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.

Yes but think of all the people with healthy BMIs who have cravings and want that to be other people's problem. They're much more important than your long term health.

So true Oranges. I shall consider myself told.

Yes I guess by that logic, I did cheat myself through university - I have bad eyesight and had to wear glasses to be able to pass the exams. And if I now nail a job interview, but they take my glasses away, I indeed can't do the job. I admit that my body is not working as well as someone who does not need glasses. Or glucagon-like peptides, as applicable.

@WeAllHaveWings thank you! I'm not on FB and I really appreciate hearing more. That all sounds good to me (apart from I presume an increase in costs to pay for it).

I am curious about what nutrition and exercise support the regulators are envisaging. Personally I feel I know a lot about healthy eating and movement and I don't want to have to click through online training courses.

I just want to point out that, having read a lot of threads about WLI, we very often get posters who spend a lot of time posting to tell us why WLI are a bad idea/dangerous/cheating/for lazy people etc. Often it turns out that these people have some sort of eating disorder themselves, or at least an unhealthy relationship with food. I actually suspect the vast majority do, or why would they be so invested in WLI threads if they have no intention of using WLI. These posters are not approaching the subject rationally and are not going to be persuaded by facts and rational argument.

This is true, but their posts and our replies are being read by people who might be.

Yes that’s true @Orangeandpurpletulips and some very good replies there are. I just thought it might help people to understand where these types of posters are coming from as it can be very frustrating and irritating reading them.

Yeah, it's worth pointing out.

I don't think it's good for either group for those people to be here, but it seems some of them will insist.

Thanks for the update @WeAllHaveWings I’d be happy with that approach. As it happens, I have a verification call this week, so will ask about it and will update if I learn anything. Fingers crossed, I will be near to the maintenance zone when I order my new pen, even at my glacial pace.

@WeAllHaveWings
Thanks for this. I look forward to receiving info directly too as I'm not on FB any more. I'm at bmi 20 so particularly interested in what the plan is for people like me. Recent weight verification video call didn't raise any concerns from the caller, pretty perfunctory, going through the motions, to be honest, and i think we were warned not to ask questions, or raise worries due to time constraints (which i had due to continued weight loss) so expecting something a bit more meaningful next time. A dedicated team sounds like a good plan.

On the Q&A Friday night she casually said they might need to up the lowest BMI they support from 19.5 to 20 or 21.

Today on her thread there are a few posts with people saying they are 19.5 or 20 and they are worried about being cut off and she has replied "we have not looked at changing that yet", so nothing definite yet I think.

I have been a bit lax about ordering my next pen from Oushk ( I had one in hand) and just gone online to discover that it's all kicking off! I'm at BMI 23 and would like to lose another 4lb (which I estimate will take me a couple of months) and then move onto maintenance. Because it's 6 weeks since I last ordered, I need a video consultation which I can't get for 2 weeks and I can't book a maintenance consultation until September! Are there any other pharmacies that are still viable to move to for maintenance? I'd hate to stop the medication, I will just pile it on again as I have done many times before! I have PCOS and a family history of heart disease, will this help my case?

I’m looking at Live Well (not sure if exactly spaces are correct) as Oushk might be in trouble and like you I’m hoping to be at maintenance but the autumn. Maintenance support is the main reason I went with Oushk (plus ability to book delivery date).

Have you contacted them? My consultation wasn’t for weeks, but they got me in on the next Tuesday when I explained.

I hear positive things about Pharmuous, Cloud and Simple online pharmacy for maintenance

I'm not at maintenance yet but I was looking into both oushk and pharmolous for maintenance as I have heard good things about both (before the recent oushk inspection)

I’m with simple online pharmacy & their pharmacist emailed me back when I asked a few questions about cut off/maintenance. Here are the first key points regarding bmi that she sent.

Key Points on BMI and Restarting Treatment:

• A healthy BMI is between 18.5 and 24.9. As long as your BMI is within this range, we can recommend you consider your maintenance options.
• There is no specific BMI cut-offfor continuing the medication, but if your BMI falls too low, we would need to assess your health.

If anyone wants me to send them the full email I’d be happy to.

I think Oushk are the first of the main maintenance prescribers to be inspected under the new stricter regulations. I'd imagine the others who currently prescribe down to 18.5 and/or have minimal oversight of patients, don't use verification videos, etc will be changing their rules and processes too, pretty damn quick (if they've got any sense at least). I'm reasonably happy Oushk will get their act together quickly (I think i read they'll be re-inspected in a month and they seem to have done a fair amount just over one weekend) so I'm going to hang on for the moment.

I'm just hoping that by the time I get down into the target BMI range the maintenance situation will have become clearer and more ironed out. I've still got a depressing 8 stone to go (5 1/2 stone down) and I'm not rushing to drop weight at a dramatic rate, or rush up to max dose - I'm going as steadily as I can, not seeking full appetite suppression because I need to be able to deal with my body's hunger cues going forward - but I would hope that, after I drop from 25 stone (which is what I was at my highest), there'd be some acceptance from the medical profession when I get there, that something is fucked in my body and it's not just that cake tastes nicer than celery (although I do actually quite like celery to be fair but I couldn't think of anything else typically diet food related starting with a c) and that they'd have a regime in place where I can remain on a very low dose either full-time or intermittently (like one week on, one week off) to maintain a BMI in healthy range. Not expecting the NHS to pick up the tab - happy to pay myself, just want the option to do that.

I'm with IQ doctor at the moment and I try to avoid pharmacy hopping as they work in terms of price and delivery predictability (for those times when I'm out at work and need to make sure Royal Mail lands on a day I'm in the house).

And I was over that tipping point where my weight made mobility hard, which made activity hard, which made my mental health fucked, which made food seeking worse and it was in severe danger of spiralling to end up in reality TV levels of weight if I hadn't intervened myself. I had a BMI of something like 54 - but I still wouldn't have met NHS current guidelines as I didn't have obesity-associated comorbidities - which is kind of daft and indicative of problems drawing blanket lines, but that's always going to be an issue wherever you draw the line for eligibility for treatment.

I remain happy to continue with Oushk. I have been well supported throughout weight loss and now on maintenance have experienced similar levels of support from a clearly extended team. The extension means that it will be more resilient - I did have concerns that if it depended on the principals that the personal service and quick response would go as it got bigger. I like the new app- it’s easy to navigate and find the things I want to see. If I feel like dipping into community threads to give encouragement to others I can, if I want advice I can get straight there. I am confident that they will sort out the issues raised by the inspection - why wouldn’t they? I’m not fangirling- just pragmatic about wanting to continue long term on maintenance levels while I reset and then continue to titrate down and content with the service.

This is interesting (and scary!). I have always been very slim until a few years ago. I then piled on weight rapidly due to birth control and stress (both now done with). Thanks to MJ I'm back to my old weight now and am titrating off MJ. I had assumed I wouldn't find it to hard to maintain my weight as I spent 35 years of my life slim! Are you saying I've changed my body's responses forever...?!

I think if you have spent most of your life slim, with only a brief foray into obesity, you may well be fine.

But those of us who have been obese since childhood and have yoyo dieted most of our adult lives, have a body that will return to fat time and time again.
It was explained to me as the fact that fat cells don't disappear. They deflate when you lose weight but will always be looking to fill up again.

But I am no scientist, the above was told to me by a nurse at a weight loss clinic many years ago.

I think the number of fat cells is set in childhood/adolescence. Once we have our allotment we keep it. Old cells are replaced with new, even if empty and unused.

This makes sense. I was a fat baby, chunky toddler and heavy set child. I then briefly became slim when I grew rapidly tall before filling out again and becoming obese during puberty.
I spent the rest of my life (now 53) yo-yo-ing between mildly obese and morbidly obese. With the odd (but few and far between) joyful period of being merely at the high end of overweight....

@flobbynomore - I've just moved from Oushk to Live Well for maintenance without any problems - that's with a current BMI if 22.5 (down from 31). I didn't want to pay for a maintenance plan. I've had a video call from Live Well, where they wanted to see a full body view, they also wanted a live video of me stepping onto the scales and to see how much weight I've lost in 2 weeks while on my current dose of 7.5mg. I've been a slow and steady loser, losing 3.5 stone in a year and I have weight related health issues, I'm not sure if that's been a factor in getting accepted by them.

@WeAllHaveWings thanka for the comprehensive update on the situation with Oushk. I’m with them and don’t really want to change. At only 4 lbs above a bmi of 25 it sounds like I need to book a maintenance call. I was planning to wait until I lost another 11 pounds.