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Mounjaro: The Unspoken Trap of Weight Loss Jabs · No Forking Nonsense - The Nutritionist UK

• 0:00
  @paulthenutritionist: If you're on one of these jabs right now, that's a sentence nobody has said to you. Not your GP, if you've ever seen one. Definitely not the website that you got it from. And here it is. You are losing fat.
• 0:14
  You're also losing muscle. And if you come off without a plan, the fat is gonna come back, and the muscle will not come with it. So you can finish this whole thing weighing the same as when you started with a completely different body underneath. More fat, less muscle, worse off than before you began whilst the scales tell you that nothing happened. And that isn't, by the way, me scaremongering.
• 0:42
  That is what the research is now telling us. Before anybody starts, I am not here to tell you that these drugs are bad. I'm not anti jab. I've seen them change people's lives. I've worked with people who've been on them, and I'm gonna go through that in a second.
• 0:57
  I'm here because somewhere around one and a half million people in this country are on these jobs, and most of them got them without pretty much any support. And nobody has told them the second half of the score... Story. So let's get into this. So I wanna start with the scales because I think most people underestimate it badly.
• 1:21
  There is a study from the UCL published in this year's British Medical Journal, and they surveyed people properly rather than kind of I don't know. You just count how many jobs. An estimated one point six million adults in England, Wales, and Scotland used a weight loss drug in the last year. That's one point six million, by the way. And another three point three million said that they were likely to consider it in the next twelve months.
• 1:49
  So we're talking about something approaching five million people at stake with this.
• 1:54
  Now the bit that surprised me was that the use was twice as common in women. Four percent of women against one point seven percent of men.
• 2:06
  And it peaked at middle age. The highest rate was people aged 45 to 55 at four point two percent. So the single most likely person to be on one of these jabs is a woman in her late forties or early fifties, which if you listen to the menopause episode a while back, is a group already dealing with muscle loss for completely separate reasons. Hold that thought, though, because we're gonna get back to that in a second. Here's what worries me mate.
• 2:34
  The researchers found that NHS prescribing data only captures a small slice of this. Most people are getting them from somewhere else, online mostly. And about fifteen percent were taking drugs that aren't even licensed for weight loss. And I'll quote them because they put it better than I would. They said large numbers of people are taking these drugs outside of medical supervision.
• 2:58
  So picture that. Over a million people running the most aggressive fat loss protocol most will ever attempt, and a good chunk of them have absolutely no conversation with anybody about what to eat whilst they're doing it. And that's the gap that I want to close in this episode. So I'm gonna say some uncomfortable things in a minute, so I wanna be straight about where I stand first. These drugs do work.
• 3:19
  They do really work. The weight loss they produce is bigger and faster than anything we've had before. And for some people, that is obviously life changing. I've got clients who've been fighting the same 25 kilograms for, you know, fifteen, twenty years who've done every diet going and who finally got somewhere. So I'm not gonna stand here and sniff at that.
• 3:40
  And if you've got a serious weight related health problem, the risk calculation is completely different from someone wanting to drop half a stone before a wedding. So this is not an anti jab episode. It's more of a here's what the prescription doesn't come with episode. This matters. I am a nutritionist, a registered nutritionist.
• 4:00
  I don't tell people to start these, and I don't tell people to stop them. That's conversation with whoever's prescribing, if they're being prescribed. Everything I'm about to say is very much from a nutritionist perspective, which is the bit I'm an expert in. So what's actually coming off your body? And here's first half of the problem.
• 4:18
  When you lose weight,
• 4:19
  you never lose pure fat. You lose a mix. That's always been true on every diet forever. The question is that ratio. On these drugs, the research puts it at roughly a quarter to a third of what you're losing being lean mass rather than fat.
• 4:35
  So there's trial data where they actually scanned people instead of trying to kind of estimate it. And they found that it had about twenty six percent of lean tissue lost. Real world data has come in around thirty percent of lean tissue lost at six months. So let's call it a quarter to keep the maths easy. You lose 20 kilograms and about five of those kilograms are not fat.
• 5:03
  Now being fair again, because it's important and the internet kind of gets it wrong in both directions, that ratio isn't dramatically worse than other forms of rapid weight loss. People lose lean mass on any aggressive diet. The headline you usually see is that these drugs are eating your muscle, and that probably is overcooked to
• 5:23
  an extent. The weight loss is still relatively fat dominant. But here's why it matters more than with a normal diet. The appetite suppression is the whole point of the drug. So it works by making you not want to eat.
• 5:39
  And that is the whole mechanism,
• 5:42
  and that's obviously what you're paying for, which means the two things that protect your muscles, I e, eating enough, protein and training, are exactly the two things that the drug makes really hard. You can't force protein down when you literally... The thought of eating makes you feel sick. And you're obviously not gonna fancy going to the gym when you've eaten 500 calories in a day. So the drug does the job brilliantly.
• 6:05
  And in doing its job brilliantly, it also kind of removes your defenses. The second half of the problem, and this is the one that will hopefully make you sit up a little bit, there was an analysis published where they looked at what happened to people after they came off a certain
• 6:27
  fat job. Didn't wanna outline which one it has.
• 6:30
  It used data from a tire... A trial called surmount minus four. And they took 308 people who'd lost at least 10% of their body weight on the drug. Then they took the drug away and watched for a year. Eighty two percent regained at least,
• 6:49
  keyword at least,
• 6:50
  a quarter of what they'd lost. About twenty four percent regained three quarters or more, and nine percent put on every single bit of it back on. And it wasn't just the weight either. Their waist size, their blood pressure, cholesterol, blood sugars had all improved on the drug. The people who regained the most all went backwards on those biomarkers as well.
• 7:18
  Now interestingly, there was something wrong with this study. So the study was actually funded by Illylily who make the drug. About seventy one percent of the participants were women. They only analyzed the group who'd been switched to a placebo. And crucially, they had no data on what any of these people were eating or whether they were training afterwards.
• 7:42
  And the last one, in my opinion, matters most importantly, and I'll come back
• 7:46
  to it. So that isn't the perfect study, and it was funded by a drugs company. But the direction is so clear, and it matches what I see in practice. If you take the drug away, then for most people, the weight is gonna come back on. Now we have to question why would you publish a study essentially criticizing the outcome of your drug long term.
• 8:12
  I'm gonna just give you a quick sentence as to what this study told us. When you're on the drug, we see weight loss. We see biomarkers improve. When you come off the drug, it all goes to shit. Interesting.
• 8:29
  So we're gonna put these two together, and this is the whole episode.
• 8:34
  Going down, roughly a quarter of what you lose is muscle. Coming back up, what returns is overwhelmingly fat. Your body does not spontaneously rebuild muscle just because you've started eating again. Muscle needs a reason to exist. It needs protein, and it needs to be made to work.
• 8:54
  So you don't come back to the same body that you left. Say somebody lost 20 kilograms, 15 of it fat, five of it lean. Then they come off it. And over the following year, they put most of it back. The scales might say they're nearly where they started.
• 9:09
  The body isn't. There's more fat on it and less muscle under it than there was before any of it begun. And less muscle means a slightly lower daily burn, less strength, worse blood sugar handling, and a harder job next time. That's the bit that nobody told the one point six million people. Not because of some conspiracy, just because the prescription is for the drug and nobody's job is the other part.
• 9:33
  Oh, and remember who's most likely to be on these. Women in their late forties and fifties who are at the exact point of their life that they're already losing muscle and already losing bone density for entirely separate reasons. Stack that on top, and you
• 9:48
  have a genuine problem. So what do you actually do? So enough of the doom. This is all fixable, and the fix is pretty boring, which is how you know it's real. As I always say, working with nutritionists is boring, and most of stuff I talk about is very simple, boring, but effective.
• 10:04
  If you're on one
• 10:05
  of these jobs right now, four things. Firstly, make sure you are getting protein every single meal and treat it as a nonnegotiable. As hard as it is, I don't want you having less than 1.6. If you're training, then a little bit higher, but about 1.5, 1.6 per kilogram of body weight per day whilst you are actively losing. More than most people are getting nowhere near, and it is essential that you are getting enough protein.
• 10:35
  But I know the practical problem. You're not hungry, And that, unfortunately, is just the drug work. And so the rule I give clients is protein first. Whatever's on the plate, eat the protein before anything else. If you only manage half the meal because your appetite's been compromised, at least you've had half the macronutrient that is gonna make the biggest difference.
• 10:56
  And if solid food is a struggle, liquid protein is fine. A smoothie, a shake, milk, Greek yogurt, it's not cheating. It's gonna get the job done when your appetite is on its ass. Remember that none of this is optimal. So we've just gotta try and work with what we're dealing with.
• 11:11
  Secondly, resistance training two or three times a week, not cardio. Cardio is great for other things, but it certainly isn't going to help us here. We need to retain the muscle. Two sessions a week minimum is the thing that's gonna do anything. Doesn't have to
• 11:26
  be the gym. It could be something, you know, that, I don't know, at home that you can do. It just needs to be something that makes your muscles work hard so that you can
• 11:37
  maintain it. You basically want your muscles to work. This is the single highest value thing that you can do that I'm talking about today. Thirdly, don't rush the loss because you can. Because the appetite suppression is so strong, people end up eating far less than they actually should.
• 11:53
  If you're losing weight frighteningly fast on very little food, you are starving yourself. That isn't a win. You are just starving. And guess what? Goodbye muscle.
• 12:02
  You're gonna look gone. You're gonna look like you're fading away. You're gonna look like you live in Ethiopia, and that is a real problem. You need to be nourished. Four, measure something other than the weight.
• 12:13
  A tape measure around your waist. How many press ups can you do, how many squats can you do, whether the stairs feel different, whether you're out of breath, whether you're going lightheaded. The scales cannot tell you what you've lost, only how much. And, significantly, if there are health implications, we need to be
• 12:30
  able to measure that aside from the scale.
• 12:32
  If you're thinking about starting two things, and then I'm gonna shut up. Have an exit plan before you have your first injection. Nobody does this. They start. It works.
• 12:40
  And then at some point, it stops, either because of the cost or the side effects or because they think they've completed it. Ask yourself now. What am I going to be doing with my food and my training when I come off? Because the answer to that question decides whether in a year you have gone completely backwards, if not worse, or not. Not the number on the scale in month four.
• 13:02
  We need to find out different markers. And get your nutrition alongside it, not after it. The drug is gonna mess with your appetite, but it does not handle what you eat or whether you keep your muscle. You're gonna be eating less, so you're gonna have less of movement and less leverage to get the correct nutrition in. It is gonna be made even harder to get the right nutrition in when your calories are so low.
• 13:28
  And these are still your job. And they're more important now, not less. So we need to identify how much and what are you going to eat to make sure you're giving your body the best chance to retain as much muscle as possible and to lose actual fat. And the way you do that is by making sure you are eating the right foods at the appropriate times with the right nutrients. If you've already come off and it's gone back on, I've got a few of these and I wanna say something to you directly, this is not your fault.
• 14:00
  The drug was doing something for you. And when it stopped, the thing it was doing stopped with it. And that, my friend, is just the impact of, I guess, biology and chemistry together.
• 14:12
  And the muscle you lost isn't gone forever. It will respond to training and increasing your protein again, the same as everyone else's. It's gonna be slower coming back on than it was going, which is pretty annoying, But it will come back so long as we are getting our nutrition right, we're eating correctly, and we are not going back to old habits which got you there in the first place, as in back to where you were. So we need to make sure we're eating enough protein. We're eating at the correct times across the day, and ideally, you
• 14:43
  are lifting weights. So important that you start there. So
• 14:48
  what do I want you to take from this? Number one, around one point six million UK adults are using the drug last year, and most of them outside the NHS, many with absolutely no understanding of nutrition at all. As a result, roughly a quarter of what you lose on these jabs is not fat. It is lean tissue,
• 15:08
  and that isn't good. Three, when people stop, most of the weight comes back on. In one analysis, eighty two percent regained at least a quarter of it within a year, and nine percent regained a lot. And remember, that was funded by a drugs company
• 15:26
  who literally make the jabs.
• 15:29
  Think of that. Four, what comes back is mostly fat, not muscle. So you're losing muscle, and you're regaining it in fat. So the body you end up with is not the body that you started with or the body that you actually want, even if the scale says otherwise. Five, protein
• 15:49
  at every meal. Get your nutrition right in terms of spacings, in terms of your nutrition around what's happening. Get your nutrition adequate. Lift twice a week ideally, that's what's gonna stand between those two outcomes. And that is it.
• 16:05
  That is your whole defense. These drugs are a tool and a genuinely good one for the right person, but a tool does not do the job on its own. And the problem is nobody really knows what they're doing. They're just jabbing, seeing the results, and thinking everything's fine. Please, for goodness sake, if you are going to take these jabs, please ask for help and do this properly if you want results that stick.
• 16:28
  I hope you found this useful, and I'll chat
• 16:31
  to you next time.