Maintenance options/plans when you think you'll need to be on it forever?

[12purplepencils]

I'm approaching my goal weight which for me is BMI 26/27.

It's taken me 1 year to lose 3 stone and I'm currently on 10mg. Still losing but not very fast, my weight now is about 11stone/70kg.

What are other slow responders' experiences of maintenance?

I feel like my options are to titrate down (not sure I'll get down very far before gaining tbh?) and/or to space out injections. But not sure where to start 🤔

It'll depend on your pharmacy and that's a good place to start. You'll need to be with one which is 'maintenance friendly' ie they'll continue to prescribe long term, especially once/ if you're at a healthy bmi. They'll discuss your aims with you, your goals, and agree a dosing schedule. Regulations are stricter now and it seems that pharmacies will need to show they have systems and processes in place to monitor maintenance patients long term, verifying their weight regularly, etc.

I'm with swift, deliberately moved to them as they are good for maintenance.

Although since my BMI is still 27 I'm not expecting to have an issue really.

Just not sure if it's best to taper down but stay weekly or spread them out more.

I’m in this boat. I’ve lost four stone and am on the cusp of a normal BMI. I stopped for two weeks as I was away with work and on holiday. I put on 2lbs which I was fine with. I never went above 5mg as a dose so am now working out what I can do to maintain. I took 3.75 this week and will try 5 next week and then maybe 5 every other week? I’m not sure!!

I’m also with Swift. I have a maintenance call with them at 0930. I’ll come back and update OP.

Thanks that would be great.

I'm not even sure if I need to officially tell them I'm on maintenance since I'm at a weight where lots of people would be continuing trying to lose.

Also they seem so good, I didn't order for 6 plus weeks as I had a little stockpile from taking 7.5 then 8.5 from my 10mg pen, and they didn't query at all. A few days from re ordering to delivery.

@HansHolbein
I'd be interested in how you get on too as need a back up in case oushk goes belly up! Can you check how low on bmi they'll accept new maintenance customers for me?

Just had a lovely video call with their GP, Dr Bano. She’s an experienced GP with an interest in obesity.

She asked me about my background to do with weight. I explained that I have been struggling since the age of 11, then was diagnosed with PCOS in my early twenties after years of no periods, hairy body, acne, and then struggling to conceive.

She asked me about my weight loss since October (I’ve lost 7st 10lbs/48.9kg) if I had any side effects, and what dose I am currently on (15mg). I’ve had no side effects, and my PCOS symptoms have pretty much gone and my periods have returned.

She asked what my next steps are. I said my goal weight is 8st 5lbs BMI 19.7. About 1.7lbs away. She was fine with this.

She advised that I now need to start titrating down to find the dose that maintains my weight and that she wouldn’t want me to lose anymore weight once I reach my goal.

She is happy for patients to stay on the medication for life and they will work with patients to support that.

She asked me about my diet and lifestyle and explained how it is important to make changes alongside the medication.

I asked how pharmacies verify height when nobody has ever asked me to do so. She said that they can usually tell from the photo, (maybe they use software or something) and if they aren’t sure they will ask for a video call to confirm.

She asked me to book another video call in 2 months time.

I’ve been with Swift for a few months now and I was impressed from the first interaction. Always responsive, caring, and understanding. Looks like I will be with them for a long time. I’m happy they ‘get’ it.

@KrankyKumquat Really sorry, I only saw your message after the call. I believe they accept new patients with evidence of prescription at BMI 21. The lowest BMI they will let you go to is 19, but that is only with certain health conditions and ethnicities, and is on a case by case basis. I think most pharmacies want to you to get to BMI 20/21 and then start maintaining. As I have PCOS (and I’m shaped like a pink lady apple) there is a little leeway.

@HansHolbein
No worries! That sounds like a really good, thorough consult.

That's really useful to know thank you

I think I will try firstly to titrate down and see if I can maintain that way.

I have certain weeks of the month, linked to my cycle, when old binging behaviour creeps back in. Maybe I can even try taking slightly higher on those weeks.

@HansHolbeinthabks for sharing that it sounds so positive

im concerned about when i get to maintenance as i cant titerate down having stayed on 2.5mg the whole way! I suppose by the time i get to maintain level my body will need less but if i am still eating what i eat now it should balance? I haven’t thought about it too much but I will look into swift now

I’m keen to try going it alone once I reach my goal weight (or even before). Worse case scenario I have to go back on, but I’ve read anecdotally that it’s not as effective at lower doses the second time around.

Forgot to add… if you stop and start gaining weight, they will take you back on as long as it’s in a 12 month period.

I am currently on 10mg and going to finish this pen then come down to 7.5. In my maintenance call, my prescriber recommended staying on the dose on which you hit goal for at least another pen to ensure you have stabilised before you begin to move down. I initially lost a further 5lbs and then sat at that point for a couple of weeks but have today put 4 back on which I can only assume is water from the current heat and an over consumption of salty deli meats yesterday!

Ideally, I’d like to maintain on 5 (or even 2.5!) but will have to see how things go.