licensed for this purpose and are effective for weight management.

@CeriMumsnet have you contacted the winner please - can you update the thread ? TY

Hi @Dizzywizz Weight loss medication can help lower high blood pressure, especially if your weight is part of the cause. That’s because losing weight tends to reduce blood pressure, whether it’s supported by medication or not. Some treatments, like GLP-1 medications (such as semaglutide or tirzepatide), may also have a small blood pressure-lowering effect on their own.

However, everyone reacts differently. Some people may experience side effects like dehydration or a faster heart rate, which can affect blood pressure in the short term. That’s why it’s important to check in with your doctor regularly while taking these medications.

If you already take medication for high blood pressure or have a heart condition, make sure your doctor knows. They’ll help you work out if weight loss treatment is safe and suitable for you. You should continue to have regular reviews for your other conditions with your GP.

Hi @ladyluck13 Firstly, well done! Losing almost 6 stone is a huge achievement.

Hair loss can sometimes happen during significant weight loss, especially if it’s rapid. Most cases of this are mild, and it should not take long to recover. Make sure to follow a well-balanced diet to help rule out any dietary causes for your hair loss. Thyroid issues can also play a role, so it’s worth checking in with your GP or specialist to review your thyroid levels and make sure they’re well managed.

Other things that can help:

• Making sure you’re getting enough protein, iron, and key vitamins like B12 and biotin
• Managing stress, which can also affect hair health
• Speaking to a doctor about any treatments that may support hair regrowth

You’re doing incredibly well, and this is just another step on the journey, which you don’t have to navigate alone. What’s important now is speaking to your doctor and working out what’s causing your hair loss so they can work out how best to support you.

Hi, thanks to everyone who shared a question for Dr Clair about medicated weight loss and weight related health conditions. The winner of the £100 voucher is @Aspanielstolemysanity - congratulations!