Sobering (depressing?!) studies on life after MJ and worth consideration?

[RoastedPickleAndChips]

I'm at my target weight more or less after 8 months on MJ. Lost 5 stone and am now 9 stone 12 so quite happy with all that

As most of us are aware, there's not huge amounts of information surrounding maintenance, mainly because people are only just getting there on the whole due to MJ being relatively new to the UK for weight loss

So I've been doing some reading and digging and it makes for pretty depressing discoveries

I always knew that I didn't need to 'educate myself about heathy eating and portion control etc etc.' I could practically qualify as a dietician tbh and I always felt that the MJ does far far more than just suppress appetite

Have a look at this study .... https://jamanetwork.com/journals/jama/fullarticle/2812936 .... it shows that for a fact pretty much everyone will regain the weight they have lost once coming off MJ

I also read this comment from someone well informed ....

MJ is not for suppression. That’s not ever been a planned target effect.

It’s a physical, mechanical, method of action. What the drug DOES do is increase insulin sensitivity, suppresses glucagon secretion, and slows gastric emptying. These are known as the target effects.

Once you stop taking the drug, the body reverts back to higher insulin resistance, high glucagon secretion, and faster gastric emptying.

And the studies show this. There’s lots and lots of information if people spend half an hour reading the studies and trials.

SURMOUNT-4 proves that “changing behaviour” alone doesn’t work. And SURMOUNT-3 applied the drug AFTER people tried to change behaviour - and we see clear massive difference in subjects there too. So the clinical effect is clear. It’s not a tool to help you get over a hill or learn how to be healthy. No more than wearing body armour makes your skin thicker.

Anyway, thoughts? Of course I want to believe that I'll be the exception, that this time I'll keep the weight off, that of course just 'eating less and moving more' is the key

But it's not is it? MJ seems to be more than just a tool - it looks like the effects on the body are far more than I'd realised and understood

So is the answer a dose for life? (Currently not available to my knowledge?)

Thoughts? I'd love to be told the above is a load of shit Thought it might be interesting to discuss anyway

I agree @FlappingMadly I used to the time to learn better eating habits generally - ie I now prioritise protein. I used to think healthy eating was having a salad. It is, but not without a giant portion of a good protein with it! I still have a takeaway or a pizza, but it's a treat every other week, not every night of the weekend. I mindfully eat - am I enjoying this? What am I getting from it? I stop when I think I've had enough, which is long before I am 'full' because when I am 'full' I've generally overeaten.

It's definitely how I gained weight 🙄 Pretending all was okay...it will only be a few lbs...errr, or stone!

I think that study is rather vague on what diet and lifestyle the placebo set had, beyond the fact that they had counselling to encourage them to stick to a deficit and exercise regime. It’s not clear that the weight came back on ‘regardless’ - I think we can all imagine a scenario where counselling doesn’t guarantee that someone sticks to diet and exercise.

Personally I used to have reasons for overeating, dating back to primary school. It’s been a very long time since they applied, or that I ate unhealthily: but repeated diets, an underlying hormone issue, and finally menopause, meant that eating what most people would consider a very sensible number of calories made up of healthy food resulted in no weight loss at all. MJ enabled me, frankly, to eat very small portions of my usual food and thereby lose weight. How much of that was lowering my insulin resistance I have no idea. My challenge post-MJ will be to figure out how much I can safely eat to stay a healthy weight but beyond that I have no other issues to crack.

I think many of us have been here too many times before to think it’s as simple as telling ourselves to weigh daily. I mean - I agree - for me, weighing daily has been essential in the past when I’ve been needing to maintain weight loss. However, over the long term, what has ALWAYS happened is that eventually life gets in the way, something happens, I get stressed or busy and before I know it a period of time has passed and it’s like I’ve slipped off the tightrope. Sometimes this has been after six months, sometimes after two years. But I’ve always wound up back where I started.

Yes, I’m not calorie counting but I’m doing two meals a day, no snacks and very little alcohol or sweet food. I’m trying to reset portions in my head - if we’re having say chicken and mash, I will have a very small dollop of mash that’s about a quarter of the size I used to have. But I can have loads of veg. If I have a sandwich for lunch that’s ok but I must not have anything else with it except a small piece of fruit. I’m only in week 6 of Mounjaro so hoping to retrain my idea of portion size over the next few months.

I was 8-9 stone for years (like 35 years). If I put on weight I’d diet/exercise more for a month or so and lose half a stone.

i somehow lost this mentality and have spent 15 years piling on stones. I’m hoping that if I can get back to 9 stone again then I’ll keep it in check and only have to lose half a stone when I need to.

Wishful thinking maybe .

But it doesn't have to be like that? Make it routine, like brushing your teeth. Which in fact is what I do. Get up, wee, weigh, brush teeth. It's hardly even a thought now as I've done it religiously for over six months. I never forget or get too busy to brush my teeth!

Weighing daily also stops it becoming a big intimidating 'thing' too.

Simply weighing yourself every day doesn’t actually control the weight though? It just gives you information. What you do with that information will be affected by the rest of your life circumstances.

@CandiedPrincess - yeah, I've done it for six months too. Like I said in my post, this isn't my first rodeo and it's a bit more complicated than having to remind us all that we just need to weigh ourselves daily. Do you think if it was that easy then the conundrum that's been eluding scientists for decades - ie why do nearly all obese people regain the weight after losing it? - would have remained unsolved?

No not at all, but for some people it is. I am one of them. It doesn't mean it is the same for everyone but chances are it will be the same for others, I don't think I am a unicorn.

When I am taking MJ that is the new normal and it is very easy to think that this time I have new habits and won't compulsively eat after I stop. But I have lost and regained weight too many times in the past and put it all on again and some more, to have confidence that if I stop MJ this time will be different and I will magically not regain.

Studies clearly show that 90% plus of people who lose weight by any means, regain in 3-5 years. I don't see why weight loss with MJ would be any different. My guess is someone who suffers from intrusive and persistent food noise and long term obesity is likely to continue to need medicine but someone who has gained weight atypically from steroids, or temporary issues might well be able to manage without. I am in the first camp unfortunately.

Good news 1. is providers are increasingly open to maintenance even at low-normal BMI.

Good news 2. GLPs only cost a couple of dollars to make in raw ingredients. We pay high prices because of patents but in the next few years they will come off patent and then generic, cheap GLPs will come on market.

Good news 3. There are some really exciting next generation GLPs under development or testing: more effective, less side-effects, tablet instead of injection.

I am very happy to be living in a time when this great medical breakthrough has taken place. Like in the 18th century when they got smallpox vaccination or the 1920s when diabetes was no longer a death sentence. I will try and reduce dose, lengthen intervals between doses, keep eating high protein, exercising, weighing daily, macro and calorie counting and taking the MJ .

Surely that’s verging on obsessive behaviour?
I’m sure most people are acutely aware when their usual clothing starts feeling “snug”…..I knew I was.

Nope @Waitfortheguinness it's keeping accountable. If my clothes are snug, then m already overweight. Why do I want to wait until I'm overweight to take action.

I'm not on weight loss injections but I hope you don't mind me commenting. I thought insulin resistance could be changed with diet and other lifestyle factors, so won't it improve simply due to the dietary changes made while on the drugs? Why would it revert back unless the person reverts back to the same lifestyle as before?

@CandiedPrincess you are one of them... for now. If you've managed five years of maintaining weight loss through the mere fact of daily weighing that's when it starts to be more relevant. Most people can observe their habits for a few months and maintain weight loss. It's over the long term the vast majority struggle.,

My experience is that no matter what I've tried, nothing (& no other meds) have helped reduce my insulin resistance. One dose of 7.5ml Mounjaro (after 2 months of 2.5 & 5ml working up to this dose) and it's significantly better.

So I don't want to come off it any time soon.

The other thing about daily weigh-ins, is that you notice your body's natural fluctuations. If you're doing a weekly weigh in and happen to weigh yourself at the wrong time of the month, for example, it can be crushing and lead you to give up. There are times when our bodies store more water an certain foods also encourage water retention.

The other thing about daily weigh-ins, is that you notice your body's natural fluctuations. If you're doing a weekly weigh in and happen to weigh yourself at the wrong time of the month, for example, it can be crushing and lead you to give up. There are times when our bodies store more water an certain foods also encourage water retention.

I have just realised I didn't get SAD symptoms this year either. How strange / cool!

I have never tried WLI, although I have considered it. But with all methods of weight loss, maintenance of that weight loss is problematic. I have struggled with my weight all my life. 5 years ago I lost 5 stone via Slimming World. I maintained that for over a year, by keeping going to class/ weigh ins , but then covid hit.....gradually put 2.5 stone back on! Back at SW and have lost 1 5 stone, but it's the accountability and focus for me. You can't just stop the thing that is working (in your case the injections) without help/ support. Yadda yadda, we should (and do!) understand why we over eat. Doesn't help! I need to keep connected to my weight, need to have it in the fore-front of my mind (otherwise I think, fuck it, and eat all the chocolate!) Not saying SW is the way forward, just saying that whatever you do to lose weight (and I have no negative feelings on WLI, know lots of people who've done really well on them!) you do need some kind of way to maintain it or it goes back on! I joke I'm like an alcoholic- if I don't go to meetings I'll relapse.

I'm not sure what support is in place for people stopping WLI, but I feel there should be some

I know maintenance after any weight loss regime is always going to be tricky, no matter your good intentions. However, I will definitely come off MJ when I’m at my goal weight because I can’t keep taking it just because I feel that I’ll put the weight back on. I’ve made lifestyle changes that I’ll continue, keep weighing myself, etc. I know I’ll keep it off in a year, what if after a year, i start to forget, etc
This time, I now know of WLIs and know it works. If I start putting on the weight in future, due to my ethnicity, I will qualify for the jabs from a BMI of 27.5 so I’ll go back on it then, I won’t wait till I’m morbidly obese, I won’t have that feeling of giving up thinking I can’t do it, etc because I now know of something that works, that’s the mindset I’m taking away from this, not fear of ‘putting all the weight back on’ but comfort that there’s something that helps. And if in 2 years time, I have to use MJ again, I’ll reassess what my maintenance plan then will be but for now, I’m enjoying losing weight and getting back slow and steady to a healthy weight.

From what I understand, gaining a significant amount of weight can permanently reset your ‘set point’ higher - if you gain more than a certain amount (~30lbs) your body’s existing fat cells cannot expand further, so your body has to split some of your fat cells in half. Once this has happened, you’re stuck with the extra fat cells - even if you lose the extra lbs. That is what triggers the weight regain/battling to maintain a lower weight - it has a permanent impact on metabolism, as the new fat cells are metabolically active and have a big impact on appetite and satiety.

This has a lot to do with why people tend to regain after coming off GLP-1 medications. The medications offset metabolic dysfunction and stop the normal metabolic changes which happen when you lose weight - increased appetite etc - so once you come off them, all of those challenges come back straight away.

One of the books I read on obesity said something along the lines of ‘you cannot exert willpower over a biological function which takes place every second of every day’.

That makes no sense, considering it is evidenced the weight regain if you stop the meds, if being a big word, is limited, significantly limited compared to if you don’t use the meds to lose. The stats are on the thread.

I don't really get the concern with taking a maintenance dose for the rest of your life? Many people need to take medication throughout their lives. If you did gain the weight again it's likely you'll have other health issues down the track that will require treatment.

My plan for maintaining my weight loss is complete abstinence from all junk food. My diet is whole plant foods. I'm not eating any fatty food, added sugar or refined carbohydrates. I'm enjoying my healthy food but I don't get the big dopamine hit and craving and withdrawal that I get with junk/sugar. I know if I ever eat junk/processed food I will instantly crave more and the healthy foods I'm currently eating will seem rubbish in comparison.
Over several years I've gradually managed to get my weight down from 19 stones to 13, and now 10 stones with Mj. The longest I ever managed to diet was 3 months at a time and then I would fall off and return to bad eating and regain a chunk of the weight but usually not all so that very gradually my weight tracked down. I mean to continue tracking all calories daily for a good while into maintenance, good days and bad, and continue daily exercise for the much needed continuity and routine as well as health benefits, and continue daily weighing too. Basically, I mean to carry on making diet, sleep and exercise my main priority in life long term.
I have high food noise, I love junk food and I binge eat. I consider myself an addict and need complete abstinence to have hopes of keeping the weight off. Even now on Mj I have a high appetite and food noise, I binged 3 times in the last month but not on junk because I don't have any in the house. I try to eat my biggest, most satiating meal for breakfast, and eat lots of fibre and beans/ lentils, I get enough protein.
I'm reading a book called 'How not to diet' that approaches weight loss from a whole plant foods direction and plan to use the advice if my weight starts rising in maintenance.
I've read that insulin resistance is caused by fat clogging up our muscles so that they can't take up the glucose in the blood, so you feel tired and hungry all the time and your body doesn't burn fat. And that's why losing a lot of weight/ body fat and eating a healthier diet can reverse insulin resistance and put diabetes into remission (usually only if the diabetes is more recent).