Mounjaro - maintenance dose for life?

[DappledOliveGroves]

So, I've lost almost two stone since July, using Mounjaro, and have around 8 to 10 pounds to go until my target weight.

The medication is great. I'm not hungry, food noise and cravings are gone and if I do want to eat, I want something healthy. But, I'm not kidding myself - this is the result of the injection, rather than anything else. Whilst I could endeavour to replicate what I eat (or don't eat) on Mounjaro, once I'm off the medication, I highly doubt that the weight will stay off. Indeed, if this were the case, I wouldn't have yo-yo dieted for most of my adult life.

Whilst I know that various providers will offer a taper dose, I don't know how useful this will be as I'm still on a low dose (5mg) anyway. So, I suppose my question is whether there are providers that effectively offer an on-going maintenance dose for the foreseeable future? I appreciate it's a new medication, so it may be that pharmacists here end up following what is happening in the US, but I am wondering whether it seems likely that people will effectively end up being prescribed these drugs for life? Otherwise, given that various studies show that most people re-gain the weight once they stop the medication, people will surely end up just going on and off the drugs in a cyclical fashion?

It may be that it's simply an unknown at this point, given that the drug is relatively new. But would be interesting to hear people's thoughts.

If you have changed your eating and exercise habits though, you just need to switch to maintenance calories. I still get hunger on MJ, but I've learned that's OK. I still get cravings, but I now just think 'I don't need that' or ' I'll have that later as part of my meal'.

I think if it was that simple keeping the weight off would be easier once people come off MJ/Oz. Reading “Why We Eat (Too Much)” by Dr Andrew Jenkinson and he talks about why most people regain weight after losing it through dieting - and often regain more than they lost.

I read a book, for the life of me I can't remember what it was called, but possibly it's the one you mentioned 85reasons.

It talked about how our current diets, full of ultra processed foods and certain fats, damage our hormone response to food and hunger, which creates this cycle (in some people) of getting hungrier and putting weight on after initial weight loss efforts stop, and increasing the body's weight set point. It was really interesting.

I wonder if losing the weight and eating healthier for a prolonged period of time with them help of Mounjaro will fix those issues, or if they'll still exist once mounjaro is stopped and therefore a lifetime of the medicine is required?

I can't see a way for me to maintain my weight without medication. The power of cravings and hunger is your body's survival instinct (for some reason distorted or dysregulated in some people, or in obese people?) and it's impossible to override it without some serious mental health impact in my experience. The compulsion that drives the regain is overwhelming - it's happened to me enough times now to know I can't power through it, not for that long

I am slightly hopeful that there might be something in the set weight point theory and that it could be possible to use this drug after the weight loss phase to stabilise for enough time to set a new weight point for the body. I'm also using the time on MJ to really work on strength training in the hope that changing my body composition and building up some muscle - as much as that's possible in a calorie deficit! - will help my metabolism going forwards.

I also am realistic about the fact I won't be maintaining a BMI of 25 or below; I'll always be in the overweight category - but if I could stay under obese, that would be an enormous victory. I let go of the idea of the kind of thin body I thought I should be aiming for all my life a long time ago.

But almost no one ever reverses obesity for longer than five years - it would be interesting if there is a lot more research now into why that is. I think people assume that the obese are just really lazy and can't be bothered, but obviously so many of us have dedicated years of our lives to losing weight, spent a lot of money on diet programmes and gym memberships and personal training - and now injections - we've read everything and learned everything we can and tried so hard for so long, and still keep failing. I would take a maintenance dose for life if the choice was that or return to obesity - it's a trade off like any long term medication, and the drugs will keep being refined and improved over time so I'm hopeful about that.

Great post. Plenty of people can lose 10stone and more. They certainly don’t lack willpower or motivation do they . Something else is at play clearly when they regain.

I an the same as you I’ll never get to a healthy weight but I just want to live a normal life which at 23 stone I was not doing

And a healthy weight is a balance, right @ThatsNotMyTeen - there is nothing magical about the number 25 on the BMI scale, or at least it's not the only important thing. Last time I was (briefly) there, I was eating 700 calories a day and crying myself to sleep. My weight might have fit the 'normal' criteria, but I was not healthy by any other measure. Better to be at eg a BMI of 28 with enough energy to function and get through the day.

I suppose its doing to their guts what its doing to my diabetic OH's guts

He gets lots of wind and digestive goings on. Its a side effect taht he tolerates for the greater good of the medication. He was on higher metformin before these injections (he is still on some metformin) and his digestion was simply awful

I also have to tolerate these side effects from him too.

He will be on this for life.

He is fantastic, such a brilliant mind in terms of this subject. Cant remember his name, Dr Weiner? or something like that

Oh yes, the farts are real @soupfiend but they also are with Champix to stop smoking.!

It works on your hunger hormones so you no longer are overly motivated or triggered by food

Side effects exist in all medications. I have had to take some sumatriptan this morning, migraine. Need to go to work

But that means that my throat has tightened and Ive got the inevitable sumatriptan cough, husky throat and feel groggy and tired. They really knock me out

I dont recall tons of long threads about how awful migraine medication is and people shouldnt take it, the side effects are awful.

I tolerate it because my migraine is now gone and I can get to work

Merformin give me horrible tasting burps it was just awful I couldn't wait to have my baby so I could stop taking it.
I'd hate to be on it for life.

I wil take anti depressants for life. I take hrt which I will almost certainly take until the end of days. I now take blood pressure medication which will, almost certainly, be for life, and, if I don’t lose weight I’ll probably end up taking diabetes medication - for life!

Looks like I’m medicated forever, whichever way I go.

I’m anticipating a reducing maintenance dose for a perhaps year, but have been on Wegovy/Mounjaro for over a year, lost 5.5st and still have 10lbs to go. I’ve been told I can stay on it for life, however.

Because my weightloss has been slow and steady, I do actually believe that the changes in diet/lifestyle and stomach capacity will be long term (ie hopefully permanent) so long as I retain responsibility for what I am eating and do not self-sabotage. In my head, the breathing space has helped me renegotiate my relationship with food and exercise, which I appreciate may not happen if people are only on it 3-6m and focused entirely on the scales.

The effect of the meds wears off over time and I am already grappling with hunger towards the end of the week on the 15mg dose - so I am coming to understand that ‘feeling hungry’ is a normal state and does not mean I need to dive into the biscuit tin (not that I have those in the house anymore anyway). Feeling hungry for me means needing to drink some water and have some fruit and just accept that I won’t pass out/collapse if I am a bit peckish for a few hours before my scheduled meal.

I have no intention of regaining weight and recent research looking at 22000 mounjaro users and 19000 or so wegovey/ozempic users shows that less than 56% of dieters regain, and only a smaller number regain ALL of the weight lost within 12-24m of stopping the injections. (The research has been posted multiple times on other threads.) This is compared to 90-95% of ‘traditional’ dieters regaining within 12m.

ie - if you are taking this drug in reliance of the appetite suppression effects fast tracking you to weight loss but are not doing anything else to prepare for maintaining that weight loss - ie consciously changing what/how you eat, changing your attitude towards food/hunger, increasing your exercise/fitness - then, yes, chances are you will regain it all. Which is a shame given the money people are spending on it.

Really interesting @CautiousLurker thanks for sharing that. Personally I have never moved up from 2.5mg and don't plan to - at this dose, I am losing slow and steady at roughly 2lbs a week, not suffering side effects and like you say experiencing more hunger as the week goes on but in such a manageable, normal way. The breathing space is invaluable.

Thanks @CautiousLurker I looked up the research (it's the Epic study right?).

I thought the chart was really interesting. The split at the regain / continue to lose ends in particular.
Hopefully someone is doing research to understand what is different between the people who regain and those who maintain or continue to lose weight. Are there differences in how they take the drug (length of time, dosage, pace of weight loss etc) or is it that there are different causes of obesity which make it necessary for some people to stay on the drugs long term to remain at a healthy weight.

Lots not yet known but hopefully as we learn more a route can be found for this to be a long term game changer for everyone.

@IsItCasualNow yes, from what I know now I think it is important to only move up doses if the current dose is not as effective - once you get to 15mg there is nowhere else to go!

When it was first launched people (and me) were gung ho about romping through the doses thinking that the higher the does the more effective it is - which is not the case. My prescriber was very firm though and didn’t let me progress unless I really needed to - that said I languished on the 5mg ozempic last year when supplies were short and lost a princely 2lbs in 4months, so was really happy to change suppliers to move up doses and then move over to MJ, so there is definitely a balance that a good supplier will help you reach!

@ThinkAboutItTomorrow yes, that’s the one. My hypothesis is that the longer you are on it, the more the lifestyle changes embed and that this is a huge factor (there is all that research looking at how long you need to do a behaviour for it to become an ingrained habit, isn’t there?) Also I know from learning a musical instrument that if you make the same mistake 100 times, you have to do it correctly 101 times to over-ride the muscle memory and I think that (because you will have repeated the new healthy behaviours over a longer period) is key to trying to unlearn the unhealthy ones that you have probably spent a lifetime developing.

I am also thinking that if you have worked hard over a much longer period to lose a huge amount of weight, the determination not to gain it back (6-6.5 stone when I reach target, in my case) is stronger than when you yoyo over 1-2 stone? Psychologically it is easier to be blasé about putting a stone or two on again if you have a record of losing the same amount over your lifetime - most of my mates accept we balloon over the winter, then diet for the summer holiday in the spring, until one day we find the spring diet doesn’t work anymore!

For me, slipping over the lose/gain cycle of 2 stone into the 6 stone territory (covid, lockdown, menopause, depression, broken foot and shoulder surgery) was a shock that showed up my unhealthy habits. Lots of excuses for the weight gain, but it boiled down to all the same reasons/habits that lead to that origin 2stones that I’ve battled with since my twenties.

I kind of feel, as a result of these jabs, that it’s like the matrix pill - now that I trully see what I’ve been doing, I cant unsee it. I know that maintaining my weight will be hard work - but I look at my MiL who is happy to go for coffee and cake and simply share or eat a half/third of a muffin/gatteau slice - and leave the rest/take it home and freeze it for another day. She’s seemed ‘naturally slim’ all her life, but actually she has healthy habits. Enjoys a shared cake and then walks the 2-3miles home (at 80!!).

I mostly agree @CautiousLurker but I wonder if you (& I'm the same) are in the 20% who maintain within a + or - 25% limit. So a history of good habits scuppered by mostly emotional eating that then got a reset from the drug (or in my case just dieting) and were able to keep it off, more or less.

But I'd also hypothesise that there's a group of around 20% who have a more physiological challenge. Maybe naturally weaker GLP -1 or something? So when they stop the drugs it's nigh on impossible to maintain because the hunger rebounds so strongly.

The two year limit no longer applies for some prescribers. Some prescribers also offer MJ for maintenance now too. Oshik, cloud (maybe), med express (if you don't go below BMI 23.5), bolt, family chemist. Maybe more.

I think in your case, you could lower down to 2.5mg to reduce when you want to maintain. I suppose you want to be on a dose where you can still eat your maintenance calories to maintain your weight. I plan to titrate down until I'm at a level where I am taking the meds but maintaining my weight. I take MJ for inflammation too, so don't want to come off it. If I can get down to 5mg, then I'll be happy to maintain there. Initially ill aim for 10mg as I'm up to 15mg at the moment.

Some people take a dose every two weeks which could be an option also. But problem with our multi dose pen, they are only meant to be used for 30 days, so can become tricky.

@ThinkAboutItTomorrow totally agree! I have been overweight since puberty (am now 57) and it goes way beyond 'good' or 'bad' habits. The hunger can be all consuming to the point of nausea and the constant onslaught of thoughts about food was exhausting.

I remember one specific incident from about 30 years when I was low carbing and my (then) husband brought me home some sushi as a treat. I burst into tears because I LOVE sushi but couldn't eat it as I had set all these rules for myself! The sheer mental effort in trying to keep on top of that was incredible.

I have had some very emotional moments on MJ when I have thought about how in control I feel now compared with before MJ. How all of the guilt, self-disgust and feelings of failure I lived with for 45 years might never have happened if this medication had been available before now.

But it IS available now and it has (and is) changed my life!

Hmm, I think because it helps the body use insulin effectively. When you have insulin resistance, your body stores insulin as fat instead of using it. (I think!) As it's storing it instead of using as energy, you feel hungry and want to eat. When the body is using insulin effectively, you are using the fat as energy so no longer get the hunger signals. (I think!)

Also, Mounjaro works with a receptor in the brain that signals fullness.

Yes, the two year limit some providers still adhere to (for now) is based on the limit on Wegovy, which is a different medication (though it is in the same class). MJ doesn't have that limit and many providers have changed their stance based on this, and on data from the USA where it's been available longer.

To be honest, I expect to be on this for a long time. I do not mind; I've truly felt like a new person since I started taking it. My best side effect has been that my mind feels calm and clear for the first time in a very long time, if ever. I don't know if I have undiagnosed ADHD, or if it's menopause, or what, but I have no interest in going back to the ball of anxiety and overthinking that I was before MJ. The fact that I'm losing weight is actually secondary to this. I told my husband within two days of my starting this that I felt like a new person and never wanted to be off of it.

Thankfully, there's a lot of research going into this because there's a lot of money involved, and there will be more competition over the years which will bring down prices.

As others have mentioned, we have a different system of storing the medication here from in the USA, and our pens don't really allow for us to safely spread the current doses out too far. So I think, and this is just my own guess, that currently the lowest maintenance dose will be 2.5 weekly, until that changes.

I'm feeling just like that cakewench I only started a week ago. I do have depression and am on multiple meds for that as well and am taking mounjaro mainly to offset some of the weight gain side defects from that medication.

But it's also leaving me calmer and is having as much effect as the mental health medications for me. I'm feeling fortunate that I have been Ok to combine them, my GP is aware and supportive, I'm also on HRT as well.

Staying on 2.5 sounds good, it is having a good impact on me already but my main concern is the cost, I am not sure if I can afford £100 + a month, and wonder if it may be available soon on the NHS

I feel exactly the same. My procrastination is less, anxiety is less, and there's no 'mania' or heightened activity in a way that feels unnatural. It's early days for me (2.5 weeks in!) but I'm very interested to see what I'll be like in say 6 months. I'm also feeling much more zen about any compulsion to buy things, for example.. so can imagine I'll have saved money over time.