Ozempic for life?

[curiousfurious]

This drug seems to be all the rage at the moment and gets good results. If you are not diabetic and lose enough weight on this to get down to a normal healthy weight do you stop taking it? Will the NHS continue to prescribe it if you are a normal weight after however long it took to reach your goal weight? If you are getting it privately because you don't meet the NHS prescribing criteria will your provider continue to provide it if you are no longer overweight?
I've read threads on here recently and there doesn't seem to be much focus on lifestyle changes or addressing the causes of being obese in the first place. I wonder if there's a danger in this being perceived as a wonder drug cure for obesity but that it's only short term. Diabetics will be on it for life perhaps but what about those who aren't diabetic? It's very expensive, prohibitively so to many, so what happens to those who can't afford it any more?

Thanks for all of your posts @Cappuccinopup.

@Cappuccinopup I'm not confused. I know what a healthy diet and lifestyle looks like. You have not answered my questions regarding responsibility I see. Not have you taken on board that I have said many factors are at play. It's not down to one thing but there are things people can take control of but for whatever reason choose not to.

Because obesity is an incredibly complex disease, which you seem intent on pigeonholing into being caused by a lack of willpower and personal responsibility. You mentioned previously you went from overweight to a healthy weight - there is often a significant difference between someone who is a bit overweight and someone who is significantly obese both metabolically and hormonally, and it seems like you are basing your views solely on your own personal experience of losing some weight.

If you have a genuine interest in understanding why obesity is classed as a chronic disease, the book recommendations posted will teach you a great deal about that, and the majority of them are written by doctors who have far more knowledge and first hand experience of treating obesity than you or I.

Someone who is obese exploring all avenues available to get to a healthy weight, including effective medicines such as ozempic/wegovy and bariatric surgery, IS taking personal responsibility. Using ozempic/wegovy is not a magic injection which means obese people can make no lifestyle choices, overeat calorific and insulinogenic foods, and end up a healthy weight. It simply facilitates an obese person to make these choices, partly by correcting the hormonal pathways which have caused them to become obese in the first place.

Wow. Aren’t you lovely?

The books are about how to treat obesity long term, and maintain a healthy weight, so I’m not sure how you reached the conclusion that they are ‘for fat women to feel happy about lacking discipline to lose weight’. How bizarre! 😂

That poster has been posting inflammatory comments throughout this thread, obviously quite spiteful and odd.

@Cappuccinopup - oh I know.

For the sake of argument, if 100 obese people were taken into a research group where they went on a residential for 6 months and were given food according to their tdee and given an exercise regime that had to be followed, what would happen? Their tdee would be recalculated weekly to ensure they were given the appropriate number of calories and nutrients to allow for any changes. A kind of Bootcamp scenario like used to be on tv. It might still be on tv I don't know. Their exercise would be at a level for general fitness, not weight loss.

In terms of the books-if they are so great why haven't the NHS adapted their advice to patients and the general public?

They are popping up on all the weight loss threads to tell us poor fatties where we are going wrong in a particularly unpleasant way.

Ozempic is not a magic bullet or an easy way to lose weight. What it has done for me is quiet the food chatter and cravings in my brain and allow me to easily implement a calorie deficit and lose weight.

I am taking this opportunity to become more active and change my habits. I'm weight training and eating more protein, fruit and veg. I am doing the things that will help me to keep the weight off.

I'm not lazy or ignorant (not that I feel I have to prove it to some random twat on the internet). Ozempic is a tool (not the only one on this thread it seems!) that has allowed me to make genuine progress in my battle with obesity and I am grateful for it and lucky to be able to afford it.

I think we should just ignore people that are plainly saying things just to wind up others (trolls in other words). A difference of opinion is healthy but not when it is framed as personal insults.

The interesting thing about that is that the drop in metabolism which obese -> healthy weight individuals get, is a much higher drop than what their TDEE would be calculated as based on their smaller body weight.

If someone gets to a healthy weight from being obese, let’s say 250lbs to 150lbs - their metabolic rate will be significantly lower than someone who has always been at 150lbs.

This has been studied in ‘the biggest loser’ contestants - ‘Prior findings from studies of The Biggest Loser contestants showed not only that metabolism slows drastically following significant weight loss, but also that regaining the lost weight does not restore metabolism back to its pre-weight loss levels’.

https://www.health.harvard.edu/blog/exercise-metabolism-and-weight-new-research-from-the-biggest-loser-202201272676

because of this, simply recalculating calories and adjusting caloric intake wouldn’t work very well.

This article goes into it really well, and speaks about each individual contestant who went from obese to a healthy weight, and the impact on their metabolism (their metabolism ended up far lower than you’d expect for their size).

https://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html

Incase anyone doesn’t feel like reading the entire article, the contestants had their metabolism measured post weight loss and one contestant burned 800 calories less than another man the same size as him (at his healthy weight, after losing the extra lbs). Another burnt 437 less, another 591 less, etc. It seems that the body permanently lowers metabolism after losing a significant amount of weight, and it doesn’t even return to its initial metabolism if you regain the whole lot.

The NHS, and governments in general, tend to be very with integrating new science re weight loss/obesity treatment into the advice which they offer. Hence the food pyramid advice of stocking up on loads of carbs and avoiding fat still being recommended to people, far after the point evidence showed that it was contributing to obesity rates rising, because of the impact on insulin.

@Cappuccinopup so they'd lose weight? Or not? I should have specified better but was hurrying. What happens as a result of weight loss is a different matter to what I meant to ask.

Assuming the results described in the article about the biggest loser can be generalised across the population, surely that result necessitates building muscle to increase metabolic weight and also increasing daily physical exercise to increase it? If it is correct that metabolism slows so significantly it's given me personally extra resolve to keep going with my healthier habits.

Posters seem more focused on going from obese to a healthier weight but my comments about accountability etc are more about those who know they have gained a bit but choose to keep eating too much of the wrong food and doing too little. There is a choice there. Lots of factors influence that choice but in most cases it is still up to the individual how they eat and exercise.

Going back to the OP. If metabolism significantly slows then once off oxempic it's going to be even more difficult to stay a healthy weight without superhero strength will power and support. It's going to be such a kick in the teeth to gain it back after spending so much money .

They would initially lose weight, but recalculating their caloric intake based on TDEE would not be effective at continuing or maintaining weight loss because their body would not burn that amount of calories.

Most replies are about the challenges of going from obese to a healthy weight because your post is about ozempic/wegovy. This is only meant to be used in the treatment for obese people, not overweight people or people who have just overindulged and have a few pounds to lose. It’s a totally different ball game.

In the scenario you describe, where someone has just been making a few bad food choices and gained ‘a bit’, the person is unlikely to have the metabolic and hormonal dysfunction which obese people have.

The body has a set point it fights to defend - if someone has just gained ‘a bit’, it’s highly unlikely this set point would have changed. It does not tend to change in adulthood - it is set during puberty, and the only times it can change after this point is during pregnancy, or if someone gains a significant amount of weight.

it’s also linked to the number of individual fat cells which someone has. If someone was a healthy weight and gained a bit, and has never been obese during their adult life, they are likely to have a normal number of fat cells. If they gain weight, their individual fat cells will get larger/more full, but they will not actually grow any new fat cells. Their fat cells being ‘full’ essentially set the body up to lose the extra weight. Obese people have an excessive number of fat cells - which again, is usually set during childhood, and cannot ever change. You can reduce the individual size of fat cells, but you cannot reduce the number of fat cells you actually have (barring liposuction which has its own risks). Fat cells are metabolically active, and contribute to the hormones around satiety and hunger which cause the regain effect in obese individuals. So when an obese individual gets to a healthy weight, they still have a hugely excessive amount of individual fat cells compared to someone who has never been obese - and each of their individual fat cells have just been shrunk, which makes the body believe there is some kind of famine, which leads to the huge drop in metabolism which happens.

You’re completely right that the metabolism slowing is likely to happen regardless of how weight loss occurs - which I presume is why it is prescribed as a lifetime medication in the US. But as it directly impacts the hormonal profile, it may counteract some of the usual hormonal rebounds and effects which happen with significant weight loss - I’m sure more research will come out about this, as time goes on and people who use ozempic/wegovy can be studied long term.

That’s really interesting @Cappuccinopup and it’s something I have read before. I wasn’t obese as a child. The opposite. Tall and skinny. I think I started to gain weight after going on the pill but that time also coincided with starting working and eating out of the home more, drinking etc. So it’s hard to know really.

It really is such an interesting area of research - hence why I have read so much about it over the years 😂. So from what I have read if you gain over around 30lbs, you do then produce new metabolically active and permanent fat cells, which will then change your hormonal profile/set point. But anything under approx 30lbs, will just be swelling your existing fat cells, so if you started as a healthy weight your body will not fight to hang on to the extra few lbs the same way it will if you pass the stage for your fat cells to be entirely full, at which point they split in two.

So @S70V12 is correct in saying it is as simple as calories in vs calories out, at least at first. I wonder how many obese to normal weight people have actually stuck to a healthier, calorie controlled diet with increased physical activity once they have achieved their goal weight. There needs to be a longitudinal study over a decade or at least 5 years to follow those who have lost from obese to normal and see what happens in the following years. I suspect most revert to their original eating habits and therefore it's very difficult to isolate insulin resistance or metabolic rate as a reason for regaining the weight. After a lifetime of eating too much and doing too little a forever controlled diet and exercise plan is going to smack of deprivation and hard work. No one is likely to stick to that.

So @curiousfurious
We're too weak-willed and idle to lose weight.
We've let ourselves go and it's all our fault.
Ozempic and other measures are a cheat because we're too idle and greedy to do it on our own.
If we do lose it we'll put it all back on because we're greedy, lazy, weak-willed and idle (natch).

I'd love to hear your suggestions, unless of course you don't have any and you just started a goady thread to give the fatties a kicking...

I think it's worth reading about autophagy as fasting does cause cells to be cleaned out.

I wonder when I read words like metabolism slows and huge drop in metabolism what these things actually mean as it's very unclear.

It's obvious that a smaller body will burn less fuel, a smaller car burns less petrol. It's a smaller engine, literally less valves. If my engine has got smaller it's happy with less fuel. I think if I'm told weird stuff like a huge drop in metabolism when actually a smaller me will be faster and fitter than a bigger me I can't make sense of what is being said.

I'm definitely perplexed at why needing less calories when you have lost weight is a problem. Maybe it's the spinach.

One of the benefits I have enjoyed is how much cheaper it is to eat less. It is amazing. I'm actually glad to need less.

The research I've read about fasting suggests early eating is the key to reducing ghrelin, the hunger hormone. The advice is to eat in the circadian rhythm so not after dusk. I'm finding this works. The less I eat in the evening the less I get any hungry signals and I wake up fasted and burning fat (I use (ketoskix)

It is not as simple as "calories in, calories out" and it's curious that that's your takeaway from it. It seems you view alternate views as a threat to your own sense of self. the issue with CICO is that both halves of the equation are dynamic and your body will independently adjust. You can also effectively excrete calories (e.g. as diabetics excrete sugar in urine) without burning them.

The best state of evidence is that the entire willpower and responsibility argument is misguided and this is what medical organisations say. The best studies on intensive behavioral interventions for weight loss have success rates under 20%... and that is by defining success as 5% of body mass. Most weight loss is short term.

The advice is for long term maintenance of semaglutide because once the effects wear off (which are both appetite suppressing and hormonal) the body returns to its previous state and weight is regained.

Medical shaming is weird. I am not on Ozempic but I have been on ADHD drugs for years which also have mild appetite suppressant effect as side effect. For the first time in my life since chubby childhood - I don't crave sweet things and can live like normal people who don't think much about food unless actually hungry or nice social occasion. I never had "food trauma" or anything like that, always had annoyingly large appetite and struggled with appetite rebounds after restrictive diets.

Because compared to someone who has always been you ‘after’ weight (at a healthy BMI), someone who has previously been obese would burn between 500-1000 calories LESS than you would expect them to burn for their size. It is not just a drop in metabolism which reflects their new body size, that is the point; the drop is 500-1000 calories more than someone their (smaller) size should burn.

Which is why ‘calories in, calories out’ does not work. The body is not a closed system - it will simply dramatically reduce the ‘calories out’, decrease satiety hormones, increase appetite hormones etc. Long term calorie restrictors are often cold and tired - the body is reducing caloric expenditure which you can do nothing to counteract.