Regulators looking to cut off maintenance below 25 BMI

[Bigfatsunandclouds]

Oushk have said that they are currently trying to fight with regulators to stop people being cut off from MJ at 25 BMI.

Apparently regulators don't like prescribing below that and that basically means unless you continue to remain at 25 or above you won't be able to be prescribed even for maintenance.

This is worrying as many see this as a lifetime medication after years of obesity but at least to maintain at a lower BMI for a little while to ensure the weight stays off. This seems like utter madness - this is surely going to lead to yo yo use of the meds which seems counterintuitive.

BMI in a lot of cases is a stupid archaic measurement anyway.

Bloody hell @stealthsquirrelnutkin

That's amazing! Good on yer girl.

I've a similar view re skin surgery btw. One of the advantages of being older is no one who matters gives a toss and a new wardrobe full of really cool clothes hides it all anyway 🥰

Any idea why the laugh react got taken away? I’m sure there used to be one..

You can't know that much about it or you wouldn't be on pens. Overweight people always act like expert dieticians in any thread about weight while not being able to shift anything.

The PP wasn't claiming to be an expert dietician, she was talking about obesity. You stating that people who are obese don't know about obesity or they wouldn't be on medication to treat obesity is...kind of stupid no?

people do know a lot about diets, calories, low carbing, etc it’s being able to sustain that way of eating which is really complex for a lot of people. Doesn’t mean we don’t know what we shoujd be doing of course.

@hehehesorry Wonder what brings you here? Pretty sad. Time to get a hobby, other than doing your creepy stuff on here, maybe.

MNHQ removed it after some people said it was being used to bully them.

Exactly. And until a person fully understands this, they are not going to have anything of value to say on the subject.

Obese and formerly obese bodies don't behave the way people want them to, they behave like they're the outcome of thousands of years of evolutionary pressure to protect us against weight loss.

Okay… so obese people are saying that only other obese people can possible understand how their bodies behave, and that those of us who are normal weight have no idea.

And I’m saying I (and many other slim people) experience a great deal of hunger on a daily basis, but we find ways to deal with it to stay slim. But the obese people are then completely discounting my experience and saying I can’t possible feel like this.

You can’t have it both ways - either both of our experiences are valid, or neither of them are. Seeing as no one can actually experience what’s it like to live in someone else’s body.

Okay… so obese people are saying that only other obese people can possible understand how their bodies behave, and that those of us who are normal weight have no idea.

No, experts who have dedicated their careers to researching obesity are saying obesity is a metabolic condition.

Maybe there are more than 2 options here though.

We are not saying that.
But whilst you feel hunger you are able to deal with the hunger.
When you eat, your body uses the food to fuel it.
Obese people are unable to deal with the hunger.
Not through a moral failing on their part, but because the obese body is absolutely hard-wired to obtain food, no matter what.

We are not saying we don't understand. We are saying we know you can feel hunger and we know you can deal with that hunger and yet be satisfied with less. And you know what, I wish I could too!

I am the child of slim parents. I have a very slim sister. We were raised around healthy food, limited portions, few snacks, lots of regular exercise.
I was the chunky baby who would only be soothed by food. The chunky toddler who gravitated to food the minute it was on the table.
The teenager who grew obese pretty much as soon as hormones kicked in.
Whereas my sister stayed beautifully thin.
Same amount of food. Same access to food. Same values regarding fitness and exercise and healthy eating.

I mean, most of us have no idea what something we haven't experienced is like. What is frustrating though is when non obese posters flock to the weight loss threads to tell us all what we are doing wrong, or what we don't know. Being told by someone who has never been obese that it's simple and we just need to eat less and move more is getting very old.
I think what obese posters on this thread are expressing more though is frustration at healthy weight and ill informed posters ignoring what science says about obese bodies. There are cellular level changes once someone is obese. An obese or formerly obese person is dealing with different issues than someone who gained half a stone over Christmas.

There aren’t any significant established health risks that outweigh the risks of WLI with a BMI under 30 (hence why they won’t prescribe first time under 30). Presumably if people can’t maintain despite a healthy diet and exercise and creep back up they can start again because there is then a risk to health? That’s not really yo-yoing in terms of weight. There’s about 1.5 stone ish isn’t there between a BMI of 25 and 30?

I don’t understand why it’s not safe to prescribe for a BMI of 29 but is fine to prescribe maintenance at 19?

From a health perspective you’re not at risk until your BMI is over 30 (unless certain ethnicities at 27). Maintaining at 21 is unrealistic for many people because that’s about ideal weight / looks and not health? Which is fair enough to want to look a certain way but there’s no risk to health so why would a medication be prescribed?

No.

One doesn't have to be obese/formerly obese to understand obesity. Indeed, there are plenty of thin people who understand that this is about science, not personal feelings.

Your experience doesn't matter and you need to stop merailing. The same would also be true of an obese person who had as poor an understanding as you do.

What I don't understand is that obesity costs the nhs a fortune, it shortens the lives of millions, including presumably some people you care about, and yet when a solution comes along that most obese people pay for out their own pocket and do the work to lose the weight you aren't celebrating. It's one of the most impactful health interventions my generation has seen and it's barely cost the public purse a penny. What exactly is there not to be happy about?

SURMOUNT-4 included a total of 782 patients. All patients entered the lead-in period (open label) and received tirzepatide treatment for 36 weeks to achieve MTD of 10 mg or 15 mg subcutaneously once weekly. At the end of the lead-in period, patients were randomised to continue treatment with tirzepatide once weekly (355 patients) or to switch to matching placebo for 52 weeks (double-blind phase).
Treatment with tirzepatide demonstrated clinically meaningful, statistically significant and sustained weight reduction compared with placebo in overweight patients (BMI ≥ 27 kg/m2 to < 30 kg/m2) with at least one weight-related comorbidity and in patients with obesity (BMI ≥ 30 kg/m2). Furthermore, across the trials, a higher proportion of patients achieved ≥ 5 %, ≥ 10 %, ≥ 15 % and ≥ 20 % weight loss with tirzepatide compared with placebo. Treatment with tirzepatide also showed improvements in waist circumference, systolic blood pressure and lipid parameters compared to placebo.
In adult patients who are overweight or with obesity, treatment with tirzepatide produced a statistically significant reduction from baseline in body weight compared to placebo. A reduction in body weight was observed with tirzepatide irrespective of age, sex, race, ethnicity, baseline BMI, and glycemic status.
The efficacy and safety of tirzepatide in moderate to severe obstructive sleep apnoea (OSA), in combination with diet and exercise, in patients with obesity were evaluated in two randomized double-blinded, placebo‑controlled phase 3 studies (SURMOUNT-OSA Study 1 and Study 2). A total of 469 adult patients with moderate to severe OSA and obesity (234 randomised to treatment with tirzepatide) were included in these studies. Patients with T2DM were excluded. Study 1 enrolled patients unable or unwilling to use Positive Airway Pressure (PAP) therapy. Study 2 enrolled patients on PAP therapy. All patients were treated with the maximum tolerated dose (MTD; 10 mg or 15 mg) of tirzepatide or placebo, once weekly for 52 weeks.
In both studies, treatment with tirzepatide demonstrated statistically significant and clinically meaningful reduction in the apnoea-hypopnoea index (AHI) compared with placebo. A reduction in AHI was observed with tirzepatide irrespective of age, sex, ethnicity, baseline BMI or baseline OSA severity. Greater proportions of patients treated with tirzepatide achieved remission or mild non-symptomatic OSA compared to placebo (Table 12 and 13). Among tirzepatide treated patients, greater proportion of patients achieved at least 50 % AHI reduction compared to placebo.

I had my weight verification call today. No mention of a tape measure - just ID checked and scale reading checked.

That’s not what I said. Obesity carries significant health risks although mainly for 35+ or 40+. Overweight generally does not.

I think it’s great the lives of those with significant obesity have been improved so much.

I don’t understand why prescribing is allowed to maintain at weights lower than any health risks given we know it’s not risk free. I can fully understand prescribing to maintain <30 to prevent health risks of obesity outweighing risks of injections. I don’t understand prescribing for health reasons to allow a BMI of 21 to be maintained when that’s often an unachievable BMI for many without under eating?

Health problems related to an overweight BMI are rare. In fact many studies show for women that a BMI of around 27 has the best health outcomes especially before menopause.

If people have weight related health issues with a BMI <30 they’re in the minority and able to be prescribed to.

I don’t know of any studies showing that a BMI of 25 is problematic. A lot of people seem to want to maintain a BMI of 21 for some reason which has no health benefits compared to 25?

So I understand maintenance doses to remain <30 and if weight related issues <25

We do need much longer term data on use in non diabetics who are trying to maintain lower healthy BMIs using it and suppressing appetite. Seems sensible.

Well why not this?

Because without maintenance they'll just put the weight back on. You may not like that fact but it is a fact and then you're just back where you started. You need to stop looking at this as an individual issue. At a population level obesity takes a lot of resource and costs lives. Long term prevention of this will benefit everyone, even you as it'll free up resources for when you need them. Plus at an individual level the people you care about will live longer happier lives. I assume that's something you want? If so, the solution is life long medication. People here have given you the evidence and explained why. Your instinctive reaction disliking it is irrelevant. It is what it is, which is why our understanding and treatment of obesity has hugely improved in recent years.

Again !!!
Some ethnicities - bmi should be 23.

The idea that one has to be more than 35 bmi is simply not true. Many of us, particularly women, will carry the weight around our middle which is a significant health risk. I was bmi 33.5 and had a 45” waist, high cholesterol, high bp, metabolic syndrome, asthma and the beginnings of heart failure - all of which have been improved by getting to a normal bmi and being on this medication. I don’t want to go back to that. This fixes metabolic functioning which isn’t working properly in most obese people which is why we need maintenance, just like any other medication that fixes something in the body

Wrong. As I said in a previous post I’m most definitely not one of those naturally slim people who never really thinks about food and never has an urge to overeat.

I was an overweight child and teen. I was the one who would eat six crème eggs when others would naturally stop after 1. I was the one always thinking about what my next meal or snack would be. And there’s a part of my brain that is definitely still like this.

And that’s kind of the point I’m making on this thread. There’s a lot of assumptions from posters that only obese people experience these levels of hunger and food cravings, and therefore it’s essential they are provided with medicine for life that prevents them from feeling like this. All I’m saying is that there are many slim people who have comparable levels of hunger and food cravings but we’ve been able, to an extent, to manage these without medication. It’s not a morality thing, or an ‘I’m better than you’ thing, it’s just a fact.