I'm seeing a lot about GLP1s. I have some worries and I'm not sure if I'm being a science dodging eejit.

[Lemonthyme]

I don't want to start on GLP1 agonists but am feeling somewhat like an outlier. It does feel like many threads on here go for so long then someone suggests it.

I'm not anti science or anti drugs if needed. I just think at my weight (BMI 26.4) there are a lot of other things I'd try first.

What I worry about is a couple of things. And feel free to disavow me of any misconceptions here if you're on them and not having problems.

Firstly I worry about what I still end up eating. If your volume reduces a lot, the requirement of the quality of those foods goes up. And as all the research I've read points to high variety of plant foods being important and high protein being important, I'd worry I'd just not eat enough to get the micro and macro nutrients I need for good health. What impact does that have long term, especially on your bowels and gut microbiome? Will it increase bowel cancer risk if fibre volume reduces? And if you have to prioritise fibre and protein when on the jabs, why not do that anyway?

Secondly I worry about muscle loss and the impacts of that into old age (ie sarcopenia). It's fat I want to lose. While you can protect a bit with strength training, you already lose some of your muscle as you age anyway.

And for it all it terrifies me starting on something that works and then not being able to come off it without setting myself back. Will it mean I have messed up my own hunger and satiety hormones?

Then there's just how much research there has been if someone was on them for 10 years, 20, more?

I don't really know if I'm actively considering it or not. If my BMI was over 30 I'm sure I really would. The benefits would be more obvious.

I don't know. I just don't think I know many people in real life using them yet there are a lot on here and a lot around my age I think (late 40s).

I'm trying 24 hour fasting which I think is working but I have to admit this was probably me trying something more drastic because I was subconsciously thinking of trying the medication route instead. Not that I could really afford it mind you.

I’ll Save your worries and your what if’s !!
your BMI is not in the range of being able to obtain a WLI by legitimate prescription -—
end of !

I went in them at bmi 37 size 18/20 and now BMI 27 and size 10/12. I cannot understand why you would go on them if you were nor over BMI 30.

Stress not. As @BeaPerry says your bmi means you're ineligible to get them as the risks would outweigh the benefits

Exactly. WLI are only allowed for BMI of 30+ or 27 with some specific health conditions.

Some of your concerns are absolutely legitimate. WLI do have downsides. But with a BMI of over 30, the health problems of being that overweight will outweigh those concerns. It’s all about balancing the benefits and the downsides, and the benefits increase the heavier someone is.

You wouldn’t be eligible.

A couple of Uk legitimate online pharmacies have started to offer WLI to people with BMIs between 25 and 27, on an off-licence basis. So the OP could get a legitimate prescription if she wanted to. I would not suggest that she does go down this route, even though it’s now available.

To answer some of your questions… if people like me could easily and consistently prioritise protein and fibre, eat a healthy but calorie restricted diet then I would already have done that and not needed WLI to help me not be obese. Nothing is stopping you @Lemonthyme prioritising protein and fibre right now without taking WLI.

Muscle loss- do some exercise, we all should’ve doing some anyway.

WLI don’t permanently “mess up” your hunger and satiety hormones.

If you can’t really afford them and are worried about the side effects or other issues, then don’t take them and continue with your fasting and so on.

The BMI cut off is an obvious misnomer.
WLI don’t work differently for the massively obese or merely overweight.
Most people get fat because they overeat calories - this is hard to do on meat, salad and vegetables.
The GLP1 helps you make better choices because you lose cravings. Easier to eat healthier choices when you are in control.

With a stone to lose you would only be on them a few months. I can’t see that being a risk given the data.

Thanks all. As I said, I don't know much about them. People seem to be recommending them on here to people in similar situations to me.

OP isn’t “fat” though. Just a few pound over weight. She probably is already in control.

she isn’t in the target bmi but I think it is widely known that people are using it to lose weight even if their weight is under the cut off, im sure there are plenty of people selling it as a side line.

@redboxerclub I had the exact same BMI at 11 stone 5, so could easily have lost a couple of stone and still be a really normal weight.
Fat round the middle is a health risk. Waist should be your height or less.
Just because the Op isn’t massive doesn’t mean she can’t lose a stone or two and be healthier.

I think this is a really thoughtful post and you’re definitely not an outlier for thinking this way.
GLP-1 medications can be incredibly helpful for some people, particularly where there are clear health risks linked to weight. But it’s also completely reasonable to pause and ask the questions you’re asking, especially at a BMI in the mid-20s.
What you’ve picked up on around nutrient intake is probably one of the most important (and least talked about) parts.
Because appetite drops quite significantly, people do often end up eating much less overall — which can mean:

• less protein
• less fibre
• less overall nutrient intake

And as you said, when volume drops, quality matters more, not less. In terms of fibre and gut health, we don’t have long-term data yet on things like bowel cancer risk specifically, but we do know that fibre intake is important for gut microbiome diversity and overall bowel health. So if intake drops significantly and isn’t replaced thoughtfully, it’s something to be mindful of rather than ignore. Your point about muscle is also valid. During weight loss (with or without medication), there is typically some loss of lean mass. The difference with GLP-1 is that if protein intake is low and resistance training isn’t in place, that risk can be higher. That’s why anyone using them ideally needs to be quite intentional about protein and strength work. On the “what happens when you stop” question — that’s probably the biggest unknown people are quietly wondering about. The medication changes appetite regulation while you’re on it, but it doesn’t automatically change habits or relationship with food. So coming off it can feel like a bit of a transition unless those foundations are built alongside it. That said, plenty of people do use them successfully and feel the benefits outweigh the risks — it’s just not a completely “set and forget” solution. I suppose the balanced way of looking at it is: It’s a tool. A powerful one. But it still needs supporting with nutrition, movement and habits if someone wants to feel well and maintain results longer term. And you’re absolutely right — focusing on protein, fibre and overall diet quality would be beneficial whether someone takes them or not. It sounds like you’re already quite tuned in to your body and trying things (like fasting) — so it may just be about finding an approach that feels sustainable for you, rather than jumping straight to something medical unless you feel it’s really needed.

l think most people would think it inappropriate to start on GLP1 drugs at your BMI, unless there are additional health issues going on like pre-diabetes or high cholesterol or blood pressure. I’m sure there are people using them in these circumstances but I don’t think it’s widespread.

I think many of your concerns are valid, especially the fact that. It can be very difficult to come off the drugs and maintain weight loss. And diet quality is definitely something to think about.

Loss of muscle mass is a concern with any type of weight loss, especially very fast or dramatic weight loss which you do often see with GLP1s. But I’d also caution against 24-hour fasting if this is a concern for you. Muscle breakdown is going to be accelerated when you’re underfuelled. The best way to preserve muscle is to eat consistent meals, consume protein with each meal, and stimulate muscle synthesis with strength training.

I managed to eat a perfectly helthy balanced diet throughout with a focus on protein, all blood tests results very healthy, and loads more energy, some suppliers will prescribe from bmi 25 and if you weigh yourself at end of the day you probably are in the 27 bmi category.

but it appears you’re over thinking, if you can’t eat enough you’re on too high a dose, it should control your appetite so ypu get full after a healthy portion, not eliminate it. Yes some people abuse it, and chase suppression, although thays less now the cost has gone up, but for everyone else, who did it correctly they still get hungry for meals and actively have to go into a calorie deficit;

There is a lot of peer reviewed and quality research out there - a quick search on PubMed will find the basics.
firstly, a BMI of 26 is not what this is for.
I have lost 10 stone on MJ. I’ll attempt to answer your questions.
regarding quality of food - you need to be aware of what you are eating. As I got lighter I started upping my running and I need to be careful to eat properly. You need to use this as an opportunity to educate yourself in actually eating properly and how nutrition supports health and fitness.
Muscle loss wasn’t something I noticed. The opposite actually as once I got to a stage where I could exercise I started putting muscle on. Now I run trail ultra marathons.
I titrated down slowly and came off WLI 4 months ago. I put 7kgs on when I was ill and couldn’t run, and my DF has just been diagnosed with cancer which impacted my exercise but it’s coming off again. My hormones were a bit all over the place initially with mood swings however that’s settled.
this medication has actually been around years - it has been prescribed for diabetics.

for most people who are on it with significant amounts of weight to lose, and risk is balanced against the risk of early death or serious medical issues caused by obesity. We aren’t talking a bit chubby here, at my worst I thought I would have a heart attack. At that point you are willing to risk a bit of muscle loss because the alternative is so much worse. And if I could do it without then I would have - it’s not like I haven’t tried!!!

To lose weight, you need to reduce your calories intake. Period. How you achieve that , be it with fasting or a drug that reduces appetite, reducing a macro (fat or carbs) or any other planning doesn’t matter. It always comes down to calories.

For all methods, once you stop, you gain back if you go back to old habits. It does seem that for the GLP-1s, you gain more fat back than you lost, so your concerns are valid. Science is emerging on the malnutrition and lack of key nutrients for those on them for long time.

How are you trying to lose weight?

Hi All,

Thanks for the replies. The thing is that for those who are doing no exercise, then starting weight training on GLP1s will help increase muscle. Great. Thing is that I'd guess most people, or certainly I am a big strength trainer already. I've been lifting weights alongside running for over 10 years. I've already been prioritising protein and fibre and started fasting once a week because none of that was working anymore. I don't eat refined carbs. No white bread (actually I've not eaten bread for a long time), very very occasional white rice, I'd more often have wholemeal if any at all, lots of variety of plants and pulses. (I'm also tee total so it's not even that.)

The reason I did think about the drugs was my HbA1c is at 5.8% which if I lived in the US would be classed as prediabetic, the limits in the UK are 6.0% so well on the way. That's despite everything I'm doing and actually a very healthy diet. So the fasting was in recognition that I was possibly getting some level of insulin resistance (or possibly I'm low in iron and B12 or both) despite doing everything they tell you to do. So it was a bit of a "last ditch" attempt at something different and it finally seems to be something that's working. I am aware though that things that work can suddenly turn into things that don't. I've been there before.

Healthy diet and weight loss are two different things.
Red grapes are extremely healthy , but if you eat a kg of them, you have ingested more than 800 calories. Same with walnuts, avocado, …. Calories add up very quickly.
You can have a very healthy diet but still put weight on because it is the calories.

Just buy a b12 supplement if you are low. It is now quite hard to get b12 from food. Even cows get it in their feed, so the b12 you get from eating meat likely come from a supplement anyway.
Same with iron, pop into boots.

How long has it taken to lose your weight?

@Snugglemonkey about 18 months. I tried to stay at a steady loss, you can very easily loose it very fast if you don’t make sure you are tracking nutrition. As I was doing lots of running I’ve had to be very careful to make sure I was eating properly.

It’s not a real question, they’re not suitable for you at your weight. You’re barely overweight

but to answer you’re question about what you eat on GLP1’s. I barely eat veg, like 10 tomatoes a day and some soup. It fills me up too much so I prioritise protein and eat 50-80gm a day, I try very hard to get at least my full 48gms a day as that’s my weight in kilos.

I used to love veg, I miss veg but it’s a small price to pay to stay strong and healthy.

I'm quite tall so I still have a significant amount of lbs to lose even if it seems to others like it's a small deal but I get your point.

I suppose my question and the answers to it has satisfied they aren't for me. But also from a nutrition standpoint it all makes me curious.

With there being very good evidence that plants, particularly vegetables are very good for gut health and microbiome diversity and increasing evidence that is linked to both physical and psychologically good outcomes, if you're having to cut back on vegetables to take the drug, isn't that a kind of scary thought? Would you not be better on a lower dose but with more vegetables? Even in the relatively medium term isn't there a constipation and diverticulitis risk? Sorry if I'm being intrusive by asking.

It's all fair points. I only introduced the idea of B12 and iron as both can even be hard to absorb from supplements but may reduce energy. The impact on HbA1c is more likely though that your red blood cells can hang around for longer, artificially inflating that result. (It's no longer a 3 month average but the cells are exposed to sugars for longer). So it's more that the HbA1c might be inaccurate. But see my other thread. While my B12 and iron were previously low, my GP won't retest even though my diet is high in both and I am not rigorous on it but do take supplements. But that's all an aside.

Although, the fasting, for now, seems to be working which is an indicator that it might be reversing some insulin sensitivity. I'm not actually cutting back a vast number of calories by not eating for 24 hours. Much as you think you would as while the intent is that you don't, you do end up eating more in that fast breaking meal. It's kind of inevitable. That's why I'm surprised in a way it's working. At least so far.

I also find this a bit concerning and I am the opposite, when overweight I didn’t eat much veg, but now I eat a load of it, with my protein.

if I remember rightly you maybe quite short, I recognise your user name, but it is not advisable to be on a very low calorie diet which is only protein.

Hi op, I haven't read the whole thread as I don't know much about weight loss jabs

However what you've said about being prediabetic could be the reason you're holding on to weight despite healthy eating and exercise. Follow glucose goddess method. I fixed my insulin resistance a few years back and dropped a stubborn 3kg I'd been holding on to for years in the space of a month. You don't have to dramatically change your diet either, a lot of it is about the way you eat.

Weight loss jabs also help manage your insulin, which is another demonstration of why it really isn't 'just calories in and calories out'.

Glucose goddess did a show on channel 4 last year too, it might still be on all4. She cured someone's type 2 diabetes without medication. I really think this would help you

I tried the Glucose Goddess methods after watching that programme. Excuse my language but it's absolute BS. In no way did it work. When I read up on the impacts she's talking about I can see why. Yes they're positive for blood glucose but they're all small effects. So yes, for example, good idea to walk after a meal but better idea to cut the sugar and refined carbs out as much as you can as well as walking (and even that didn't work till I introduced fasting). The problem I have with her is she tries to claim you can just use her nudges without doing some more wholesale drastic change and honestly, you can't. Especially when in perimenopause.

wildgoat yes, VERY short. My calorie intake can only be 1000-1200 or I put on weight.

OP, I don’t have any bowel problems as even though my calorie intake is low what matters is the PERCENTAGE of fruits/vegetables and mine is still 25-40% of intake