End game? Is there one?

[Ledochas]

Hi all
I have been thinking about weight loss injections for a while and am in that peri menopausal post kids phase of life and feeling rubbish about myself.

I'm just really worried about how to 'finish' the programme. I've read loads of posts on these boards and can't really see how people ever come off without putting the weight back on. I know you need to make lifestyle changes but I don't trust that's enough - I put weight on so easily I can't imagine that I wouldn't just put it all back on.

I don't want to be on injections forever and so I keep not starting but can't get very far in my solo efforts of less carbs and booze and more exercise - hence back here reading again!

Help?

One of the big benefits for me of having started this journey is accepting that this really isn’t our fault. We’ve been conditioned into thinking it was but it really isn’t.

I started March this year and my projected target weight date is October next year. I'm going the slow and steady route, giving myself the time to learn new food habits. I have now just completed my first year of gym membership and still go regularly, as I actually enjoy it (which was a revelation)! By the time I reach my healthy weight, I should have totally revamped all the mental stuff that caused me problems previously.

It's hard work and not the easy fix that a lot of people seem to think it is. I suspect the ones that fail will be the rapid weight loss ones who rely on the WLI to cut appetite and don't make any lifestyle changes.

@unsync many of us on WLI have lost and regained vast amounts of the of weight over the years, including having long periods of having made the lifestyle changes.

For people like me what is proving critical is actually to NOT feel like I'm on a diet. I'm being more healthy and exercising more and mostly making very good choices. But I'm experienced enough at this to know that over the long term having made these 'lifestyle choices' wasn't sustainable before GLP-1 medication, because we were struggling with chronic obesity. It's a condition that makes our bodies crave more food than we need. Which is what GLP-1 medication is addressing.

Two years ago I was running 10Ks and maintaining a 6 stone weight loss successfully... but here I am..

@85reasons I'm in the same boat. It's been a struggle. But this time, there is a definite shift in mindset. I can't really explain it. I'm not good at explaining, but I see in some of the threads here the patterns of attitude(?) / behaviour/ speech for want of better words that I have had previously.

There's a lot in the psychology as well as the physiology and biology. It's getting everything in sync, picking up all the threads. The mental side of what food means is often overlooked. We all go on about how the WLI quiets the food noise, but how many are actually working on why it's there in the first place? We know the physical effects, slow gut transit = slow sugar release and what effect that has on insulin and blood sugar. Is that what shuts down the noise? What brain chemical / response is switched off?

It can't just be the slow gut transit. The switching off of the food noise happened much more quickly from the first dose for it just to be blood sugar levels. With the volume of food I was eating before my blood sugar levels must have been high all the time anyway.

I'm really happy with about the weight I've lost so far. I'm even happier that I'm not getting the constant thoughts of "what can I eat next" and the self-hatred of knowing I'd eaten way too much. That absolutely ruled my life. If I have to stay on medication to keep feeling this way then I'm content with that. I see it like taking antidepressants. If it helps, it's worth it.

I do think that there will be more, and better, medications coming out in the next few years. The drug companies have got to be working hard to find a shelf stable version or one that can be administered as a tablet. That will make it cheaper.

I'll give you an example of the difference for me now @unsync - I've just been for a food shop on an empty stomach, having not had time for breakfast.

Not only did I scoot round the supermarket merrily buying food for myself and the family without needing to buy something to scoff in the car, it didn't even cross my mind. This is not a "habit" I've learned. It's the absence of a need.

I then got in the car, with bags full of stuff - lots healthy, but a few treats for the kids too. After I'd been driving for about five minutes, I thought "hang on, I'm hungry!". But it was a gentle feeling, not a panic, and again it didn't cross my mind to pull over and rummage through the shopping bags to find something. Previously I would have caved and eaten both of the two cinnamon pastries I'd bought for other people. And then pretended I'd never bought them in the first place.

It's just a completely different response to hunger, and a completely different level of hunger - hunger without panic, or urgency. It's got nothing to do with having learned something, my body is just reacting in what now feels like a much more normal way.

@85reasons that's it exactly. On MJ I feel like I've got a normal reaction to food. I enjoy what I eat but it's not ruling my day. When I notice I'm hungry it doesn't instantly become an obsession, it's just something that gets added to the to-do list.

@85reasons I understand that. It's how people with 'normal' physiology behave. I'm not having a go at you. I get why maintenance doses are needed and I have no problem with that. I've done the same thing as you, scarfing down cakes and hiding the evidence, then feeling bad and eating more to push it away. That whole vicious cycle while your brain yammers on at you, the disgust at why you just can't stop.

What I'm trying to understand is what caused the break from having 'normal' physiology? I don't think I was born with food cravings or compulsions. At some point in my life it developed. I suspect I know, for me anyway, where mine started and the subsequent issues/choices/whatever that compounded it.

It's not a nature/nurture thing, it's a combination. Can it be undone? Is it possible to achieve indifference to food without medication? To reset whatever it is that causes the noise and compulsion?

I'm OK with doing the deep dive into my psyche to see if there's an answer there, but I also understand that not everyone is willing or able to do that. There can be a lot of trauma attached to a lot of food and eating, and that can be a very difficult thing to deal with. I'm at a point in my life where I have poked at all the other crap and purged most of it, food and my behaviour around it is the last hurdle for me.

I hope that makes sense.

It's okay - I know you're not having a go 😁 I guess I've spent years having therapy and being aware of the complexities around my emotional eating (as I would have called it) and I am now if the opinion that regardless of nature/nurture, it's a process that is disconnected from my conscious decision-making processes.

"Why we eat (too much)" by Andrew Jenkinson is very good on this subject - and he does believe it's possible to rewire the brain/body of a chronically obese person and sets out a path for doing so. It sounds possible but very very hard work and involves tricking the body very slowly into accepting a permanent low body weight set point.

The comparison has been made to anti-depressants on this thread. Unlike anti-depressants, which always made me feel like I had a tiny bee buzzing unwelcomely in my brain, I don't feel odd, or as though I'm "on" something with MJ in a way that makes me feel uncomfortable. I think that's why the thought of a low maintenance dose is appealing to me. And I am generally someone who resists medication!

My guess is that it's a combination. I think some people have a built-in genetic propensity to overeat, just like some people have a built-in genetic propensity to developing schizophrenia, or being resistant to anaesthetics. But the habits and feelings that build up around that propensity then influence how it's expressed over time. How MJ can just turn that off overnight I don't know but I'm very grateful it does.

Have a listen to the zoe obesity interview apple podcast shared earlier.

I don't think you should ignore these worries you have OP.

Seems like some massive court cases waiting to happen to me tbh.

Am at the same stage of life to you and decided to give weights and low carbing a go as these are the lifestyle changes recommended for our age.

Since you're going to have to do this anyway in order to sustain a healthy weight when you reach it, i figured I'd try that first.

You know what? I've lost 1/2 a stone in 2 weeks and am feeling WAY more energised. Much less achy, moody, brain fog.

Why not give it a really good go for 6 months? You can always go back to the injections later if you want to.... 🤷🏻‍♀️

Many of us have been through a few rounds of trying low carb and exercise. It definitely works - and has worked for lots of us - the reason so many people are led to WLI is precisely because over the longer term these things have not worked at enabling people to maintain the weight loss.

95% of people regain the weight they lose - no matter what method they use to lose it. It's not because we're all fat and lazy. We're all supremely gifted at losing weight but our bodies force it back on by sending ott hunger signals because metabolically broken people do not have appropriate hunger signals. If you are not at this stage and don't need to resort to WLI then that's great, but some of us are doing this precisely because we've tried all else.

I’m really glad low carbing works for you. You’re metabolically healthy and your body is responding as it should. I urge you to listen to the Zoe apple podcast shared earlier. It will help you to understand why it doesn’t work for many and then you might temper your advice for people you don’t know.

@85reasons and some people don't have so much to lose but are using WLS as an easy option, because it's not prescribed by a doctor who sees them.

The fact remains that once you stop you will go back to square one. The food noise will return if you don't make changes.

Eating less calories than you need is not healthy in the longer term.

I am someone who struggles with weight and am insulin resistant. I understand why people take these. I just see nothing that convinces me it's going to help in the long term. They've not been around long enough. The OP expressed concern and I think it's worrying how many people are being encouraged to ignore their perfectly reasonable concerns here.

@NoCarbsForMe how will it be back to square one exactly? I won't be obese or overweight when I stop taking medication, I will be a healthy weight and able to exercise in a way I haven't been able to before. I will have had many many months of eating in a totally different way. That's not back to square one, where square one was a BMI of 50 and needing to lose more than half my body weight. And constantly snacking and overeating. Do you believe that as soon as the medication has fully left my system I'll be right back into constant snacking and overeating?

I'm in the same place and I'm so hoping that at a smaller size I can exercise more and be more able to do things.

My fear is yes, without the drugs that my body will return to its larger size (set point theory)

I'm even wondering if I need to plan for a maintenance dose. We know 95% of people who lose weight regain it but we don't really know long term results of these drugs when people come off them yet

I think it's worth considering whether your finances make it possible to continue with a lower maintenance dose for a period of time if you find you need to. I am planning on stopping and seeing how I do on my own, with the knowledge that my BMI need never go to the highs of 40 or 50 ever again as I can restart if I need to at any time that my BMI is over 30.

The injections r just a tool, u need to work on mindset and change yr lifestyle completely, then once u r at goal eat at maintenance calories every day, it can take a while to get that correct. Injections rnt a magic bullet just a tool.

There are studies showing that if you lose even just 5% of weight and maintain for a number of months your risk of diabetes is great reduced. MJ are some people’s only hope. You’ve said what you wanted to say. @NoCarbsForMe and yes some people are abusing WLI but so what?
If someone is genuinely concerned I would hope they talked through with their doctor and not rely on anonymous users.

podcasts.apple.com/be/podcast/zoe-science-nutrition/id1611216298?i=1000660424275