I think the frustration of how long the final stages take is connected to two things.
First is, where we set our goal weight. I think many of us assume that getting to the top of the healthy range is the bare minimum, and many will want to go further. Obesity specialists are much less ambitious for their patients. They look for improvements in metabolic health, quality of life and functional ability. If the diabetes and sleep apnoea are resolved, and the person is now able to be (and is) physically active, without pain etc, then the doctor will tend to think the job is done. The focus then shifts to maintain the improvement rather than further loss per se.
The other thing, with WLI, is whether the patient is willing to stay on them long term. And for most of us, despite being morbidly obese, that means being able and willing to pay. If all your comorbidities are either resolved or vastly improved, if quality of life is good, but weight is stalled, you have to decide whether to stay where you are, or go up a dose in the hope of further loss. If you do choose to go up, you’d better be willing and able to pay for it for ever, because you may not ever be able to reduce your dose and keep the weight off. Or you might - but you won’t know that unless you try.
The reason I’ve been thinking about this stuff is that I started MJ in the belief that it would be temporary - I would lose the rest of my weight (having already lost a load without it, and bedded in good eating and exercise habits) and then be able to stop. But now I see that may not be the case.
I still want to get to the goal I set myself, which is 11 stone. But having got there, I want to stay there. Once those size 14 or 12 clothes are in my wardrobe, they are staying there. Now, as long as weight loss is continuing at my current dose, all is well. But if it stalls significantly above my goal, well, I’ll have to decide what to do. That will be the time to decide whether I can accept and stay with where I’ve got to, or if I want to go further. But if I do decide to go further, it will be on the assumption that I will be paying for the higher dose for the rest of my life.
To put it another way….. having faced this reality, I am able and willing to continue paying for my current dose, for ever, if I need to. If this dose won’t take me all the way to 11 stone, I will think about how much I really want it. And the other possibility, I suppose, is that I get to 11st one and find that I am still losing. Then the decision is whether to taper down (and save money) aiming to stay steady…. or to keep going and see how far it goes, having already decided I’m willing to keep paying.