Can you get weight loss injections with a BMI below 25?

[ThatDaringDenimTurtle]

Hi I am considering weight loss jabs, I am not particularly overweight, I have a BMI of 23.5 but I am heavier than I like to be, and struggling to fit into my clothes. I would like a short fix to drop a dress size. Has anyone done this? Can you get mounjaro etc if your BMI is below 25?

Let's suppose you do get a prescription and have started on 2.5 mg of Mounjaro for four weeks. You tolerate it well but, like for lots of people, it hasn't actually given you satiety or stopped the food noise and you haven't lost any weight either. You move up to 5 mg, then 7.5 mg and again it hasn't changed anything. Now you're starting a 10 mg dose and finally the medication is working. It's 16 weeks since you started and you've lost the pounds and dress size you intended. Now you have to decide do you titrate down or stop cold turkey. Human biology dictates you now have a lower basal metabolic rate and increased hunger, which means if you do stop you'll very quickly put the weight back on and probably more. What do you do then? Will you have to stay on a maintenance dose for the rest of your life? How much is that going to cost?

Human biology dictates you now have a lower basal metabolic rate and increased hunger

what on earth are you talking about. Your metabolic rate lowers as you lose weight, it is irrelevant of the drugs. Are you suggesting she never loses weight so that doesn’t happen? And there is no scientific evidence you’re hungrier when you come off the drugs.

people have such issues with these drugs, normally the ones who want them and can’t afford them,

But this happens for anyone who loses weight regardless of WLI or obesity. Anyone who loses weight will likely lower their bmr in doing so making it harder to not regain the weight this is literally why people end up obese in the first place. Lots of people who are obese now were a bmi of 23, 24 once. Wouldn't it have been better if they'd been supported to keep their weight in check back then rather than ending up gradually becoming obese?

If you do, you're either lying about your weight or the website is dodgy.

I'm not knocking WLI as I'm wegovy myself, but I'm obese but my BMI is just short of 40 and aside from arthritis in my knees I have no weight related conditions (no diabetes, hypertension or raised cholesterol, though I suspect I may have sleep apnoea) so don't qualify on the NHS.

I work as a mental health liaison nurse, and work with anorexic clients a lot. I was shocked that one client with a BMI of about 15 managed to get hold of them. I had to send photos of myself but she used AI to distort hers. It's shocking.

She doesn’t have body dysmorphia FFS. I’m also BMI 23.5 and heavier than I’d like. If I could get GLP-1 injections then I would. But I can’t, and won’t take the risk to fake it to get it.

she simply said she’s heavier than she’d like and her clothes are a bit tight. Nothing wrong with wanting to lose a stone at BMI 23.5. She just needs to go about it the normal way of eating less and moving more

Someone posted a few weeks ago about a clinic (Leicester based I think) that prescribes microdosed amounts to people under 25 (like 1mg a week type dose). It would be off label, and stupidly expensive. I suspect that level of dosage would be more to help temper food noise to maintain rather than cause much actual weightloss.

People can angrily wave their fist in the air but I really do think these drugs will increasingly be prescribed off label and have increasingly broader audiences. I wouldn’t be surprised if half of Hollywood are on it now.

Interested to understand why you think someone with a BMI of 23.5 would end up in A&E? (Unless you mean obtaining from a dodgy site of course).

I find it interesting that you couldn't be prescribed weight loss injections at a BMI of 25 but if you started at a higher BMI you can continue them at that BMI and lower. As someone with personal experience of the effects of an eating disorder it is concerning. I know how easily weight loss can become addictive and the unhealthy outcomes that can result.

You can get them at 25. A couple of pharmicies are now offering it.

But surely you know if you’ve had an eating disorder then it is a mental health issue?

I'm literally stating the obvious. Biology which has evolved over millennia, will fight to maintain your body at a particular weight as it doesn't want you to starve to death. When you lose weight, with or without weightloss injections, you will have a lower BMR and your body will increase hunger hormones and lower satiety until your body is satisfied you're no longer in a "famine".

It makes no odds to me how someone who only has a few pounds to lose does it but starting on medication probably isn't their best choice.

Again, that was my argument. Starting on medication is not the best choice when you're at a much lower weight than someone who is obese. There's a trade off.

Here's one researcher.

Dr. Kevin Hall, a NIH researcher modelled that for every kg of body weight lost, appetite increases by 95 calories while expenditure decreases by 25 calories per day.

Incidentally I can afford the medication and have been taking it for over six months. Would I have started if I only had a stone or two to lose? I hope not as it's very expensive and I don't know if I can maintain my weightloss if I stop.

I literally know someone that this happened to, she was bmi 25 and wanted to lose a stone. OP is bmi 23.5 and as an nhs worker myself I'm fed up of those misusing weight loss medications and expecting the nhs to deal with the fall out.
As for your comment on "being silly" why don't you move on ahead without being insulting or patronising to another person, you don't have to comment if you don't agree but clearly you are that kind of person, yes the unkind type.

What was she admitted with?

No. As an aside, my BMI is 23 and I’m a size 8 with a six pack. If you feel “fat” with a BMI of 23 it sounds like you already have low muscle mass. Taking MJ would likely make this worse. I suggest instead a body recomp where you stay at the same weight, add muscle and lose fat. Eat more protein and lift weights.

Pharmacies and clinics who continue to prescribe previously obese patients who are now BMI < 25 should be monitoring more closely for this - both weight and body composition.

I have seen posts with patients around BMI 22 complaining once their pharmacy saw their latest photo/video they have challenged and had a more in-depth call with them.

I think you’ll find that the STEP 4 trial for Ozempic/Wegovy and the SUMMOUNT 4 trial, showed that hunger returns with a vengeance after stopping. With the average regain upwards of 75%. This is entirely logical. How could it not ? It works on the control of blood sugar. Which in turn suppresses appetite. Therefore without the drug , the same insulin resistance returns and dramatically increases hunger. Insulin resistance usually caused by yoyo dieting is prevalent in obese individuals.

This is why people like me who have lost 9 stone and had a BMI of 38 am still permitted to order my pen each month despite now having a BMI of 23. I would not be permitted to do this without the evidence of being formally obese and a complete order history over the last 2 years. 1 year was to lose the weight the second to maintain it. I will remain on it (or whatever drug that replaces it in the future) for life.

To my knowledge neither Voy or MedExpress would consider prescribing it to someone with a starting BMI of 25. I think people are confused by the pharmacies which prescribe at that BMI for ongoing weight loss from a starting point of BMI 27 with co morbidities (high bp, sleep apnea etc) and ethnic background prone to obesity related issues OR BMI 30 and above. This is the licence requirement for standard prescribing.

It can be prescribed below this BMI ‘off label’ but this the prescriber to believe it is clinically appropriate and also leaves the prescriber with the responsibility if anything were to go wrong. So very few are going to leave themselves open to that.
Bear in mind that people like me who take it at a healthy BMI have been on it for a long time without issue, therefore the prescribing pharmacy is not open to the same risk.

@Fishingboatbobbingnight here is an article on the Voy website which explains that they may prescribe from BMI 25.

https://www.joinvoy.com/blog/bmi-for-weight-loss-injections

Here’s MedExpress’s help page explaining how they will prescribe from BMI 25, under the “Am I eligible…” FAQ answer.

https://support.medexpress.co.uk/hc/en-gb

@Fishingboatbobbingnight I got MJ from Voy with a starting BMI of 25.1

I started with a BMI of 27 and both high cholesterol and a history of PCOS. I’ve been up and down all my life although never obese - BMI up to around 28/29 after pregnancy. My BMI is now around 22.5-23 and I’m now taking a low dose and tbh I’d like to do this longer term as it means I don’t have to use constant willpower to keep my BMI in the healthy range. I would NOT want to increase my dose to get my BMI lower than 22.5 and I find it remarkable that clinics are prescribing at lower BMIs.

Considering the increasing list of unexpected health benefits from GLP-1 treatmentsand the way they are now being rolled out for normal weight heart and stroke patients I expect the prescribing guidelines are going to change and become a lot less restrictive.

Semaglutide tablets are available in the UK, making GLP-1 treatment available to needle dodgers. They'll be cheaper to distribute and store, and once the patent expires the prices will become less daunting.

I think that a lot of people with a BMI in the middle of the healthy range will be buying them, to dampen food noise, help them make healthier food choices, and protect against strokes, heart attacks, liver disease and alzheimer's, as well as improving a range of painful conditions that are triggered by chronic inflammation.

They have already proved to be more effective (over a wider range of inflammation mediated conditions than expected) and at least as safe as statins, which are now prescribed to just about everyone.

Give it ten years and they'll be over the counter at the chemists, or with the Night Nurse on the shelf where you have to ask a chemist to fetch it for you and answer their questions before they'll sell it to you.

With lower BMIs pharmacies should be looking at body composition - someone with a small frame and good muscle mass could look and be healthy at BMI 20 and if medication helps them to stay there and not relapse, I don't see the issue.

Alternatively, someone with a medium frame and low muscle mass could look frail and undernourished and there should be further conversations around their health.

It cannot be judged only by the BMI number.

The roll out to those with existing heart and stroke risk is still a clear health vs risk assessment.

I see them being prescribed for more health conditions over time, but I don't see them being available off the shelf. Jeez, we can't even get B12 injections, or Melatonin off the shelf in the UK! But you never know!

I think it would be very hard (impossible?) to tell on a video call. The problem with maintaining lower BMIs on WLI is the long term risk of very low calorie intake, without adequate protein or weight training. Body composition scales are a start (and better than nothing) but even they under estimate muscle compared to a dexa scan.