Tolerance - Mounjaro no longer working after longterm use

[Mrsmunchofmunchington]

I have been on mounjaro for about ten months and it has been really useful.
I've lost a lot of weight but still have about 10kg to lose to get to a bmi of just under 25.

I haven't had any side effects except perhaps mild constipation.
I have moved up the doses as I felt no suppression at all until 7.5mg and then found doses effectiveness wore off after about 8 weeks or so.

I am now on 15mg and starting to feel like it is not as effective anymore.

I do think it still has some effect as I know how much I used to eat pre mounjaro and I don't think I could do that now but the effect isn't enough to help me eat a sufficient deficit to lose anymore weight.

I am disabled and can't exercise.

Also have a restricted range of foods I can eat due to disability, food aversions, plus I am a vegetarian.

I had thought, pre price hikes, that I would perhaps stay on mounjaro for life but I now don't know whether to risk coming off.

It could be that mounjaro is enabling me to pretty much maintain my new weight, even if not actually lose any more.

I am wondering if it does stop working for some people whose bodies are particularly tolerant?

I'm grateful that my body tolerated it so well in that I have never had side effects, and that mounjaro worked so well for me.

Just wanted to ask if anyone else has got to the point where they decided to stop because it wasn't doing enough anymore?

The thing is MJ isnt meant to be a “forever” thing, its a tool to teach you about eating healthier & not giving in to cravings.

Not true. It can be forever just as medication for other medical issues is forever.
Anyway OP. Ignore the unhelpful previous comment. As you lose weight you often need less calories so perhaps thats and issue and you are eating for maintenance rather than in a deficit. How long has it not been working?

Can you maybe look at what you're eating rather than how much, and see if there are swaps you can make to reduce calories without reducing the quantity of your food, so you get more of a deficit without feeling hungry?

@Mrsmunchofmunchington , I’m vegetarian, started Mounjaro 10 months ago and am on 15mg currently too! I’m within a couple of pounds of my goal, we are very alike. I’m 62 and have hypothyroidism in case that also is something we share. I too am starting to feel that the medication is not so effective and it really worries me for maintenance. I do want to eat more though because my hair is falling out in clumps and while everything I eat is super healthy many days my calories are very low, yesterday was less than 700, despite this these last few pounds are being really slow to shift and I’m basically maintaining which does not bode well for how much I will ultimately be able to consume.
I’m absolutely certain that if I stopped taking this medication completely my weight would quickly return to my starting point and after years of yo-yo dieting I can’t face that again I think it would mentally destroy me. After this pen I’m going down to 12.5mg and I intend to go back down the doses very slowly until I find a dose that helps me keep at a healthy weight.
The new prices are a body blow but my weight had me at a BMI of 35 when I started and it was only going up! My new BMI is 23.2, much more healthy. For the sake of my health both physical and mental I have to find a way of maintaining and so I’ll suck up the price increase (I know I’m lucky that I can). I live in hope that I find I can maintain on one of the lower doses. Eventually the manufacturer will no longer have the sole right to produce this medication and there are daily tablets coming to market to there is hope of a cheaper path to maintenance. Good luck!

@ComfortFoodCafe Did your prescriber not explain to you that you can take it long term? When you came off, what helped you maintain?

OP, please could you let us know what you eat in a day? I’ve started tracking what I’m eating and I’m finding it really helpful.

It not a teaching tool. It helps your body work the same as everyone else’s and do what lots of people’s bodies do naturally.

Like most fat people I don’t need “teaching”.

@Icanthinkformyselfthanks thank you for that helpful insight. Lots of similarities.
I don’t have thyroid issues now although I did for a while as a side effect of immunotherapy.

I often think I have the metabolism of a highland pony because even pre disability I only had to look at something extra to gain weight!

I have been on 15mg six weeks so this is a similar timescale to when lower doses stopped working as much for me and I knew it was time to move up but of course 15mg is the maximum dose.

I do track my calories and energy use precisely. I have nutracheck and an apple watch.

I know full well how many calories I need to eat to lose, how many will maintain and if I go over that amount then to gain. That isn’t why I was asking about the medication losing effect for me.

Mounjaro helps me eat in deficit and possibly for maintenance.

I know it is not having as much effect because I feel different, that it is becoming harder to eat in deficit.

I wondered if anyone else has felt the same thing.

I am a retired nurse and lifetime on/off dieter so knowledge about what to eat or limit isn’t an issue, it is the ability to do so.

I think I will have to do my best to maintain and then hope new drugs are here soon because I really worry that I need lifelong help, especially given my personal circumstances.

My weightloss has tailed off (not even 1lb a week now), but I wouldn't say that I'm able to eat more - maybe I can? But I don't think so - I actually think it's that now I'm 30kg lighter so my day to day activity burns many fewer calories.

I've been trying some tricks to fool my body into burning more again - wearing a weighed vest, trying to put breakfast off until after the school run and not eating in the evening (ie. a short eating window) as well as doing my best to eat protein first, MCT oil, and challenging myself to eat as many different plant foods in a day as possible.

Something in the list is working, because the weight started to go down again (albeit more slowly than when I started).

Says who? You?

I have found the effects of Mounjaro fluctuate quite a lot. Some days I feel hungry and eat more - I can easily finish a normal sized meal for eg. Other days I feel full after a small portion and don't feel hungry at the next mealtime. I think this is just how it works in the longer term. I've been on it 13 months and even on hungry days I can manage not to overeat because the Mounjaro seems to change my feelings around food even if I feel hungry - does that make sense?
Also being vegetarian do you track protein? I'm vegan and found I was under eating protein quite significantly because I was just relying on appetite suppression to lose weight - it worked, but I wasn't mindful about what I ate just how much. If you really focus on protein you will naturally reduce carbs and be less hungry overall.

Oh good lord. I know how to eat healthier. I have had the lecture from SO many nutritionists. I don't 'give in to cravings' - my house is generally biscuit free etc.

What Mounjaro does for me is give me the feed back you probably take for granted - on MJ, my body tells me when I'm full. Without MJ I walk through life continuously able to eat, not knowing when I've had enough, having to manually count every calorie in order to lose weight which is an enormous mental burden!

I'm cutting down to 1200 calories a day to lose the last few pounds - basically to go from the top end of healthy BMI to more towards the middle. I've lost two stone from BMI 29 averaging 1400 a day, but it has slowed down now I'm at BMI 24.9

My maintenance calories will be about 1700 which I should find ok without mounjaro (it was what I was eating to lose weight previously, which should have worked according to all the calculators!) but will tirate down and gradually increase calories when I get to goal weight.

@ComfortFoodCafe absolute twaddle!! Mounjaro IS meant to be a lifetime drug to combat metabolic dysfunction.

Loads of people are obese because their bodies do not produce correct levels of grehlin and/or leptin, or they have insulin resistance, PCOS etc. and it has NOTHING to do with ‘eating healthier’!!

Hi OP. I have found as time has gone on it is less effective. I've been on it for 13 months and lost about 5 stone but most of that was early on and not much this year at all.

It does fluctuate - some days I eat nothing but junk and in scandalous amounts, other days I'm not hungry and able to control the food noise. I have a theory that it relates to what I am eating and I'll be able to make it more effective again if I go back to strict eating windows (e.g. only eat between 12-6pm), low carbs, all the healthy foods only). I think it's not working for me because I stopped being strict with not only calories but also what I ate e.g. i started adding in junk if it was within my allowance and over time that's just progressed.

Time will tell if my theory is right but I need to mentally work up to being strict again, get a good plan together and stick to it.

A tool to teach healthy eating would be a book, an app or similar. Teaching involves giving information.

Literally not true at all. In the same way hypertension medication or insulin is not a tool to teach h you how to regulate your BP or your blood sugar.

Insulin is a necessary drug because those with diabetes don’t make their own. You cannot live without insulin but you could live without WLI. Although your health may deteriorate without some form of weight management.

Metabolic disorders are often easier to control without medication by focusing on food types. I was diagnosed with insulin resistance many years ago. The only way I can maintain a healthy weight is to eat a very low carb diet. It can be restrictive but if I don’t avoid carbs I’m like a zombie.

I could take WL drugs but all they do is replace my will power by manipulating my biochemistry to crave less carbs.
I took Metformin, a for-runner to the newer drugs. A lot of people don’t lose weight while taking them because they are not insulin resistant. I suspect that if you are not insulin resistant you probably need quite high doses of WLI to keep losing weight.

I’ve noticed that many of the US TicTokers who use a maintenance dose have PCOs which is associated with insulin resistance. It works really well in these individuals because their weight gain is a direct result of their condition. Most gain weight even on a healthy diet with no excess calories. Whereas those without insulin resistance lose weight because of the effect on appetite.

In the future it will be possible to work out why an individual struggles with weight maintenance because this is in fact the problem. If we maintained our weight from the outset we wouldn’t need drugs. Obesity is not necessarily the result of deliberate overeating but we don’t always overeat because of poor eating habits or gluttony. If you have insulin resistance you over eat ( particularly carbs ) to maintain blood glucose levels. It’s not a conscious decision but a physiological need to top up declining glucose levels.

Once you get into a carb eating cycle thats difficult to stop, due to the insulin constantly reducing your blood glucose levels. However, avoiding refined carbs stops the cycle. It does seem counter intuitive. You expect eating more carbs would increase your blood glucose but it actually has the opposite effect if you are insulin resistant.

We need a lot more research into these drugs to support their use across the board. In most trials there is considerable variation in individual response. It’s the same for many drugs. Using the hypertension example, some people only need a single small dose of one drug, others require multiple drugs to achieve a small drop in blood pressure. We are complex chemical factories each with a unique operating system. As with hypertension you often need to try multiple combinations of drugs to achieve the desired result.

Once we know more about how WLI in the individuals who have reached a healthy weight they will be able to tailor the regime to fit the individual. Like most successful drugs they have hit the market rapidly and use has exploded. The research is way behind. Statins were very similar and it has taken 30 years to fine tune their effective use.

You also need to remember that they were developed to treat tT2 diabetes, weight loss was an observed and pleasant side effect that further helped the control of the diabetes. It stands to reason that if you are not T2 diabetic the drug may not be quite as effective as a weight loss drug.

I genuinely struggle to understand why you’d rush into a thread about something you don’t know about and give advice, genuinely I am curious. can you help us understand?

The medication is used to treat obesity and the multiple underlying metabolic causes, and is a life long medication should it be required, like many other drugs, this is why all the global health authorities, after extensive testing has approved for life. It is why the WHO will shortly recommend and also likely put on their essential medication list, meaning every country with a functioning health care system needs to offer it to their population, the last one I think was the medication to treat hiv/aids.

it isn’t simply a teaching tool and a short term learning opportunity for fat people. What on earth would make you think that’s all it is? Why would you think all fat people don’t know how to eat healthy? And do you understand why it is deeply offensive to anyone struggling with obesity to suggest such a thing?

This is absolutely why it's not working well for you. By eating junk you're working against the effects of the drug. It can't do the job by itself.

@Wildfairy It’s almost a daily occurrence. Non WLI people coming on to these threads to tell us what we are doing wrong and why it won’t work - whilst having no personal experience themselves. We’ve heard it all before 🥱

Yes I’ve been on for about 18 months - 12.5 is just keeping my weight at an even keel now. I find 15 too much on the side effects for me at the moment. Menopausal here. I lost most of the weight in the first 11 months and haven’t lost any since June ish. Still have a bmi of 25.9 so not like I haven’t got a bit to go although obviously I feel a lot better at this weight. It really doesn’t work as well for sure. I’m kind of hoping that if I can keep affording it for as long as possible then it might give my body a chance to adjust to a lower set point at least. It’s a bit of a worry.

Hi OP

I started MJ almost a year ago, and lost everything I needed to on 2.5mg, reaching goal in January. I decided to keep taking it for a year to hopefully reset myself from a lifetime of yoyo-ing. I have never had a single side effect, so I'm guessing I was a super-responder / very lucky.

Since February, I could feel the food noise returning, and little by little I edged my dosage up, until July, when I found myself at 7.5mg, and STILL fighting the food noise. This is all in maintenance mode, eating to stay at 22 BMI, doing all the right things, prioritising protein and fibre, guzzling water like no tomorrow etc etc.

Anyway, when I saw the price increases, I decided to take a risk. I missed a week. No jab for 14 days. Then I jabbed 5mg. So a 33% decrease. And OH MY GOD it's like it was at the start again. No food noise, Christmas dinner level full after a small healthy meal, totally meh when I see biscuits. It's bloody amazing. I did 5mg again Tuesday just gone, and it's the same. I'm going to do 5mg for a couple more weeks and then try moving down again after another week off.

I'm both delighted, and also annoyed at the money I've wasted creeping up my dose when potentially I could have just had a week off back in February and probably stayed on 2.5mg. And more than the money, I'm annoyed I've been fighting the food noise for so long, while jabbing ever increasing amounts!

Obviously we all react differently, and you should check with your prescriber (yada yada) but a small break might be worth a shot?

@mjuser that is interesting.
I have known similar effects (thought with much longer gaps of not taking the particular medication) with painkillers.

I presume tolerance can be decreased again after pausing mounjaro and restarting.
Something to consider.

Omg It isn’t magic?!
Well that’s it. I want my money back.