Getting to goal weight, isn’t the end goal; it’s all part of the journey. Once people have got there and had a really steady period of maintenance, they may start to consider going back to the person prescribing their medication to change the dose or stop the medication completely. My advice…
First, diarise habits
In that period of maintenance before stopping the drugs, they should diarise all the lifestyle habits they have been doing that are working for them – their meals, hydration, workouts, sleep etc. – and aim to keep things the same, despite any changes that might be happening around them.
Stick to routine
Once they come off the medication or lessen the dose, it is likely to be harder, but they should stick to the same routine and not listen to hunger cues at first and see how that goes. The body likes patterns and behaviours, so if you stick to what you’ve been doing then it tends to work very well. It’s not a time to change, but to continue exactly as you have been, especially for the first few weeks.
Reach out to their doctor
If people start to find that continuation too difficult without the medications and after a period of time trying, they should reach out to their doctor again and express what they’re feeling. Their doctor can consider whether they need to reintroduce the medications or increase the dosage again.
Siema’s story
Siema was a patient of mine in her 50s. She lived in London and had a family history of heart problems. She was menopausal, and also had issues with cholesterol and insulin resistance. She was medically advised to take weight loss medications and had been taking them for less than a year when I saw her. She had a period of a weight she was happy with, followed by a period in which she maintained that weight. She discussed whether she could come off the medication with her doctors and they carried out a series of tests. She still had some inflammatory markers and so they told her to stay on the drugs for a little longer, and then come off them.
Working on the plan
During that time, I worked with her on a plan, as Siema was incredibly anxious and knew that she would find it hard without the medications. We discussed what she had been doing well, what she’d been eating for meals and snacks, how she’d been hydrating herself and other lifestyle choices whilst on the drugs so that she could maintain those habits when she came off them.
Managing food noise
When she stopped the drugs, her perception was different from reality. She found the first two weeks incredibly tough and thought about food more, but she was supported and didn’t go back to old habits. The thoughts soon subsided and although she did regain some weight, it was minimal.
Keeping control
She had three months off the medications and felt really good. Then came a big event, a holiday and an Indian wedding where food and celebration were the centrepiece. She struggled to maintain her new habits and was concerned. Her doctors recommended a short period back on the lowest dose of her medications, she did that, without feeling shameful about it, and is now off the medications again and doing really well. She says she feels good and in control. Like many people, Siema has obesity genes (found through DNA testing) which combined with her family history, was always going to make it harder.
Medical support helps
What I’ve found with some people who weren’t under the guidance of medics when they came off the drugs was that they weren’t able to maintain their weight and they waited far too long to reach out for help. They sometimes went over the weight they originally started at, which is a real shame. You want to give it time to see if you can maintain your weight, but you also want to catch it if you are falling back into old habits.
Emotional side of weight gain
Often what I’ve found is that the cravings for sugar and other foods can go, because they’ve not been present when the person was on the medications. Those habits have been erased, but they can return. Hopefully, people have addressed the emotional, as well as the physical aspects of their weight gain whilst on the medications, as that is key. If these things haven’t been addressed, they are likely to return. It’s very important to consider sleep and stress, as when we are tired and stressed, we are less able to resist the foods that don’t serve us well. We also need to keep in mind the importance of sleep – prioritising good sleep – quality, not quantity.
If you go off plan, don’t worry
If it’s not working out how you want, go back to your notes which detailed what was working for you, then reach out for support as you can’t do this on your own. If you’ve tried as hard as you can, go back to the prescribing doctor because maybe you do need some medical intervention at this stage and that’s not a bad thing, you haven’t failed. It’s ok to go back on the medications if that’s what is suggested, but sometimes people don’t need to go back on them. Often people have grown some really healthy habits and their health goals have changed as a result and they’re striving for other things in life, which is wonderful.
Visit Jodi’s website to get more advice and support – and check out another SlimrChat appearance from Jodi where she talks about people demonising weight loss drugs. “If these jabs help chronic illnesses – use them. Obesity is the real threat.” And remember, you’re not alone in this. The SlimrChat community is full of people finding what works – for real life. Come chat with us, share your wins, vent your frustrations, and learn what’s actually helpful.
