It’s a valid point that replacing an effective therapy (Ozempic) for a chronic condition like obesity with nothing other than good wishes is inappropriate. It would be like telling someone who feels good on an asthma puffer for a month that their asthma is now cured and they shouldn’t take it again.

There are a number of strategies that can be offered to people with significant obesity when they are tapering down from the rather intensive “weight loss” part of their journey to the rather more difficult “weight maintenance” part. I can’t detail them all, as what’s appropriate for some people won’t work for others, however, there are some obvious standouts that can be more-or-less universally applied.

Surveillance. A weekly weigh-in is probably mandatory, otherwise it’s easy to lose track and allow kg after kg to stack back on. Body composition scales (Withings makes nice ones, but there are other alternatives) that sync with your phone are excellent as they tell you about your fat and muscle levels, which is more important than weight, as your weight can fluctuate for a whole host of reasons but it’s your fat and muscle mass that you want to stay stable.

Exercise. Exercise isn’t great for weight loss but it’s been shown again and again to be great for weight maintenance, mental health and physical health. At least 3 hours a week of “proper exercise” including some aerobic and some strength work. Pilates, yoga, light weights, and aqua aerobics are all excellent. Making yourself a slave to exercise may not be sustainable, but aiming for that minimum should be.

Meal replacements (3-4 per week). Meal replacements are high protein, low carb meals. They can be Very Low Energy drinks or bars, but other meals are similar. They help keep you in the habit of “eating enough” while eating small and can be used as good alternatives when decent food is hard to find.

Ongoing medical therapy, or medications. Weight loss medications can be used at lower doses, they can be combined with other cheaper and easier to obtain medications or they can be replaced by other cheaper and easier to find medications. The list of medications “approved” for use is small and the PBS covers zero of them because of Obesity Stigma. Still, we actually have a number quite suitable for “off-label” prescriptions after assessment by someone experienced in the field. These meds include Topiramate, Phentermine (or both combined), Naltrexone or Bupropion (or both combined), some of the diabetic meds like Metformin or Trulicity, as well as the GLP1 agonists Saxenda and Ozempic. Some of these meds are available on standard prescription and some need to be made up by compounding chemists. Pretty much all of these require assessment by people who have decided to become very involved in this field and most GP’s simply have too much to do to feel confident in this area.

I hope this has answered some of the question. Thanks, A/Prof Michael Talbot.

In your article, you state: “Similarly, if a patient is being prescribed Semaglutide for obesity and is at the weight maintenance part of their therapy, other alternatives are available.”
Which “other alternatives” are you referring to? Because like so many, when the weight is gone, all prescriptions for medication also end. The aspect of a patient’s therapy doesn’t seem to include a maintenance phase with any appropriate alternatives to maintain the loss, this is reflected by so many patients within these above-mentioned communities.

To me, this just indicates that understandings of weight loss and obesity as a whole are quite poorly understood, with patients not getting the full support and therapy they need to set them up for long-term success.