My doctor rang me to tell me off!

[Willowy2]

I'm just posting to have a little rant!

I've been in MJ for 18 months. Started at a BMI of 30 and mu BMI is now 20 and I'm on a maintenance dose which I aim to come off fully by the 2 year mark in August.

Yesterday my doctor rang me to say he got a letter from a pharmacy that I'm on MJ but my BMI is too low, why am I on it, it's dangerous, this is the first he's heard of it, it's only for BMIs 27+ etc.

Firstly - a letter first appeared on my GP record in October 2024 as I can see a copy on the NHS app.

Secondly - The most recent letter states I am maintaining and that they can prescribe maintenance down to BMI of 19 with close monitoring and it's been verified that I was previously eligible. I've been with the same pharmacy since November 2024.

Thirdly - When I tried to explain the above he wasn't listening and just kept repeating how dangerous it was!

Honestly, I was in shock when I came off the phone. Are GPs really that clueless about this medication?

I've seen a few posts where people haven't wanted to disclose to their GP as their GP is clueless / judgemental etc. And the responses are usually things like that the letter just gets uploaded to your file, as if you're going to get a phone call from your actual GP....Well turns out I did.

He just kept repeating BMI of 27+. Right, so I get to a BMI of 27 then, have to stop the medication just to get fat again and repeat?

He wasn't interested in me saying how I train regularly, eat 2000+ calories a day, the best health I've been for ages.

Honestly, I was furious, felt told off like a child!

Anyone else had similiar from their GPs? Clueless, absolutely clueless.

Op has said it’s for maintenance. This is often the hardest part of any weight loss program.

Trying to ignore food noise and other people trying to tempt you with “come on, one more won’t hurt”, even when they know how much effort it took to reach your goal.

It’s well-known that yoyo dieting is very harmful, and OP doesn’t want this to happen to her.

Explain to me how this works, at BMI of 20 - why the need for a maintenance dose for 2 years?

That’s a genuine question by the way.

With any medication the risks should be weighed (no pun intended) against the benefits.

If you're diabetic or obese or have a weight related health condition, the benefits of using WLI likely outweigh the risks.

You're BMI is already within the normal range, and actually you're closer to being underweight, so the risks are actually increasing, as being underweight is risky in its own right, and the benefits are decreasing as you are a healthy weight and not taking it due to diabetes.

No medications come completely without risks, even if they've been in use in the population for extended periods.

The GP is incorrect about the “27 BMI” comment which isn’t going to be helping anyone agree with anything else he’s saying. You don’t need to or have to stop if your BMI gets to under 27. It’s a pretty basic error to have made, as the whole point of this medication is to get the patient into the healthy weight range before either continuing for maintenance or stopping if the patient wants to. The GP is also wrong about continuing use for maintenance which has been approved. The OPs BMI is 20, not 19, and she is maintaining not losing any more weight. The GP was also wrong about this being the first he’d heard of it, given the history the OP described about the first letter being in 2024.

So at least three errors there, which I would certainly complain to the practice manager about.

@Willowy2 where did the GP leave it at the end of the call? Are they going to write to your pharmacy?

No, he just sort of said 'well fine if you're coming off them' and out a note on my record saying advised to stop due to low BMI being less than 27. I felt like he wasn't really listening to me tbh.

I am aghast at an unsolicited phone call from a GP. You sound perfectly healthy so it is ridiculous a GP should have gone to trouble of phoning you when there must be so many people who desperately want to to speak to them about their medical concerns.

I guess being a doctor doesn't make you knowledgeable! Giving you such a dressing down in that way was unprofessional especially not allowing you explain your circumstances. I'm also taking a maintenance dose with a BMI of 22.5, having started with a BMI of 34. I have no plans to stop right now.

To wrap your head around this you need to understand that obesity is actually a disease. And because it is a disease it has changed the way your body works. If you put two women side by side with an identical BMI of 20, one of whom has never been obese and one of whom has and has lost the weight, the latter one (without medication) has a body that believes it is in crisis. It believes it is severely underweight and needs to get back to its set weight. So it is screaming at her to eat, eat, eat. That is why it is so very hard to keep weight off. There is some evidence if you can keep your new weight for two tests the set weight resets itself, but because this is something so few people do the evidence base is very slim (no pun intended!)

To maintain the goal weight . Soon as you come off the jabs all the food noise comes back . This maintenance keeps the food noise at bay and helps maintain your weight loss. It’s not a high dose . I titrated down to 5mg and all my food noise came back and had weight gain. I’ve realised this is a medication I’ll need for the foreseeable future and I’m back up to 7.5mg which is personally my ideal maintenance dose . There’s a good podcast / YouTube video that Oprah done with a doctor that dives in to it all and was really informative.

Theres so many comments on this thread that show people don’t understand WLI , including the OPs dr.

So the GP cares about your health and actually rang to question you.. As someone who is married to someone with severe multiple health conditions that has to push on their behalf for telephone calls and appointments for serious issues my sympathy is pretty low on this one. I'm on WLIs myself and wouldn't be outraged in these circumstances. People are always quick to complain they get no input or help from their GP but here's one potentially doing their job and its outrage.

Even though your BMI does sound low, it’s a rough tool anyway that doesn’t take into account weight distribution and skeleton width etc. On the bmi scale I can technically lose another 2 stone and be “healthy” still yet I’m a small size 10. If my weight lowers anymore I’ll look ill. It sounds like the opposite for you and that you need to be at the lower end to look healthy. Just keep on with your plan as it sounds very sensible to keep the weight off long term. Think they are just being cautious as I do have a friend with an ED who abused them, but he should have spoken more calmly.

If he cared he’d take two mins and educate himself. The man is a buffoon, these meds are recommended for life long use and maintainance, by all the global health authorities, as obesity is a relapse disease. They are not to get you ro bmi 27 and stop,

he’s a fool. I would complain to the practice manager. Link to the mhra guidance, and request the gp educates himself before wasting your time again,

@Willowy2 I would definitely object to any note on your record about being told to stop with a BMI of under 27 as that’s just plain wrong. And it’s easily checkable, so the GP is being very odd about that.

I can see the GP worrying about prescribing for you taking it at such a low BMI. If you fell ill with a serious side effect how would they explain their actions? You may think it is OK I'm not sure the GMC would.

• Minimum Threshold: Many clinics will not prescribe maintenance if your BMI is below 22–25, as it may no longer be considered safe or necessary.

The gp doesn’t prescribe it what are you on about and it’s safely within the guidelines for maintainance.

Thank you @Dolphinnoises and @ExplodingCarrots that makes sense - sorry, another question, you mention tests I think. What is that?

If I’m being too nosey, just ignore me. I just know that I don’t know anything about it and I might be guilty of assumptions and judgement through ignorance.

The MHRA has not assessed the safety and effectiveness of these medicines when used outside of their licensed use, for example when used for weight loss in people who are not obese or overweight.

FFS the misinformation and utter nonsense that gets peddled about WLIs is staggering. Been on them for over a year, been at target for 8 months, plan to stay on them forever. Pretty sure they're doing me less harm than my daily 60mg of prozac and my mild to moderate prescription painkiller addiction.

He’s right to be worried, you sound defensive and to be minimising the valid concerns.

@Holdonforsummer , this is clearly a subject about which you know a quite limited amount.
Firstly a BMI of 20 is a healthy weight and @Willowy2 is seeking to maintain that weight, not lose any more.
Secondly she started with a BMI which was obese and unhealthy, she hasn’t misused the medication.
Thirdly all indications are that the majority of people who stop taking the medication sadly put all or most of the weight they lost back on. Obesity is a lifelong condition, we don’t put those with hypothyroidism on Levothyroxine and then when their levels return to the healthy range take their medication from them because if we did they would become unwell again. This medication is no different.
Lastly the original use of these medications was to treat type 2 Diabetes and it was noted that not only did people’s diabetes improve but they lost weight while using them. This was then studied and their use as a weight loss tool was born. The medications themselves have been around for over 20 years though and there is plenty of data on their long term effects moreover there is ever increasing evidence to their positive impact on numerous conditions from dementia through osteoporosis and addictions.
I actually think it’s extremely unhelpful to claim medical qualifications and then go on to talk about a subject you clearly haven’t studied but I’d be interested to see you site the evidence for your claims?

He was interested in a having a conversation, it was a telling off! I'd be more than happy to talk through my experience, and my reasons, listen to his concerns etc, but I couldn't get a word in edge ways.

They can see when you’ve ordered them and the dose etc and so it will be obvious that you have reduced the doses and are easing yourself off them.

He was right to question it but not tell you off for it without knowing the full details.

It seems that you are doing things sensibly and I can’t fault your plan.

What is the 'close monitoring' that you get via the online pharmacy that told you that 'close monitoring' was necessary for a maintenance dose at your BMI, @Willowy2 ? Perhaps your GP thinks that 'close monitoring' by an online retailer is not likely to be adequate.

How many posters attacking the GP are themselves GPs? Or is that different?

The GP was definitely correct to get in touch with professional concerns about using WLI with such a low BMI. How on earth is the supplier allowed to provide them?

I've had 6 monthly weight verification video calls, and have to supply photos every 3 months...I think that's all they are referring to.