Re: maintenance, this article was in the Mail today - interesting reading:-
Ozempic didn't work for me because I kept making this big mistake.
By RHIANNON DOYLE FOR THE MAIL ON SUNDAY
Published: 16:47, 11 January 2025 | Updated: 16:48, 11 January 2025
My patient was in pieces. A 52-year-old mother of three, who we’ll call Lisa, told me between sobs that she felt like a failure. Like many women, Lisa had struggled with her weight for years.
It had left her self-conscious. And, worst of all, no diet or exercise programme had worked.
Then hope finally arrived in the form of revolutionary weight-loss jabs – originally an off-label use of the diabetes treatment Ozempic and later including Wegovy and Mounjaro.
Lisa began the weekly appetite-suppressing injections early last year, which she bought from an online pharmacy. And for six months it worked – she was eating smaller, healthier meals and managed to lose around three stone.
Rhiannon Doyle is pictured in 2019- before her weight-loss regime
However, once she reached a weight she was comfortable with, Lisa made a big mistake – she stopped the jabs. And within months her weight ballooned.
She had come to us desperate, saying she needed the medication again.
It’s a story we often hear at Slimmr, the private weight-loss clinic that I co-founded. Patients reach their goal weight and feel good about themselves. Then, because of the initial success, they decide the drugs have done their job and simply stop taking them.
In nearly every case their weight goes back up. Then they start on the injections again and the whole cycle repeats.
We call it ‘the Ozempic yo-yo’ because it’s just like the long-standing problem of yo-yo dieting, where people go through a pattern of repeatedly losing and then regaining weight.
Those unable to get a prescription for weight-loss jabs on the NHS often turn to online pharmacies, but don’t get any specialist advice with it. So they are deciding for themselves when it is right to stop taking the jabs, which leads to the weight regain.
It’s demoralising, unhealthy, psychologically damaging and often an expensive waste of money. It’s also something I personally feel strongly about, because I went through a very similar experience.
In my 20s I was naturally tall and slim and didn’t really have to worry about my weight at all.
But in my 30s, things changed. Although I live in London, I come from a large Welsh family where food was so much more than just fuel – it was used for comfort and for celebration.
I’d always been fond of a drink, pints of lager and pale ale in particular, and as the years progressed the weight started to pile.
At my heaviest I weighed 16 stone and was a size 18. I was officially obese and my GP warned that my cholesterol was too high.
Rhiannon, seen today, now weighs nine and a half stone after taking Mounjaro this year
I tried hard to diet and exercise, but nothing helped. So I panicked and looked for a quick fix.
In January 2023 I found an online pharmacy that sold me Ozempic with no questions asked. I started taking weekly injections, gradually building up the dose.
It cost between £180 and £280 a month but was well worth it. The ‘food noise’ disappeared – all those maddening thoughts about eating. Within a year I’d lost three and a half stone and dropped to a size 14.
I still had more weight to lose but I felt I could do it by myself.
So I just stopped the injections. But within weeks I could feel myself falling back into old habits, into comfort eating and procrastination eating.
By the end of the month I’d regained about half a stone – so I restarted the jabs. And that was the cycle. I would lose weight, stop treatment, put weight back on again, repeat.
In recent years, medicines such as Wegovy and Mounjaro have transformed obesity management. They work by using an appetite-suppressant known as a glucagon-like peptide-1 receptor agonist (GLP-1). Studies show that obese patients taking GLP-1 injections can lose up to 20 per cent of their body weight within a year.
However research also shows that more than half who come off the drugs regain at least two-thirds of the weight they lost. Nearly one in five put all the weight back on – or even exceed it.
This is in large part due to patients who stop the medication and see their appetite come back with a vengeance. It’s thought this happens because, after a dramatic weight loss, the body believes it is starving, which triggers intense hunger pains. There’s even a term for it: rebound hunger.
Now many experts warn that GLP-1 patients will need to stay on the injections for life. The doctors I work with at the Slimmr clinic think there is a solution which allows patients to eventually stop taking the jabs.
Once our patients reach their desired weight, they are switched to a much lower ‘maintenance’ dose which is roughly half of their previous dose. It means they stop losing weight but also don’t put any back on either.
Crucially, it gives the body time to get used to its new weight so it no longer believes it is starving. Most of our patients stay on this maintenance dose for about a year, then stop the jabs completely.
We combine this treatment with exercise classes, psychological support and the option of specialist dieticians and psychotherapy.
It’s important to note that using these small doses is still an experimental practice, as there are no clinical trials looking at its effect. And it’s certainly something that patients should never try without medical supervision.
However our patients have had fantastic results. And I have also benefited from the approach.
In February I started taking a weekly injection of Mounjaro, and I gradually built up the dose. Not only did I shed the weight I’d regained, I also lost more – and now weigh nine and a half stone. And in October I switched to a weekly maintenance dose, which I’m planning to stay on for half a year.
It means I can stay the same weight without having to think very hard about it. I enjoy food. I enjoy cooking. I enjoy going out for meals. I just don’t have cravings.
It’s lovely when people say: ‘Oh, you look really great,’ and I feel more confident about myself. But the real benefit is my health.
Rhiannon Doyle is co-founder of the Slimmr private weight-loss clinic (getslimmr.co.uk).