After major weight loss (BMI 48.5 -> 30) should I aim for healthy BMI or maintain?

[PuzzledObserver]

I have been morbidly obese the vast majority of my adult life. At my biggest, my BMI was 48.5. I have yo-yo’d down and up, many, many times. I have long known that the problem was my dysfunctional eating, and that my weight was a symptom. But that knowledge did not enable me to change.

A couple of years ago I started yet another weight loss attempt, prompted by health and mobility concerns. I did really well for over a year, then the familiar story: a return to binge eating, total loss of control, rapid regain. Only this time, I managed to put a lid on it, having only regained 18lb of the 5.5 stone I had lost. I joined a program which deals with the disfunctional eating. I lost part of the regain, then stabilised.

And here I am now, with a BMI somewhere around 30, but pretty much weight stable. I am wearing the same size clothes as I was over a year ago and have done so continuously all that time. It’s a bloody miracle.

So here’s the thing: for someone who starts out as obese to get to the healthy BMI range is very uncommon. And to stay there, even less so. If you start out morbidly obese, the probabilities are even lower.

Medically speaking, I have improved my health situation hugely by reducing my BMI from 41.5 a couple of years ago, and all time high of 48.5, to 30. If I could reduce it to 25, my risks would be even lower. So logically I should try to do that. But the probability of success is very low, and presumably the effort required would be huge. Whereas I do seem to be able to maintain my current weight.

Have you travelled this road? What did you decide?

I’m ina very similar situation. I started mounjaro 14 months ago with a bmi in the low 40s. It’s now 29. I’ve been on the lowest dose, 5 mg, this whole time but I haven’t lost weight since roughly November.

I actually look pretty good at this weight. I’m quite tall and so I don’t look thin exactly, but I’m happy with it. And it’s easy. I am not struggling to maintain this weight at 5 mg at all. I have some loose skin which is ok, but I don’t know what it would be like if I lost even more.

Ultimately, I have decided to increase to 7.5 mg though and make that last effort to get to a healthy weight because that was the point of starting this. I might be happy at bmi 26 or even 27. Maybe. I’m just not sure yet.

Buying summer clothes was a consideration for me as well because I don’t have many that fit and it’s a waste to buy something just for this summer ( I know, vinted). I just want to get to my final weight and be settled, and stop thinking about it.

I was around BMI 40 and 16 stone at five feet 3 and now around BMI 27 after two yrs on mounjaro and thinking of maintaining around this if possible.

I find this calculator helpful called the smart BMI online. It takes into account your age as well

@Orangesandlemons77 that’s interesting, thank you. It puts me just into the moderate risk category, and says that a loss of 10lb would be of benefit to my health. That’s much more manageable to think about than the 2.5 stone which would be needed to get me to a BMI of 25.

@hennybeans clothes are the perennial issue - I’m a charity shop girl myself! My last regain cycle ran from May to the middle of August last year - I was buying 16’s, and there was just one pair of crop trousers which fit (just) when I bought them but I never actually wore. It would be nice to wear them this summer…. I wouldn’t mind going through this summer in last year’s clothes, but it would be lovely to have to buy some size 14 jeans in September.

BTW I haven’t used WLI. So there’s the thought of getting them while I’m eligible to shift a couple more stone, and then try to maintain from there. But I confess, I am terrified of regain. I’d rather stay here than go down to a 12 and then have to come back up again. And I wouldn’t want to stay on them for life.

Those ones are very helpful to try op, as ideal bmi does increase with age.

Also, even the standard BMI used to allow higher values.

I am not sure of your age op, but I have noticed my friends in peri are starting to gain and tbh, the ones who are a little heavier - not in the obese category, but tipping into the overweight - actually look the best for their age and seem healthy and energetic and less prone to other issues.

As I understand it, the smart bmi calculator reinforces this kind of observation. I think Nature intends a bit of "middle age spread" and current trends fight against it. I realise your journey has been in the opposite direction - from higher to this level, rather than creeping up - but it may be worth checking with a Smart bmi as you may not be as far off healthy for your age as you think.

I am always quite interested in BMI discussions, because for many years I was at the low end of healthy - which I thought was the "good" end - but had quite a few discomforts, mainly circulatory but a number of things. When I gained a few kg on advice, more towards the middle of healthy, so many things just resolved. I am a slight build, so it wasn't a "big bones" type adjustment; the bmi range just didn't cover my optimum functional zone accurately.

Oh sorry: you've just done it while I was typing all that! I'm glad it was a reassuring outcome. And well done on your journey!

What you decide in the longer term is your choice but congratulations so far! I would make sure that you are maintaining and have the correct level of vitamins and minerals in your system before embarking on more loss though because it’s easy to deplete when dieting. I yo-yo a bit but find I can maintain around a bmi of 28 without feeling like my life is missing anything, if I drop lower I tend to just regain weight as soon as I relax if that makes sense, I’m happy with my body and lifestyle now, was miserable depriving myself

Is it an all or nothing choice?

Could you maintain for a while, and when you feel ready and if you want to, try and lose a bit more?

Weight loss is pretty relentless, tbh even maintaining has it's challenges. I wouldn't blame you for taking the pressure off for a while and enjoying your current success.

It's so cheering hearing this sort of post.

I know people who have really struggled with weight, and the attitudes around weight issues and BMI can be incredibly toxic.

It is really encouraging to hear people are listening to their bodies.

Eta and the more people do this, the more it will become acceptable to approach things this way. I get annoyed with the "obesity epidemic" being used to cloak prejudice and unkindness - and I actually think a more forgiving attitude would in fact encourage people who have real issues to tackle, not the reverse.

Quite a few of my late 40's friends are happy round that 28 level - and look great.

For my part, I feel at my best a bit lower than 28, but I have a slight, hipless sort of frame, which I think is relevant. I think it's really important we realise there are differences in build and optimal bmi. I think it is depressing so many people flagellating themselves to get to that 25 and below range when their body just resists it and it may not even be the best for them. But other people struggle with anything other than very black and white thinking and, being so, they tend to be quite vocal about it.

I agree that it’s not one or the other as a choice right now. Maintaining is important, to get out of the yo yo cycle, it’s not worth pushing hard for a lower BMI right now if it leads to a rebound regain. Better to maintain and then maybe think about what small changes you can make that are sustainable to then start to gradually lower your weight. But still prioritising the ability to maintain where you are now.

I’ve gone from BMI 50 to BMI 25ish, and ideally I’d want to get under 25 but not at the expense of a rebound regain. I am happy to spend a fair while at this BMI to stabilise, if necessary.

I would probably opt for WLI in your position. You have done brilliantly.

As the chances of anyone who is obese type 1 (bmi 30-34.9) successfully dieting to healthy BMI >25, is 1/120 and 1/644 for those in your starting category of serious obesity. (BMI 35+) OP , you need to give yourself a massive pat on the back for such phenomenal will power - as the type of yo-yo dieting you describe is the main contributor to insulin resistance. IR is the reason dieting is next to impossible by calorie control alone . Of those stoic ‘1s’ sadly 78% out it all back on and more within 5 years.I know you haven’t maintained for 5 years yet but a year is a bloody good start.
I was BMI 38 and lost 9 stone. I did it with MJ though, so the expensive route - but given the odds of 0.2% vs 85-87% on WLI I opted for the latter based on the statistical likelihood of success. Personally if were you I would look at WLI the moment you notice your weight moving upwards of 5-7lbs. If it does, otherwise keep doing what you’re doing.. but don’t let anyone accuse you of ’cheating’. It’s no different between giving birth with or without pain relief. No one comes around with a rosette afterwards. It doesn’t matter how you get there …

I am happy with the prospect of staying on 5mg for life. In my eyes I was already resigned to being on statins and bp meds to keep me alive - which are no longer necessary, I am much happier to be on a medication for life that keeps me healthy ..

The cost thing is nowhere near as bad as it seems once you take into account how much the weekly shop has reduced and incidental spending on coffee , cake and meal deals. Plus petrol station choc bars , boiled sweets are now non existent. Not because I deny myself but because it just never crosses my mind. I simply have three very small portions of nutritionally balanced home cooked food and eat until I’m full. My weekly shop has gone from £80 a week to £35 and incidental spending from £50 per week to 0 or negligible (perhaps a bottle of water if I’ve forgotten mine) . Which means my MJ 5mg pen actually saves me £211 every 4 weeks.

Some really helpful thoughts from several posters there, thank you. To answer a question - I am 62, so well post-menopause. I can’t say my weight “crept” anywhere, ever - whatever hormone-driven changes there may have been have just been dwarfed by the yo-yo. I have never been pregnant, so that’s not a factor either. I was a compulsive overeater/sugar addict from before I can remember. I have only once been in the healthy BMI range, that was in my early twenties, after losing more than 6 stone. And I stayed there for about 3 nanoseconds before the regain started - 4 stone in the first year.

So to the person who said maintaining for a year was a bloody good start - you’re right, and I recognise it. It hasn’t been complete weight stability - I went from 14-1 at the start of last year to a low of 13-3 in May. Back up to 14-7 in August, then after I got the grip (through joining Overeaters anonymous) I fell back to 13-12 by October, but then stalled. That did my head in, so I stopped weighing. I last weighed myself in January, and I was…. 13-12. And since then…. I don’t know….. no major change anyhow. For context, at the start of 2024 I was 18-11, and my all time high was 22 stone.

A couple of people said it doesn’t have to be either/or, and that’s right too. I am running a half marathon at the end of May, and a few weeks ago I decided that getting a bit more weight off would make that a lot easier. So the past few weeks I have tightened up on a few aspects of my eating. In essence I lost my weight by doing fairly strict low carb plus fasting. And I have stabilised/mantained with a slightly less strict low carb and intermittent fasting, 2 meals a day and no snacks. So to flip back into weight loss mode I have tightened my carbs a little and reintroduced a couple of fasting days each week.

As I said, I’m not weighing myself at the moment (though sorely tempted), I think I will feel the change in my jeans or see it in the mirror. Or feel it on my runs! My plan was to do the half marathon, and then reassess. If I’ve got the bit between my teeth and feel like I can continue with the stricter regime, well and good. But otherwise I can come back to the two meals a day and slightly less strict carb level. And sit with that for a while.

Fear of regain is a big thing for me. It’s probably better from here to only try to lose small amounts at a time and then hold steady for a while. To build confidence, as well as skills.

Just to add…. I have been saying to friends that I don’t really have loose skin, because it’s not just skin, there is still a lot of fat inside it. I have a tummy apron (more of a duvet), definite bat wings. Back and side fat when wearing a sports bra.

I guess I can forget about a new career as an underwear model…..

But if all the excess subcutaneous fat went away, I would then have more skin than I needed, and I dare say that would bump my weight up compared to if I had never been obese.

What delights me is that I can run and jump, no longer worry about fitting into chairs with arms or seatbelts, my psoriasis has resolved, I no longer sweat profusely at the drop of a hat, I am full of energy and can buy clothes anywhere. And after close to 30 years with type 2 diabetes, I am off all meds and now have levels in the prediabetic range.

I have probably already had 90% plus of the potential benefits of going from my start point to the magical BMI of 25.

That's brilliant OP. If you could keep maintaining without weight loss meds that would also save you a lot of money.

I'm nearly 50 and going forward thinking about bone health I don't want to lose too much because of the risk of osteoporosis.

However my mum struggled with her weight and had osteoarthritis which is linked to a higher weight.

I guess it's all about getting a balance and feeling what is right for you and your health.

it can be done, i started mj last march at bmi of 46 and now bmi 24, i plan to carry on till bmi of 23 then start to maintain. ive been overweight all my life, im 45, look and feel better than ever. fitter than ever too, i train days in the gym, a mixture of weight training and running. i do have diet fatigue, but i have to remind myself how far ive come.

Congratulations on your huge effort. Can I ask where MJ figures in your plans going forward?

Thats another factor In my equation. I have come this far without WLI. It’s likely I could lose more if I started to use them….. but if I needed to continue them indefinitely to keep the extra off, but can maintain my current level without them, then I’d rather do that.

i will be staying on mj forever, its been life changing for me, no side effects at all other than some slight heartburn in weeks 1 and 2.

I would agree with that analysis OP.

Thank you. Although I can’t get the idea out of my head of doing them for maybe 1 or 2 months, see what I lose in that time (half a stone? A stone maybe), and then go without for a few months and see if I’m able to maintain. If not, then the regain of that extra loss wouldn’t be catastrophic, so long as I don’t gain from where I am now. And if I DID succeed in maintaining the lower level for several months, then go again.

Kind of a trial and error approach, looking to find the weight that I can sustain long term based purely on lifestyle.

You have done really well! iI would suggest a focus on the healthiest possible eating. For most people that will mean more vegetables and pulses, mostly lean protein (so less red meat), eliminating UPFs as much as possible, fewer refined carbohydrates (eg anything made from white flour, more ‘good’ fats such as nuts, seeds and olive oil.

This type of eating over time is likely to lead to a gradual weightloss and will set you in good stead for good health. If you find, you’re not losing any weight, you probably need to reduce carbs and up protein.

If you're older, it's better to be slightly above BMI guidance. You can find papers on this.

I'd look at your body composition & work out what you need.

Bone & muscle matter & all weight loss involves a % of muscle loss too.

So my bmi is 36 but if I lost 7kg, my fat mass would be 30%, which is acceptable for someone my age. I'd still be obese probably but to get to less than that is really difficult for me. I want to avoid yoyo diets as weight gain is usually fat, so you end up more unhealthy every cycle.

I think though Op, gaining then losing isn't ideal, because of they way the weight goes back on (more fat).

I think you have reached a good level and would focus on maintaining for now to secure the progress you have made and also make sure you have sufficient nutrients. If you find that is sustainable, it would stand you in better stead for pushing for further gains, but if you can't maintain at this weight, it will be harder again lower.

The yo-yoing can become the problem.

I am already doing this, with the exception of more pulses (because I eat low carb) and less red meat ( cause I don’t agree that protein should be lean - natural fats are fine from a health perspective). I eat almost exclusively single-ingredient foods, no sugar apart from the tiny bit in 2 squares of 85% dark chocolate, I routinely intermittent fast, so 2 meals a day and nothing in between. I eat loads of mainly non-starchy veg and salad, what I would consider normal portions of meat, fish and eggs, full fat yogurt, nuts and seeds and a helping of berries each day. I will have a couple of small new potatoes with a meal, but seldom eat pasta, rice (I do cauli rice instead) or bread - an occasional slice of sourdough or a bit of naan once a month when we go for a curry.

I’ve also had a regular strength training program for the past 2 years.

Yeah, I wasn’t intending to make a habit of it! An experiment…. Say I lose half a stone with WLI, then stop them for a while. Several months. If I kept that half stone off, then try for another half stone. But if I regained it, or most of it, then stick whether I was rather than try to lose more.