Obesity as a Disease - Medication

Hello everyone. So, weekly update. I'm due to take my injection today so this is the start of Week 10. Another 1.5lbs off today so that's 17lbs off in nine weeks. I've gone from 205.4lbs to 188.4lbs.

I can't see or feel much of a difference yet. I had been hovering around the 180s for most of 2021-2023, so most of my clothes were bought to fit the size I am now. I did feel like I was bursting out of some things a couple of months ago, and now they are a little more comfortable.

Not so many side effects this week, but I did eat a lot healthier over the weekend, prioritising protein and fibre.

My cousin's husband popped over to drop some things off during the week. He is the one who is a diabetes and obesity consultant. I just managed to squeeze into conversation that the Ozempic was going well with some side effects but nothing I couldn't handle. He said that actually, there's really no need to suffer any side effects at all, as long as you stay on the lower doses for as long as they work for you, and only go up a dose if you feel you need to. So that might be comforting advice for anyone starting out. He was really pleased that it was working out - I suppose if you are quite a vocal advocate of these drugs its good to hear the success stories (not that I am quite that yet).

30lbs down in a month is a massive amount - that's about 13% of your start weight. I don't want to burst your bubble at all- I'd say you're delighted. But be careful regarding losing that quickly on an ongoing basis. Rapid weight loss can be because you are losing both muscle and fat. Once you hit your goal weight, your metabolism will be very low if you've lost a lot of muscle. And then there's the hair loss, gallstones, saggy skin and hormonal imbalances that may come with rapid loss.

I really don't want to be a Debbie Downer - the freedom that Ozempic gives you when it works is intoxicating, especially if you have struggled with food intake and hunger for years/forever. But this is a marathon, not a sprint. You may not feel like it, but in the long term it might be better to up the calories you are eating during the day and lose a little slower.

As far as I can tell, it's not the losing the weight the old way that's the problem, it's maintaining any kind of loss. The obesity specialists are now saying that if you go into a calorie deficit, your body drops your metabolism accordingly. So you might lose 10%-20% of your body weight but your body increase your hunger and reduce your fullness in order to make you regain the weight. That's where the problem lies, and that's where Ozempic really comes into its own. It appears that when you reach the amount of weight Ozempic allows you to lose (which is different for everyone), the hunger comes back but crucially you don't put weight back on - as long as you stay on the medication of course.

I haven't felt a huge amount of nausea - only when I overeat or eat very high fat/high processed food. It's actually more diarrhea I've suffered with. 90% of the time it has been very mild but I have had two or three days over the 10 weeks so far where I'd describe it as moderate, where I have had painful cramps and have lost a couple of night's sleep. I've also had sulpher burps, which are unpleasant but the least worst of the side effects in my opinion.

Week 12, Day 1 and my first gain. I weighed in at 187 this morning, which is a gain of 0.6lbs, for a total loss of 18.4lbs.

I took my Week 11 dose a day late last week. No reason except for a bit of laziness. I also only took 0.4mg. I don't really know why - maybe after the conversation with my relative I thought that I'd try to keep the doses low in order to avoid the side effects.

Either the dose was too low or I'm getting too used to the medication, as I had very little side effects over the past week but also very little effect from the medication. I definitely felt hunger - proper stomach rumbling hunger and I could eat larger portions than I have been able to up until now. But the big downer was the food noise and cravings. Boy did the cravings come back. My two times during the day when I find it difficult to avoid cravings are on my way home from work when I'm in the office, and around 9pm at night. I definitely felt the inner voice coming back - debating whether I'd buy this or that, how much I would eat of this or that. It's hard to know whether Ozempic provides some sort of placebo effect - where you're told it gets rid of cravings so you kind of ignore them when they come, or whether it has a true effect on that part of the brain. Either way, it definitely wore off this week.

Anyway, I've taken my Week 12 dose this morning instead of this evening, hoping it might kickstart things. I have also upped to 0.55mg. I know it's not a big jump from 0.4mg, but I don't want to fall into the trap of taking a larger jump in dose and getting harsh side effects, just because I'm impatient with my weight loss. If I don't find that 0.55 is an improvement, I'll go up to 0.65 or 0.7 next week.

I do hope that Ozempic allows me to lose some more weight. I realise that the average weight loss in the trials was 6% after 12 weeks, and 10% after 24 weeks, so I'm exceeding that at this stage. It'll just be difficult to only lose just over a stone when I really have three more stone to go, and have to fork out €146 a month to merely maintain that smaller loss. If I was paying €146 a month to maintain a 3/4 stone loss it'd much easier to justify.

I'm trying to stretch out the doses for as long as possible so that I don't get to a point where the 1mg dose "stops working" (I realise that's somewhat inaccurate to say, because if I am maintaining the loss then the Ozempic is working). It'll be a long old time to wait while maintaining before the Wegovy comes on the market and I'll be able to titrate upwards again.

in fairness, he is actually a consultant endocrinologist (I mentioned him in the first post) but you weren’t to know that 🤩

I should have also said that I discussed my titration with my GP at my appointment last week. He agreed that it was ok to take a lesser dose if the side effects were getting too much, though he said it would be better if I stayed a bit longer on the same dose.

I do get what you are saying though. Before I went to my first appointment I was reading some of the threads on the UK websites and I thought - j*sus, this is the Wild West with people just making up titration schedules. However when I mentioned it at my first GP appointment he said going slower up the doses was not necessarily a bad thing and some people can and should stay on lower doses if the are getting decent weight loss results. He did say that it was probably better not to mention that to my pharmacist because “their heads tend to explode” (his words) if you don’t follow the manufacturer’s guided timelines.

I very much agree with this. By far, the first thing you need to fix is the food intake, both quality and quantity. And while I understand that exercise is needed in order to maintain weight loss, it is - in my opinion - next to useless in helping you lose weight. Now, that's not that I don't understand the concept of calories in versus calories out. But in my experience starting exercise (whatever that may be, weights, running etc) while obese is nearly counterproductive. It's painful, because of the strain on the joints. It generally increases appetite, which is something you are trying to avoid while you are correcting a previously unhelpful diet. And it requires a nearly superhuman effort, because you are carrying around the extra weight all day anyway, and you are eating in calorie deficit, so you're starting from exhausted. Mentally, I find that you are much better off spending your efforts on meal planning, reminding yourself to eat healthy snacks, spending any extra time catching up on tasks so that you are not stressed, and getting more sleep. The time to take up exercise is better when your are say, a stone away from healthy weight.