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Mounjaro and Ozempic: why the weight comes back · No Forking Nonsense - The Nutritionist UK

• 0:00
  Speaker 1: Hello and welcome to No Forking Nonsense, the second most listened to nutrition podcast in The United Kingdom. And we've got one goal to answer your nutrition questions with no nonsense. To send your question in email podcast@thenutritionistuk.com. Give me your name, what your problem is, what your question is, a little bit about yourself, and we'll get your questions answered. Let's get stuck in to today's question.
• 0:24
  Hi, Paul. I've been on Mounjaro for nine months, and I've lost over three stains. Pardon? I feel brilliant, and I'm so glad I did it. But coming off it in a few months, partly because of the cost, and, honestly, I am terrified.
• 0:38
  My appetite has been switched off this whole time, and I don't really know what normal eating looks like anymore. Everyone I speak to says the weight just piles back on. Is that true? And what should I be doing now before I stop to give myself a chance? This, my friend that's from Karen in Nottingham.
• 0:56
  This, my friend, is a brilliant and a brave question, and I cannot wait to get into this. So you're asking the right question exactly the right time because most people don't ask this question until they've already stopped and the wait has indeed come back on. Now some of you listening to this are potentially on these medications. Some of you are thinking about it. Some of you wouldn't touch them with a barge pole, and that is all fine because today isn't gonna be a debate and me slugging them off.
• 1:31
  They do work. They are genuine. They're a powerful tool, and the NHS seemingly absolutely love pushing it at the moment. And they have helped a lot of people. And if you are one of the people under proper medical supervision and you are taking it, I'm not here to tell you to stop.
• 1:49
  But here is the thing that pretty much nobody is talking about, and it's why this episode is gonna be more important to way more of you than just a jab. Because the jab isn't really the point. The point is what happens when the thing that was doing the work for you just disappears. Right? And that applies to all of us, Whether it's medication, a very rigid diet plan, weight watchers, a coach, a six week transformation challenge, at some point, all of that is gonna disappear.
• 2:21
  And if you don't build anything underneath it, the whole lot is gonna come down with it. So this is an episode about what happens when all of that is removed, which sooner or later is gonna be all of you. So let's get into it. So we need to be honest about what happens because the research on this is not very comfortable reading. When people stop these fat jabs, a significant amount of the weight tends to come back on.
• 2:48
  In one of the biggest trials, people who came off fat jabs, they regained a large chunk of what they'd lost over the following year, while those who stayed on it kept it off. So when people tell you that it piles back on, they are literally reflecting on the data that we have. But the part that people leave out, and this is important part, is that the regain isn't that you're cursed. It isn't your metabolism being broken. It's mechanical.
• 3:17
  And once we kind of understand the mechanics of this, you can actually do something about it. So these medications work by largely turning your appetite down, so your leptin, which is the hormone that tells you that you're full. So they slow your stomach emptying, and they act on the appetite signals in your brain. And the results is that you just are not fussed about food. So the constant kind of background, thoughts of hunger and eating just pretty much disappears.
• 3:48
  And what happens is the portions shrink without effort because you're just not that interested in food. So the the kind of endless negotiating with yourself just dissipates. Now there are dangers to this in that this can impact hydration as well. Some people just don't wanna put anything in their stomach. And that obviously can be great.
• 4:08
  Well, not not drinking water, but in terms of your appetite. And it's probably if you're someone who just feels like you're always hungry, trying to separate myself as a nutritionist here, If that is the main issue, then that that's obviously working quite well. But what that means is for nine months, in Karen's case, your appetite has been managed for you. You haven't had to build the skill or managing it yourself because you've outsourced it, so you don't need to. And it was the drug that was doing the job.
• 4:36
  So when you stop, the drug stops doing that job. So your appetite comes back. And the problem is it comes back into a smaller body that now needs fewer calories than it did before and into a life where the habits didn't really change. And that's the problem because your hunger returns, but you didn't learn anything about nutrition. You just weren't hungry.
• 5:01
  And so the old patterns in your lifestyle essentially just return, which means that the fix, I guess, is kind of obvious. You use the time you're on to build the thing that it can't give you, but many people don't bother with that. So here's what I want kind of everyone listening to this who's on these medications to hear or thinking about going on these medications. The time you spend taking the jab is just a window, but you it's not gonna fix everything long term. It never does.
• 5:35
  For once in your life, hunger isn't fighting you, which is obviously extraordinary, but it's also a really important opportunity. And most people just completely waste this opportunity because yeah. Okay. They eat less and they celebrate the scale going down, but you don't change you don't take the opportunity to build habits that will continue things afterwards because and this is the problem with all quick fixes. They think, oh, well, this is everything sorted now.
• 5:59
  I used to be a big greedy gut, and that made me overweight. And now I'm not interested in food. So I'll fix this, then everything's gonna be great. But you need to think of it like this. Medication is a set of kind of stabilizers for a bike.
• 6:10
  Brilliant for getting you moving, but if you never actually learn to balance whilst they're on, then when we take stabilizers there, if you're just gonna clatter into a fence. So the question isn't, okay. Well, how do I stop the weight coming back after it? What am I currently building while I'm on it so that there's something there when the Ozempic goes or the Mounjaro goes? So, Karen, in your case, you've got a few months, and this is kind of a gift, so we we probably wanna use it.
• 6:40
  So what I would actually build, and I'm gonna make this practical, because this is what I'd want anyone on these medications doing. And, honestly, it's what I'd want anyone doing, full stop. We need to change our approach to nutrition. We need to create some really basic simple habits. The first one is protein.
• 6:59
  Shock. I'm talking about protein. But protein, protein, protein, protein. This one is big and it's urgent. When you lose weight fast, especially on these days when you're eating very little, you don't just lose fat.
• 7:10
  And this is why a lot of people have Mounjaro face or Ozempic cheeks, whatever it's called. You lose muscle too, and that's why people look gone. And the data suggests a meaningful chunk of the weight loss on these medications will be lean tissue. And that matters enormously because muscle is what burns your calories. And if you come off the jab with less muscle than your you started with, your body will need fewer calories than before, and that makes the regain much more likely.
• 7:43
  So get your protein in every single meal even when you're not hungry, at, in fact, especially when you're not hungry. And this is the one thing that I would absolutely prioritize. Second, if you're comfortable to do so, lift something heavy. Resistance training two or three times a week will make a huge difference for the same reason, really. It's the single best thing you can do to hold on to whatever muscle you have while the fat comes off.
• 8:12
  Eat the protein. Do the training. Thirdly, learn what a normal portion actually looks like. Karen, you said it yourself. You don't know what normal eating looks like anymore, so learn it now.
• 8:25
  While your appetite is not really there and there's no pressure, you can play around with building a plate properly. Understand what a real meal looks like for your body. Practice it while it's easy so it's automatic when it isn't. You want to look to try and get yourself into habits of creating decent, fulfilling meals that are super high in volume that do fill you up so that when you do come off it, those habits are ingrained. Fourthly, build the habits that create structure, not just for the weight loss.
• 9:00
  So breakfast, your shopping list, planning your meals for the week, batch cooking, what you're doing at the weekend, all the unglamorous stuff because when your appetite comes back, habits are the only thing standing there waiting for you. Habits are what you'll have left. Fifthly, get your head straight about hunger returning because it is gonna come, and it is gonna come hard. And when it does, you're gonna feel like you're failing and the old you is coming back to gobble you up because it's gonna feel really alarming. And you're going to think that something's gone horribly wrong when actually nothing's gone wrong.
• 9:35
  That is just your appetite coming back online. Expect it. Don't panic, but have your plan ready. If you don't plan, you're gonna go to shit, and all that weight is gonna come back on you. You're gonna think you're broken.
• 9:47
  And one important thing, any decision about coming off tapering or dosing is between you and your doctor or your prescriber, and that is obviously firmly in their call. What I'm talking about here is everything else that sits around it. So here is why this matters even if you'll never ever ever go near these drugs. This part applies to everybody. Every one of us has done a version of this.
• 10:15
  You've had a diet that worked whilst you're on it, and then the plan someone gave you was great, the challenge, the the boot camp, the coach who put you on 1,000 calories. Something external held it all together, and then it ended, so did the results. And that's the same failure. Something else was doing the work. And when it went, there was nothing underneath.
• 10:37
  The jab is just the kind of most powerful, most obvious example of a very old problem. Anything that does the job or you will eventually stop doing the job. The only thing you actually keep is what you built while you had the help. So whatever your scaffolding is, use it to build something because scaffolding always comes down eventually. The bottom line.
• 11:01
  So, Karen, here's where I'll leave you. You've done something really, you know, significant. You've lost three stone. That is a lot of weight. You feel better, and you should be proud of that.
• 11:13
  And don't let anyone sneer at how you got there. But the most important thing here is that the medication is not the achievement. It was the opportunity. And you've still got a few months of that opportunity left. So it's so important that right now you use that opportunity.
• 11:32
  Get the protein in. Start lifting heavy things. Learn what your new normal plate looks like. Learn how to build meals. Build your habits now while it's easy so that when you get off the jab, they're waiting for you when your appetite comes in and, you know, you're you're starting to feel hungry.
• 11:52
  And talk to your doctor about strategies, you know, when you do come off them. Unfortunately, experience tells me that that's usually almost like it. You get given the certificate, and it's like, see you later. But if you do what I've said, coming off the jab shouldn't be this big cliff edge. It's just the day the stabilizers come off that bike and you know how to ride.
• 12:14
  And to everyone else, whatever your stabilizers or scaffolding is, ask the same question. What am I building underneath it? When all of this ends, what happens? And this is something that I do with my clients. We always have a phased out point.
• 12:28
  So what how are we gonna operate beyond me? How are you gonna learn how to eat without me in your corner? You know? How are you going to continue this way? Like, do you have all the resources you need but to still make progress a year from now?
• 12:42
  What I do with my clients is we set years goals even if you're stopping next week because I need you to be working towards something and to feel like you have what it needs to get there. So, Karen, that's your question answered. If you know someone on these medications who hasn't thought about the after yet, send them this podcast because it might be the most useful thing they hear all year. I hope you found this useful. Please do continue to send your questions.
• 13:09
  And if you are considering going on one of the fat jabs, then hopefully, this has helped. If you are on the fat jabs, hopefully, this has helped, and I'll speak to you next time. Thanks, listening. Thanks for listening to this episode of No Forking Nonsense. If you would like to get your question on a future episode, email podcast@nutritionistuk.com.
• 13:30
  If you would like a free meal maker resource, the top link in the description. Don't forget to follow me on Instagram Paul, the nutritionist. Chat to you next week.