A slight case of overblogging

On weight loss medication.

Wed, 09 Jul 2025 07:56:54 GMT

I wrote this on Bluesky last week, but wanted to save it in slightly longer form

On obesity and weight loss and medication

As a well off, educated, active person, who likes food including healthy things, but still has a lifelong struggle with my weight I do find even the best intentioned discussions around obesity hard. I'm currently heading towards a healthy weight/waist size using Wegovy, but that's a short term aid. What happens when I stop taking it? The advice from my practitioners is that obviously unless I keep up enough healthy changes I will gain weight, and I know that. But I don't know *how*. How to not eat when I'm hungry. How to never want to eat the foods that other normal people eat. I can book in some one-to-one sessions with a dietician and psychologist when I'm closer to trying to maintain my weight, but I honestly don't know how much it will help.

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The first time I lost a big chunk of weight I was *sure* I wasn't going to be one of those people who gain it all back again. But I found it so so hard to stay where I wanted to be that eventually I couldn't face trying any more. I do wonder if in future a very low dose of GLP1 agonists or similar will be a long term maintenance option for people like me. Its not an option now. When I hit a BMI of 23.5, or reach 2 years of taking them, I'll be cut off. Then we get to see what realistic help is available at that point. I don't want to have to battle my weight forever, and right now it's not a battle. But how do you even prepare for that?

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Quick catch up

Tue, 18 Feb 2025 10:13:36 GMT

The bathroom has tiles! We can use it again, and the bathroom pod on the drive went back. I got a very entertaining graph of the temperature in the pod for most of the time it was there: ranging from 14 degrees max to about minus 2.5 degrees at a minimum. (There was actual ice on the floor inside the pod one morning, from the drips from the shower door being left open). There's some issues with the coloured grout having made everything BLUE, but most of it has come off again. We're just waiting on getting the bath resurfaced (on the 27th) and then I'll get some photos. It's lovely to have the house back together again! Insurance company agreed to pay for the extra electricity and the bath re-enamelling, which is good.

My iron levels are still a bit on the low side, so we're testing again at the end of February, and I'm taking over-the-counter iron supplements in the meantime. They're "gentle" ones, so I'm not getting such tar-like poo as with the stronger prescription ones. I've persuaded the GP to do another HbA1c test at the same time because...

The Wegovy prescription seems to be doing its job. My appetite is reduced a little, but mostly it's just making it possible to do the "eat less, move more" advice without wanting to rip my own arms off because I'm thinking about food all the time. (I don't actually take their advice move more, I already move enough most of the time, but we'll not quibble too much). Weight is coming off steadily, about the same rate as when I was just dieting without the drugs: but without the constant surveillance mode being needed. And without being ready to *stop* after 12 weeks. I'm a couple of kilos away from being only officially "overweight" rather than obese. As a result it seems like a good idea to check my blood glucose control (HbA1c gives an idea of the "average" blood sugar levels over the last 3 months) and see whether I need to be taking a high dose of Metformin as *well* as the weight-loss drug which also treats diabetes.

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Healthy You - second session

Thu, 21 Nov 2024 13:37:36 GMT

Weight loss talk

So Tuesday was a) my birthday and b) my second online class with the Tier 3 Weight Management "Eat well, move more" Healthy You programme.

We have a workbook to accompany the course, and I was somewhat surprised to discover us jumping ahead to session 4, which was entirely about exercise. So this fortnight's session didn't contain anything about food at all. We had about half an hour talking about exercise recommendations, and about half an hour of gentle exercise. And a suggestion at the end of making another SMARTER goal around exercise "snacking" again. I did mention that last week's goal had made me cross, and the course leader for exercise sounded surprised, but did ask why. I explained that the goal did not seem very relevant to me, as I already meet and exceed most of the NHS exercise suggestions, and that this was adding 5 minutes a day, burning around 17 calories, and not getting my heart rate into even the moderate zone. With an inadvertent pun I said that while I'd done it anyway it felt like a bit of a pointless exercise. So, I have suggestions of things to do this week - increasing the time or distance of my existing exercise, or to increase the intensity of my cycling if it's safe to do so. I can also up the weights or intensity of my "snacking" but if I do I should make sure I had a proper warm-up and cool down to make sure I don't cause any injury. Which I suppose is fair enough.

So at the moment I don't have a SMARTER goal (I can't remember the ER anyway, Evaluate and Review? Something else?) but just a woolly thought of OK, I'll add 5 minutes throughout the day, I'll try to add something flexibility and something balance and a squat or similar for legs and something with weights for arms and something like their seated plank for core muscles. But 5 minutes a day still feels pointless. I think what would *actually* be good would be finding a pilates class, preferably on a Friday late morning or early afternoon! Plus trying to actually notice when my watch tells me I haven't moved enough this hour. It buzzes at xx:50 every hour during the day time, and I ignore it.

Second dose of Wegovy taken. No effects or side effects noticed yet. I do have a bit of a stiff neck today, and I think maybe he was right about not waving round a pair of 2kg weights without warming up. Or maybe I'm just not very well, I have a slight headache too.

I've also noted another new change bloody Google have made to the Fitbit app. As well as removing the web pages where you could look at your data they've now also update the weight tracking bits of the app itself. It no longer has a BMI over time chart (which I liked to use/screenshot when sharing information with health professionals) but also it's changed the number of points it displays on the "All time" graph. I've got weight numbers going back to 1994. Sometimes only one or two entries a year, but sometimes a reading every week. It's showing about 30 or so points in total, and the rounding as a result means some things you could point to on the graph are no longer visible. You can't see my sister's wedding any more (losing weight to fit in my bridesmaid dress). It's hopeless! So I'm going to have to export all the more recent data which isn't also recorded elsewhere and start constructing my own graphs again. Gah!

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Wegovy time

Tue, 12 Nov 2024 10:58:36 GMT

Weight loss talk

Prescribing nurse on the phone: so what do you know about Wegovy? Me: well, it's a GLP-1 agonist, and it was originally developed to help diabetes, but it was also discovered to help with weight loss, even in people who don't have diabetes. And it helps with appetite. Nurse: OK yes. :)

The outcome is I have a prescription at the lowest level, which will arrive by post tomorrow. 4 weekly doses in an injector pen, with a sharps box. And I need to watch out for eating too quickly, as it may cause nausea, and keep an eye out for low blood sugar, which is slightly more likely given I'm also taking Metformin. And she'll talk to me again in a few weeks to see how I'm getting on, and whether to increase the dose or not.

Again, having been told it would take 6 months, and not everyone would get Wegovy, I'm a bit startled how quickly this has all happened. Diabetes check up on Thursday this week too, so will make sure I let them know.

I'm still doing my 6 minutes of exercise every day. (5 different exercises, 1 minute each, I cut the rest intervals to 15 seconds). I have decided that in this particular SMART goal the R stands for Resentment. I'm going to try and insist that future goals are actually more Relevant.

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Well that was a thing

Tue, 05 Nov 2024 21:33:11 GMT

Weight loss talk

So today was my first 90 minutes session on the Tier 3 "fresh start programme". It consisted of about 45 minutes of nutrition information and 45 minutes of physical exercise information, and that's the shape of the next 11 sessions too - one a fortnight

The nutrition part talked about diets we may have tried before, and then introduced the Eat Well plate, and its friend the Weight Loss plate, which differs in having more fruit and veg, and leaving off some of the finer details. Basically eat lots of fruit and veg, lean protein, preferably wholegrain carbs, healthy fats in small quantities, and everything else (e.g. cakes, crisps, sauces) occasionally in small portions. So far so nothing new.

The exercise part suggested we try "exercise snacking" - building in 5 sets of 1 minute exercise, alternating with 1 minute rest. Once a day for the next week, aiming to increase to twice a day next week. Try doing a set while waiting for the kettle to boil, or during an ad break! Example exercises were done with or without a chair, and with adaptations for if standing up from the chair is a problem. Grab a couple of cans of food! (I picked a pair of 1kg weights instead as they were more convenient). To be fair, doing this sort of thing a couple of times a week, making sure I include a variety of things, will be good for muscle strength and flexibility. But not cardio. And I'm skeptical about weight loss. I did not need to worry about my blood pressure. The actual time exercising was about 10 minutes, much of it stretches.

I was very polite, and did not outright say that I thought they were wasting my time. But I thought they were wasting my time.

My personal goal for the next couple of weeks: try and eat more fruit and veg. Aiming for 10 portions a day instead of 5 would probably make a difference, especially since I don't always manage 5 anyway. And I'll do the exercise snacking. I did some more ankle rotations in the bath, since I could. I'm very glad this programme also offers some one-to-one sessions with dietitions, exercise specialists and a psychologist, because otherwise it appears to be just the same advice we've all seen before. Apparently you need to attend 80% of the sessions to be eligible for Wegovy. And we'll need to have a session with a nurse practitioner for that, which should happen sometime after the second session. What I need to *not* do, is start obsessively calorie counting, because there lies unsustainability. No counting!

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Gosh, that escalated quickly

Fri, 01 Nov 2024 14:22:30 GMT

Weight loss talk

Last year I did a Tier 2 adult weight management course via the NHS, with a team called Healthy You. It's a programme you can self-refer for. Lost 10kg over 12 weeks, put it back on again over the course of the year. In the final 12 month follow-up call I asked if I could be referred to Tier 3 services, and heard nothing. That was June.

In late September I got back in touch via my GP practice's team, and asked again if I could be referred for Tier 2. The Healthy You team finally got back to me, and it turns out for referral to Tier 3 you have to talk to your GP. So I made an appointment, the GP agreed I met criteria for it (just) and made the referral. (I'm right on the 35 BMI with diabetes boundary, but having done Tier 2 and not succeeded is also relevant).

On Tuesday I got an initial screening call, to check some details, and was told that at the moment there could be up to six months wait. Today I got another call, to check some more details, and make an appointment to start a 12 week course. Next week. !

I've got a phone appointment on Monday morning to talk through what it entails, and then group sessions online start on Tuesday evening. Which is a bit sudden to say the least. I've said I'm not interested in weight loss surgery, but am interested in weight loss injections. (Given I'm a) type 2 diabetic and b) *always* hungry Semaglutide sounds like a no-brainer to me). I may or may not be eligible. Apparently I should expect a 5-10% weight loss in 12-weeks, even without, but we'll see.

I honestly wasn't expecting to hear for months, so I'm a little blindsided here!

I'm not clear exactly which if the Tier 3 Programmes I'm starting, but I'm sure they'll tell me on Monday! Tier 3 programmes summary

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Trigger warning: Weight talk

Fri, 21 Jan 2022 12:51:49 GMT

For those who think fat people should "watch their weight" it turns out I have indeed been watching it, in probably far too much detail, for nearly all my adult life. Having just added entries from my medical records, before I started tracking it myself in 2001, and for the last year in order to inform my diabetic review next week, the graph shows a ludicrous number of points.

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More on cancer and causes

Wed, 03 Jul 2019 09:32:33 GMT

Ok, so it's probably just bad reporting, but this BBC article, states (for example):

Bowel cancer - Of around 42,000 new cases, being overweight or obese causes 4,800 - I make that 11%. The figures for other cancers are: Kidney (22.4% caused by excess weight), Liver (22%), Ovarian (6.5%!)

But from their own figures there are 14.9 million obese adults in the UK, which is 22.6% of the UK population. Once you add all the overweight people too - you could be talking 63% of the population or more.

I really *really* want to know how they are determining that it was someone's weight which caused their cancer, because surely they don't just mean all the other 37200 people were not overweight? There is definitely *something* missing from this equation.

As others have pointed out there are all sorts of reasons why this campaign is misguided. If it's about population level health it shouldn't be shaming people on billboards. Smoking is something you do, whereas being overweight is something you *are*. Weight loss is not a solved problem. It's horrible for those whose loved ones have cancer - even if they are thin. And it shames those who are overweight and have cancer *even if* their cancer is not linked to obesity (eg leukaemia).

They've even had advice on how to target obesity campaigns - and this is *not* it. I'm utterly furious with them - and with the press's reporting of it.

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"Obesity causes cancer too"

Mon, 01 Jul 2019 12:51:46 GMT

I passed an advert today, with a phrase on the lines of "obesity causes cancer too" on the side of a mocked up cigarette packet. So I did some digging. Numbers approximate as of 2018.

Obesity is considered the second most common cause of preventable cancers in the UK. The first is smoking. Reading the graph on this BBC article it looks like roughly 54 thousand cancer diagnoses a year are attributable to smoking, and 23 thousand to obesity. Apparently there are about 6.1 million smokers in the UK, and in 2018 28.1% of adults had a BMI of over 30 (which works out as approx 13.8 miliion obese poeple). This works out as 0.88 percent of smokers and 0.16 percent of obese adults receiving a cancer diagnosis - making smoking 5.5 times worse than being obese.

0.16% chance of being diagnosed with a cancer that was caused by being obese is quite possibly still worth looking at - but reliably and permanently turning an obese person into a not obese person is not something which is easy to do. Even if giving up smoking is hard I would suspect this is a lot harder.

I don't know who those posters are aimed at, but I wish they'd stop. Raising awareness of the link between obesity and cancer is only *one* part of Cancer Research's campaign, but those posters do not mention *any* of the other things they are doing (policy on diet and obesity) and they are thoroughly over-simplistic. It's just one more thing to feel bad about.

I'm 104.7 kg, with an estimated body fat percentage of 49.9%, my blood sugar levels are slightly raised, and I know being thinner might improve that aspect of my health, as well as making hill climbing easier. I've done it before. Twice. And a set of simplistic weight loss tips is not going to suddenly make it easy.

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