Live Well LIVE! Getting the Best from GLP-1s

Añadido: 2026-05-13

[00:00:00]webinar. We're going to start recording.

[00:00:03]It's Monday the 11th of May. We are live. It is Live Well Live. It is your weekly weight loss webinar from the lifestyle team at Boots online doctor. My name is Dr. Samantha Wellapilly. I'm a GP. I'm a yoga therapist and a nutritionist and I'm absolutely passionate about holistic health and supporting you specifically on a holistic weight loss journey. I'm joined today by my colleague Ruth who's going to say hi as well.

[00:00:29]Hi everyone. Very warm welcome to everybody who's joining us today. I'm Ruth Taylor and a nutritionist with Boots online doctor. Also a registered nurse and health and wellness coach. And we love bringing these webinars to you each week.

[00:00:42]Generally it's every week of the year.

[00:00:45]We are here on a Monday lunchtime on a Tuesday when it's a bank holiday weekend in the UK. And we'd really love to hear from you. Do say hello in the chat box.

[00:00:54]Let us know where you are. We have a big audience with us today. So we're going to go through some slides with you to with we're here doing slides for the first half an hour 20 minutes half an hour of the presentation and then we will be coming to your questions. So plea from Sam and myself is as much as possible to pop your questions into the Q&A box. We have started doing an up voting mechanism on the questions just because we are attracting larger audiences.

[00:01:22]We are fearful that we may not get through everybody's questions. So the up voting option allows you to choose which questions we put a little bit of focus and attention on. So hopefully that will be of greater interest to you.

[00:01:35]And we will go through as many questions as we possibly can towards the end of today's webinar. And we'll start by showing some slides and we will go on.

[00:01:44]So yes, what's brought you here today?

[00:01:46]How has everybody been? How's your last week been? Last week we were talking about how to eat for weight loss. So if anybody was there last week who's here today, have you had any insights in the last week? Has anything happened for you that has been um a new awareness? Have you had any wins? Um have you noticed any positive changes? Or have you maybe noticed that your appetite is beginning to feel a little bit steadier? We'd love to hear from you.

[00:02:12]Um there are and even if it's just insight that something's tricky to eat all of the wrong foods and that's actually a very positive insight and hello to everyone who's saying hello in the chat box.

[00:02:23]Um generally looks like we're all in the UK at the moment. Gosh, from all over.

[00:02:29]Fife, South Wales, Cambridge, Derbyshire, London.

[00:02:32]All over [clears throat] the shop. I haven't got any sun cuz it's really chilly down in Hampshire today for some reason. It's clouded over in Brighton but it was a glorious morning.

[00:02:41]Absolutely. Inverness, Scotland. Oh my goodness me.

[00:02:45]Toronto, Canada. Okay, you're winning the further afield award at the moment Effie. So, really welcome to you everyone wherever you are. Yes. And no sun in London either. Cloudy. Here we are, we could talk about weather for half an hour. We'd better not. Let's move on. We probably better crack on.

[00:03:03]>> [laughter] >> Today, we're going to start um just thinking about where you are. There's no right or wrong wrong answers. We've shared a poll with you. Please do take a little moment to have a look. It's completely anonymous. We don't know who is answering what. We just know you're taking part and we've optimized that you can vote for as many options that are relevant to you. So, again, it doesn't just have to be limited to one answer.

[00:03:29]Um Yes. On the on the chat box, may I say, um lots of people are letting us know where they are and they're just telling us the hosts and panelists. So, if you want to talk to everyone, do switch that to everyone so everyone can hear your wonderful comments cuz I know we get some great suggestions and comments in the box. So, um please do share with everybody. Um Welcome again. Thank you for starting that poll but we'll get cracking with the next slide. Oh, rainy in Hampshire, see. I haven't got your rain, but I must be near somewhere. Okay, so let's think a little bit about what's going on for you. And obviously, we're here today and we want to know how to get the most out of GLP-1s, which is obviously a very important subject for everyone or for a lot of people. Um, but I think we really want to start by bringing back the focus of why we're all on a weight loss journey, for those of us who are on a weight loss journey.

[00:04:20]So really, we know that actually having that focus and having an understanding of what's brought you to this point where you want to focus on your health or you want to focus on your weight is really important.

[00:04:30]And we often talk about this why and what does this mean? So for us, what this means is your deep-seated emotional reason for wanting to lose weight.

[00:04:41]What your goal is, you know, sometimes we have a goal that's so far in the distance it seems completely intangible.

[00:04:47]So you might need to be thinking about making smaller goals.

[00:04:50]But we also need to be thinking about the motivation that sits really, really at the core of our health journey. So it's not the external motivation, it's the thing that actually is an emotional connection with your reason for wanting to to focus on your health. You know, what is the thing that perhaps actually, when you think about it, really and truly makes you feel quite emotional, maybe a bit tearful, maybe a bit stressed. Is it health focused? Is it disease prevention? Is it because you want to improve your mobility? Is it for reduction in pain? We know that a lot of people who start on a health journey or for a weight loss journey are wanting to focus on something related to the health. It could be that you've had a new health diagnosis. So really connecting with that reason is really important. Because actually, one of the things you want to see during this journey is some physical health improvements, isn't there?

[00:05:43]For some people, it will be about appearance, it will be clothes sizing, it will be about special occasions wanting to wear the right clothes and to feel good in those days or it could be a combination of all of these factors.

[00:05:54]I think the most important thing is your why won't disappear on you. It needs to evolve. So, it's like it will change during this journey.

[00:06:01]And for some of you, you'll be in maintenance. So, it might now be about comfort and confidence or energy.

[00:06:08]Um >> [snorts] >> really be interesting to hear what's going on for you.

[00:06:12]So, what is it that you wanted to hear from what What would you need to support with? So, let us see what's going on in this poll. So, I can see probably around 50% of people have taken part in the poll. So, thank you very much to for taking part.

[00:06:25]Lots of people are really interested in Sam in building healthy habits alongside medication. So, that's really good to hear.

[00:06:33]A lot of people want to know how what and how much to eat. So, we've got a few previous webinars on that and we'll be re-running those. We can give you links for those.

[00:06:42]Lots of people would like to know about dosing and long-term use and also sort of the thoughts around being consistent and considering all of those things. So, Sam, I'm going to hand over to you. It's good for us to know what's going on for you. So, thanks for taking part.

[00:06:56]>> Absolutely.

[00:06:57]in that poll.

[00:06:58]>> Thanks for those. Yes. So, just a brief overview on how GLP-1s work. So, um basically, they're mimicking a natural hormone, a glucagon-like peptide-1.

[00:07:09]That's what GLP-1 stands for. Um it's released from intestinal L cells after eating and it helps the body to regulate appetite, digestion, and blood sugar.

[00:07:19]So, basically, the benefits of using the GLP-1s um because they are they slow the um they slow the speed of how um how your your food leaves your stomach. So, it's basically slowing that transit time. So, you feel satisfied for longer and they make you feel food full sooner.

[00:07:40]Um they act on the brain's appetite centers centers to decrease cravings and overall food intake. So, they're reducing that hunger and the food noise, which I think anyone here who has been on a GLP-1 will really notice.

[00:07:53]Um, they also prompt your pancreas to release more insulin only when your blood sugar is high and reduce um glucagon, which is a hormone that raises blood sugar by releasing your sugar stores, okay? Um, they have some other more technical things that they do.

[00:08:11]Um, they work by stimulating glucose-dependent insulin secretions from beta cells in the pancreas. They inhibit that glucagon secretion from the alpha cells reducing the liver glucose output. Um, and they're working on those central receptors in the brain promoting that feeling of fullness and reduced and therefore reduced food intake. Um, and this is what this includes what most people talk about as dialing down the food noise, okay? That delayed gastric emptying um, reduces the um reduces the the spikes of sugar in the bloodstream and uh prolongs that feeling of fullness, okay? So, over time these mechanisms improve your sugar control, reduce your body weight and support cardiovascular and liver health. So, we see better lipid profiles, less inflammation and lower lip- lipid fat liver fat, sorry, um over time with prolonged use. So, what we encourage people people to do when they are on these medications for weight loss is to think of the medication as giving you breathing room, giving you head space to put into place those new habits uh without that that noise going on, without that constant distraction, okay?

[00:09:28]Um, so this is a real opportunity to to use the space that losing the food noise gives you to put in place those changes, changes to lifestyle, changes to the way you choose your meals, your snacks, your drinks, how you sleep, how you manage your stress. All of these things that we know contribute to this um holistic sustained weight loss over time.

[00:09:52]We really want you to use that time. And for those of us on on the maintenance phase of our journeys, we might have achieved our goal weight, this is where GLP-1s can stabilize your appetite whilst your long-term habits can strengthen, okay? So, they they can prove to be incredibly useful for a lot of people who've been um around and around uh the weight loss circuit several times.

[00:10:16]Very much the same. Sam, I can see that we've got a few questions creeping into the chat box, which we will try and find when we get to the Q&A section, but as much as possible, if you can pop them into the Q&A box, which you'll see at the bottom of your screen. I think for some people on phones, that can be a little bit difficult, so we'll do our best to dig them out of the chat box, but we will start by working our way through the Q&A box, um just so you're aware of that. Um I don't want to miss anyone that's asked something important for us to try and answer. We will do our best to find as many questions as possible. So, Sam, talk to us about dosing. Yeah. So, basically >> [clears throat] >> start low, go slow. That's basically what we're talking about when we are talking about dosing of your GLP-1s.

[00:10:59]They're a weekly dose.

[00:11:01]Begin at the starting dose.

[00:11:03]The best dose for you is the lowest dose that works, okay? You only need to increase if it's needed, if you're finding it's not working for you. Um you know, I need to increase the dose.

[00:11:14]Obviously, there can be side effects. I think we probably all know here that there can be side effects. They're mainly gastric in nature, so that's uh maybe constipation, maybe diarrhea, nausea, vomiting. People also notice headaches sometimes. Um they can also notice reduced energy, sort of fatigue.

[00:11:32]For most people, these are short-lived and they resolve, okay? But this is if you are experiencing strong side effects, one, speak to your healthcare provider, whoever's prescribed to you, to help. But generally, if they are not severe and intolerable, it's important to recognize side effects that are intolerable and to stop the medication and seek medical advice.

[00:11:53]Um you don't need to race up to the full dose in over the you know, the shortest time. If you're finding the lowest dose works well for you, great. Stay on that for as long as it is working for you and then if you're tolerating it well, you may want to increase. We we really want to encourage this going slowly because it reduces the likelihood of those side effects and helps your body to adapt to the medication. Everyone's journey is slightly different. Um Comfort, consistency matter more than the speed of that dose increase, okay?

[00:12:24]Because this we're really looking at this as a fairly, depending on how much weight we have to lose, of course, that's going to be individual to us, is a fairly long-term journey. And certainly, the maintenance phase will be hopefully a lifelong journey where you are maintaining the the goal weight that you have achieved, okay? And that again, that goal weight is totally personal to you and it might not even be a weight, it might be a dress size. It might be, oh, I you know, I can fit into these jeans again, whatever size they are, it doesn't matter. Again, very personal.

[00:12:54]Um So, um I think that's the main thing. If anyone has specific questions about dosing, um please feel free to ask. Just we're going slowly, incrementally. We're not looking to lose masses of weight in one go. We want to make sure that we are dosing so that we are still eating every day, we're still managing at least two meals a day and hydrating well over the day. We're not starving ourselves, that is not how these work. In fact, that might have the opposite result to what you want because that by not eating, you will slow down your metabolism and you will make maintaining your weight loss very difficult because the body thinks it is starving because even though you don't feel it because of the medication, your body still needs nourishment, still needs nutrients every day. There's still a requirement, so please bear that in mind. Um it's it's really important to keep eating on these medications.

[00:13:46]Very much so.

[00:13:48]Yeah, it's a really important factor.

[00:13:50]We're going to talk about why we want to be thinking about and it was really interesting to see that a few of you in the poll wanted to know how to wrap around everything else around this GLP-1 medication that perhaps is supporting on that journey.

[00:14:04]So, we want to be thinking about habits.

[00:14:06]We know that as creatures, as human beings, we probably most of our life, most days of our life run up to 70% on what we normally do.

[00:14:16]So, in most of our activity, most of our behavior, most of our foods that we eat, most of our activity, how we sleep, what time we go to bed, it's sort of very much orientated about what we normally do.

[00:14:29]So, we are creatures of habit, and this is one of the things we want you to start thinking about. Which habits are working for you?

[00:14:37]And which habits perhaps aren't getting you the results that you want?

[00:14:41]And also, not just the results during weight loss, but the results during weight loss maintenance, too.

[00:14:47]So, this gives you, we think, that the GLP-1s, if you're taking one, is giving you that window of opportunity to really put some focus on the areas of your health and the areas of your life that perhaps need a little bit more thinking, a little rethinking, and a bit of support. So, this is the how.

[00:15:05]So, all of these factors that are on the side are really important for us to be putting a little bit of attention and consideration into.

[00:15:12]We don't recommend that you do all of this in one go.

[00:15:17]It is perhaps an opportunity for you to just sit back and think, "Okay, which bits am I getting right, which bits are working for me, and which bits do I need to put some attention and change?" And this is where our webinars are here to help you, because we have webinars on all of these subjects.

[00:15:34]We know that GLP-1s will not change your relationship with food.

[00:15:40]And it won't change your emotional relationship with yourself or with food.

[00:15:45]And that's really hard, and it's really important for us all to grasp that actually the work has to go on in the background as well.

[00:15:54]If you're somebody who is under a lot of consistent stress, then learning how to manage your stress could be a really important aspect of weight management.

[00:16:03]Because all of these factors, if we have long-term stress that we're not managing well for whatever reason, if we don't sleep well, if we have a really difficult emotional relationship with food or with ourselves, all of these things are going to be the things that will trip us up not only on our weight loss journeys, but also in the maintenance phase of weight loss. We've all read in the press that if we come off a GLP-1 too quickly medication, that we will find that our appetite will go absolutely crazy. So, learning to eat the right foods is really important.

[00:16:36]So, what we want you to do is to start bringing some focus to the habits that are going to hold you where you want to be. So, this is about keeping you steady when life gets busy, and about creating lasting habits that are going to see you through not just the journey, but the maintenance journey as well.

[00:16:55]So, we have lots of tools that we're going to go into later to help and support you. We have lots of webinars.

[00:16:59]We have replays of webinars. So, if you've missed any of the really helpful webinars that we've run recently, do you listen to the replays. So, Raman, if you could support um everyone here and share a few links. And welcome to Raman. Say sorry I didn't introduce you. Raman is here. She's part of our Beat online doctor team and she's here very much today supporting everyone here, sharing links with everyone. So if you can share this sort of how to eat and what to eat links cuz we've run those webinars recently. We will be running them again later on in the summer or early in the autumn, but for now, you know, and if you have questions related to that, do ask.

[00:17:37]We [snorts] want you to be really thinking about your triggers as well. So really think about what's going on for you and because these are the factors or these other elements of the factors that are going to keep you where you want to be and help you get there. So if you have any specific questions, do you ask about them and Sammy is just going to talk a little bit about side effects.

[00:17:56]Yes, thanks Ruth. So um I think we I think most people on this call are probably on GLP-1, so you probably are aware of side effects. Um common ones as I said before are gastric in nature, so feeling sick, um constipation, reflux, feeling quite bloated or um having sort of burping, fatigue, um and there are serious side effects also which I will go on to. Um but there are just some tips on here just how to manage them. Nausea, have really have a look at how fast you're eating. Sometimes this is just sort of drilled into us from a young age that we really wolf down our food or we don't have much time, so we we end up eating quite unconsciously.

[00:18:40]Smaller portions, slower eating, bland foods if you need, okay? Not too many strong flavors there. Constipation, hydration, hydration, hydration, some movement, um also adding fiber. So something like soaked a half to a full tablespoon of flax seeds soaked overnight and then um you can add those to your um your porridge or your yogurt and granola, whatever your breakfast is um or you could you could just drink it like that. They're meant to go a bit sort of jellyish and it's that jelly stuff that kind of helps move the gut. Okay, that's quite a nice natural way to do it. Psyllium husk, you can buy over the counter. You can buy various laxatives over the counter, of course, your Boots pharmacist can help you with that.

[00:19:23]Reflux or bloating, again, smaller meals. With a GLP-1 on board, your your your system won't be able to tolerate the same size portions or the same size meals as you did before. Um try not to eat late in the evening so that you're not going to bed soon afterwards, and avoid lying down after eating.

[00:19:41]Um fatigue, really resting, hydrating really well, and making sure you have protein every meal with every meal. So, you're really looking for that palm-size portion of protein, whether that is plant-based or animal protein, um having that with every meal.

[00:19:56]Serious side effects. Now, there are unusual side effects that we need to be aware of, and those tend to focus around abdominal pain. Okay, so if you are suffering with abdominal pain, um which is not relieved by going to the toilet, for example, then you want to be you want to be monitoring that. If it is severe, get in touch with a medical professional. Whether it is if you need to go to A&E directly, um or contact your GP. Those are both viable options, okay? Especially think about um if you have where the pain is on your stomach, if you have sharp pain, if your urine has turned a dark color, or maybe you're feeling faint, that might be a sign that you're dehydrated, and you need to take more fluids. Um abdominal pain, if you have blood in your urine, or a temperature, you know, you need to contact more urgent care than you would perhaps through an online provider than you would get through a online provider. So, getting in touch with NHS 111 can be helpful, or heading to A&E.

[00:20:57]The milder side effects tend to settle as your body adapts to the medication.

[00:21:01]Slow down your eating, hydrate regularly, make sure you have plenty of fiber in your diet. So, that's that's vegetables on your plate. Um there's simple steps that will support you in every phase of the journey. It's really important to recognize side effects that you cannot tolerate. You don't want to become so ill that you're dehydrated and end up having to go to hospital. And we have to recognize that GLP-1s do not support do not suit everybody. For some, they just um can cause problems. Okay? Um I'm sure we'll get lots of questions about those.

[00:21:33]So, please do put your questions in the Q&A box cuz we get a lot of questions through um through Boots online doctor about side effects. Um and we want to support you cuz I know that those can be worrisome.

[00:21:44]Definitely much very much so.

[00:21:47]So, yeah, I think hopefully we're being really honest and clear that actually the GLP-1 is part of your success, sorry. That actually the best long outcomes is around what you do alongside that GLP-1. We almost see the GLP-1 medication as an opportunity for you to just take stock and really think about what you need to do. So, it's about your movement, your meals, how you're eating, what you're eating, your mindset, really really working on that consistency, working on what your motivating factors are, what your real why is deep down inside of you.

[00:22:24]The other thing to be thinking about is movement and exercise because it's such an important part of the maintenance of weight loss. We want you not to be losing weight so quickly that you're losing muscle mass as well as fat mass.

[00:22:38]We want the focus to be on the fat mass, which is why we recommend very much that you have the lowest dose that is working for you and you stay on that lowest dose for as long as possible and only increase if it stops working for you.

[00:22:51]We want this to be a fat loss journey.

[00:22:54]We want you to be losing the right weight. And this is really important. We don't want you to be losing muscle mass.

[00:23:00]This is where being active to the point where you can be active and different people here will be able to be more active. Some will be able to be less active. We understand that we're all on a different journey. We all have different health issues going on in the background. So, start wherever you are.

[00:23:16]I think that is the key thing is is whatever we have a whole series of exercise videos that the Beat online doctor team have recorded for you. So, do take a look at those and they really are progression. So, they will start for people who are not able to be very active at all or aren't regularly doing any form of regular movement. So, do take a look at those. We want you to be building strength in your muscles because we know that actually having strong muscles is one of the things that is going to help you maintain your weight loss.

[00:23:48]If you lose muscle mass as well as fat mass, you're going to find it much harder to stay at a healthy weight because your basal metabolic rate will have dropped. You'll have less calories to play with if you lose muscle mass. If you gain strength in your muscle and your muscle mass increases on this journey, then you're going to find it a little bit easier to maintain your weight loss. You're still going to have the hunger issues. The physiology of when you stop that GLP-1 is real in terms of how it's going to make you feel. But, we are going to help you get prepared for that. All of the strategies we're talking about today are really important. Each and every one of them have a very important um role to play. So, for each and every person, it is about finding what is important for you.

[00:24:35]So, I guess it'd be really interesting to know what's going on for you.

[00:24:40]Think about those strengthening, those steady, lasting habits because this is what's going to get you those lasting results. So, we know that GLP-1s are amazing in terms of giving you that break, but they're not a miracle cure.

[00:24:54]They're not going to be the only thing that's going to make this work, this has got to come from you, too.

[00:25:00]So, Sam, you're going to talk a little bit about how and when to stop. Again, something we get asked quite a lot, really, and I can see there's some questions here already today about this, so. Yeah, it would be good, actually.

[00:25:10]Can we launch the poll to see where our audience today is in their journey? If we could see how many early early early journeyers, mid-journeyers, and end-of-journeyers we have. That would be great. Um again, results those the polls are completely confidential. It's just good for us to know who we're speaking to. Um so, GLP's, think of think of GLP's as a bridge. We want to get somewhere with these and these medications can really support us on um on our way, on our journey. Um but we we need to think of it as a For for most people, this is not a forever medication, right? Um we need to plan for that when we approach when we're approaching our goal weight, thinking about gradually tapering off our medication. Um and continue to continue with those foundational steps in place. You know, balancing our meals, making sure we've got protein and fiber at every meal.

[00:26:06]Having that emotional awareness of ourselves, this this journey of weight loss is when we want to make deep, lasting change, there's a lot of emotional work that has to go on at the same time. It's not just a physical change that we're making. Because if we have For example, if we have a lot of weight to lose or if we've, you know, we've been carrying this extra weight for a long time, there may be some some reasons behind that.

[00:26:29]There may be some um some things that we haven't looked at behind that. There may be some emotional reasons. We're eating because we're stressed, because we're sad, because something has happened and we're comforting ourselves and we find comfort in food so often. Um so we need to really look at and have that emotional awareness because once we come off the medication, we need to be in a place where we can step forward in confidence, okay? Um and we've talked Ruth has talked um very eloquently about regular movement and and muscle strength, maintaining our muscle strength and growing our muscle strength through resistance training as we can according to our the way that we can uh use our bodies. Um and this doesn't have to be perfect, but they they do need to be consistent, okay? So, we've got uh okay, so most people here well, just starting out or midway through, but we have a good number of of maintainers as well. Thank you for letting us know where you are on your journey. Um it's it's good to know because more and more we're seeing more and more maintainers come through, obviously now that GLP-1s have been around for so long. And I know that there's a lot of anxiety about coming off medication. Um and it's something to to be bearing in mind because we're so in a in in a society that thinks of weight loss as a old dieting, which is why we try not to use the D word as much as we can as a temporary thing. So, we are dieting to lose weight and then we stop the diet and everything goes back to how it was.

[00:27:58]We can't think like that anymore, okay?

[00:28:00]We can't think like that even though we're using medication, you know, and it gives us this helping hand, we have to really look at our approach to food, the the choices we're making. Now we have more space cuz the food noise has calmed down, we have this real opportunity to to really build our plates differently, to do our our weekly shop differently, and to really be looking after our bodies and to develop that love for the foods that love us back, okay? And not the ones that have led us down this path to a position that we don't want to be in, that we are desperately trying to come back from, okay? And I think there is a there is a fear of regain. There is an anxiety certainly about losing the support that the GLP-1 may may give you, which is why we do generally um um recommend a gradual tapering down of medication so that it's not such a dramatic stop, full stop let's say. Um it's it's it's more gradual, um more gentle than that so that you can incrementally notice that okay, my appetite is a little bit more but what am I going to do? I'm going to put more fiber on my plate, I'm going to put more protein on my plate, I'm going to drink more water, I'm going to do all these things to balance my blood sugar so that I'm not getting um the cravings that um that I that I have you know that I'm I'm fearing so much.

[00:29:19]Very much so.

[00:29:21]And we just wanted to put it together on a slide so these are all of the resources that are here for you that we've produced. We've got all of these, I'm not going through them but if anybody would like any of these resources, maybe the GLP-1 meal builder would be a really great resource to share and also the protein sources of food. Um Raman, if you could share those that would be great. And for anybody who's struggling with emotional aspects of food or not really working out or finding it difficult to figure out the triggers when they go off track, maybe keeping that mood and food diary. Or if you're really struggling with stress and energy, the food and mood diary would be really worth just tracking what's going on and seeing if you can find patterns.

[00:30:03]Maybe your breakfast is a little bit too light, maybe you're just not eating enough across the day or if you're stuck in a plateau, um again tracking things for a week or two can really make a difference just in terms of understanding. So do have a look at these resources and see what would be helpful to you. It's about picking and choosing the things that are relevant for you and one stage it will be one thing and another it will be something different.

[00:30:28]So today just thinking about what we're saying really. So we're saying manage your side effects, you know, be aware of them, don't ignore them. I think sometimes we can almost bury our heads in the sands and hope that they're going to go away, but we know if a lot of people being properly hydrated can be a really key step in managing some of those gastrointestinal side effects. So, really make sure you're bringing in that water.

[00:30:54]Really think about your habits and how that's going to be helpful to you in the long run um in terms of just, you know, really thinking about what you can do to make this a forever journey rather than a I'm here and now I'm going to go back to the start. We really don't want that to be your story. We want this to be your success story. This is why we're here.

[00:31:15]Um and really that whole one step at a time, staying low, going slow, really really thinking. And we've just sharing our final poll.

[00:31:24]We're just going to let you know what we've got coming up in terms of the webinars over the next few weeks. We are going to be here every week in May. Um on the 25th of May, it's a bank holiday, so we're moving again to the Tuesday, the 26th.

[00:31:38]So, do come along to all or any of these that are relevant and helpful to you. Um Raman, can you share the link to sign up to the next few webinars as well, please? They tend to go up in a block of time, so I think they're up there until the end of June currently um on Eventbrite to book onto.

[00:31:57]So, let's close down the slides and we will come to your questions. I can see we have a huge number of questions, which I guess is no surprise.

[00:32:08]Um we've got a poll as well, Ruth, here.

[00:32:10]Yeah, I'm sharing the post. Do you want to have a look at that, Sam, as well?

[00:32:14]Yeah. So, um thank you for answering the poll. So, the takeaway message is really what's your biggest takeaway? I think the winner is GLP-1 support change, they don't replace it, which is a great message to go home with um because they don't do all the work. Unfortunately, the lion's share will be each of ours because we have to um we have to make the changes that are going to stick and help us to maintain for life so that we don't have this regain and this yo-yoing and just going backwards and forwards.

[00:32:43]We want to achieve our our goal and maintain as close as we can, but we need to do all those things around and about it. So that's building the muscle, managing our sleep, looking at how we cope with stress, looking at our triggers for stress eating or emotional eating and and and facing them and processing the things that are pushing us in the direction that we don't want to go in.

[00:33:07]Great. We're going to come to your questions now. So thank you so much for the notes. We'll take it from the top because you're up you're able to update the questions. Um so do you take a look through the questions and see which ones you feel are really helpful for you to hear about as well.

[00:33:24]Um we're going to be here till 2:00 and we will be focusing on your questions now.

[00:33:29]So somebody um is saying they've only just started taking Wegovy mainly to overcome a fatty liver. Really worried about the potential to regain weight when they finish. Is it guaranteed that you will regain the weight or is this going to be a forever medication? I think the research is beginning to help us understand. Sam, would you agree?

[00:33:49]That if you don't do all of the things that we are wrapping around the medication, all of the lifestyle factors, it is very likely that you will find that you will gain regain weight.

[00:34:02]This is why we are super keen to bring you into the webinars to really help you understand to do all of the other things as well.

[00:34:10]So we need to put some focus on learning to love the foods that love you back is number one. Get that protein, get that fiber, get those vegetables and the protein in. Learn to love them. Learn to make them your go-to foods because they can see you through.

[00:34:26]We think the the sort of recommendation is going to become that people titrate their doses. It's a bit like when you start on a weight loss medication, you start low and you increase slowly.

[00:34:38]We think that the recommendation is going to become that we go back down the ladder again. So, gradually wearing yourself off the medication rather than abrupt stopping abruptly.

[00:34:50]So, that your body can get used to it, you withdrawing. But, also we will make GLP-1 from the foods that we eat. So, if we're eating high levels of protein and we're eating fiber-rich foods, that will really help support your own natural production of GLP-1. So, don't forget this is a natural chemical that we can make from food. Sam, what would you say?

[00:35:12]Yeah, I think basically the research shows time and time again with weight loss, bearing in mind GLP-1s are kind of a new thing, okay, relatively new over the last few years. So, we the the evidence from previous, you know, from GLP-1 use is quite fledgling.

[00:35:28]But, time and time again, it's the behavioral changes that are shown to keep it off for the longest, okay? And that is everything that we're talking about, your approach to food, your sleep, your stress management, emotional eating, all of those things. It it of course I can totally understand how worrisome it is to have come to the what we call, you know, the end of you've reached your goal, you've come to the end of the journey. Oh, but there's it's not that we drop everything and go back and I'm not being facetious, I'm sure that's not what anyone here thinks is is the way forward. But, we have to think of ways to just put one foot in front of the other and really maintain what we what, you know, all the progress that we've made, everything that we've achieved and really put those um, put those new habits in place. And the hope is because we've practiced it so much with the help of the GLP-1s that they're all second nature. That these are all things that you just do naturally and and the the old habits, the habits that got you into the situation of wanting to lose weight, they're they're not your habits anymore because you replace them with different things that support you more, okay? So, it's it's we we don't want to overwhelm you. It's taking one step at a time and just putting one foot in front of the other and being consistent with the small changes because they all build. As you repeat things, they become more natural to you and they don't seem you completely foreign and and undoable because once you once you start to do it and you see the change and you feel the difference in yourself that say having protein and fiber in every meal makes your day and your energy levels, then you kind of want to do it anyway cuz you know you actually have a better day, a more clear-headed day when you do those things. If that makes sense. So, that's sort of developing that emotional awareness, that self-awareness. How am I feeling? Am I feeling full? Do I need to eat something else? And actually, no, I don't want that, you know, chocolate biscuit at 11:00 anymore. I know I've had it every day for years and years, but actually, I don't need it anymore.

[00:37:23]My body doesn't need it cuz I had a breakfast that protein and fiber in it.

[00:37:28]And I'm and I'm good to go and I can just manage hydrating myself through the morning. But, you know, these are small steps. I know we're all starting at different places. So, um we take it step by step and if we need to have a snack at lunchtime, maybe it's not chocolate biscuit. Maybe we've prepared and we've got some walnuts and we've got a couple of apples and and that's going to see us through.

[00:37:48]It's it's um we each have an individual journey, so I'm trying to make this accessible to everybody as much as possible. Yeah. So, and then another question on the same sort of vein really, but about food noise flooding back in, how to prevent this. I think prevention is probably unrealistic.

[00:38:08]I would say all of the research tell us that food noise for people who experience that food noise are likely to experience food noise again.

[00:38:17]Um but, it is about the wider context.

[00:38:20]It's about understanding why you're getting that feed noise.

[00:38:24]It's about learning to dial down the noise, you know, as much as you can.

[00:38:28]It's almost like having a belief that you don't need to eat every time your brain or the noise is telling you it's time to eat. That can sound really harsh and hard. It's not intended that way, but I think it is about Make sure you've got that protein going in there absolutely 100%. It's got to be nailed.

[00:38:49]If you're finding you're hungry, we always suggest you start by thinking about 1 g of protein per kilogram of your current body weight as your starting point.

[00:39:01]If you're eating all of that and you're managing that across the day and you're really, really hungry, dial that protein up. Go to 1.2 g per kilogram of body weight. This is about you finding your rhythm and finding the rhythm that works for you.

[00:39:19]I will say think be prepared with some delicious hot drinks because hot drinks or maybe even a bone broth can really just switch off that appetite in between meals. So, we have to be very strategic.

[00:39:32]We have to be planned. We have to be ready. It's not just GLP-1s which are going to have this effect. It's going to be any really strict form of weight management is going to bring in this element of increase in feed noise. So, it isn't just a GLP-1 story. It's weight loss story, full stop. So, I think be prepared, be ready. Maybe think about having a big bowl of vegetable soup at the beginning of your meal and then having the meal. Really fill yourselves up and really [snorts] just monitor how that works for you. And almost become your own awareness, you know, really build that awareness and take control. I know that sounds hard, but it's achievable.

[00:40:13]Sam, anything else you want to add on that?

[00:40:16]Uh no, that's That's fantastic. I think we've covered everything about coming off.

[00:40:21]Let's move on. So, So, the update see you Yeah, I've got that. I've got there's someone here who's asked, um, about felt very well on Manjaro for a long time, good diet, etc., steps and exercise. What's the realistically what are the factual risks of staying on them? So, I think if if Manjaro is working for you long term, um, we don't have any specific data to say you can't stay on them long term. I think most people don't want to stay on medication unless it's totally necessary long term. You might want to try decreasing the dose and just seeing if you need, I don't know what dose you're on, if you want to decrease it and if you have a you know, if you if you've reached your goal weight and you're maintaining, you can maintain with medication as far as we know. Um, some, you know, and as far as I know, I'm not aware of any risks of of maintaining on a medication if it's necessary, and some people will need to. I think it's a minority of people will choose to stay on medication long term. Um, but as far as I know, there's no real um physical risk if you're tolerating them well to staying on them.

[00:41:32]Yeah, somebody's saying 2 years seems to be the published data. I think that's because again they are early in their infancy in terms of being used to help support people on weight loss journeys.

[00:41:43]Um, I think the science, the research, is constantly being updated and changing.

[00:41:50]So, it's a moving story. Um, what we're saying now is likely to be changed in a year's time. So, obviously we can't promise anything. We work very much around the research. Around the research at the moment. That's not known and and yeah, people have probably been followed up for 2 years and and that was all fine.

[00:42:08]So, there's no we, as far as we're aware, um, there's no reason to stop if you if you really want to carry on with the medication. It might be I mean, a lot of people want to stop. A lot of people don't want to be on medication for the rest of their lives if they don't want to be or or for years on end if they've reached a goal, but that might not be the case for you. We're all individuals.

[00:42:27]Yeah, exactly. Um, somebody is saying that they lost, um, a significant amount of weight initially on on taking a weight loss medication, Mounjaro, um, but have lost no weight in the last 5 weeks. We know that what I think what we all need to understand is weight loss is not linear.

[00:42:45]It doesn't just happen as we expect. It doesn't happen that every week we get on the scales we've lost weight.

[00:42:52]Um, it could be that some weeks we'll lose more, other weeks we will stay the same. We may even find a little bounce will come back on. So, it is just not a process where every week it's going to go down down down down down.

[00:43:06]You'll also hit times where your body just recalibrates. We call that plateau.

[00:43:12]So, very much that is a very expected normal process in any weight loss journey where you just won't shift.

[00:43:20]But, what you may notice that your waist circumference is less or your thigh circumference is less, that your body composition is changing and the weight isn't. So, really really see how you go with that. Um, it is very much an individual thing. So, it can be frustrating. We think that's an opportunity to just re-look at what you're eating and whether you're hydrated enough. Hydration is really important, too. It's a really important part of the journey.

[00:43:48]So, if you're getting the food right, but perhaps you're not drinking enough water or clear fluids, that is something that can really help support weight loss, too, in terms of, um, we know that the research tells us that drinking enough can support lipolysis, the ability to break down fat. So, really have a look at what you're doing, whether you're sleeping well. If you're not sleeping well, we know our appetite will be bigger.

[00:44:11]Um if you're stressed, we know you'll be producing more amounts of cortisol and insulin, so that is going to have an impact on your ability to lose weight.

[00:44:19]So, it's time to really start looking at what are the factors in your life that might be holding you back. And it'll be different for everyone.

[00:44:29]Um Ramandeep, I'm just scanning through the chat box. Could we share the exercise videos link, please? And I see you've put in the feedback form. We'd be really grateful for your feedback today, team. It always helps us to develop our webinars further.

[00:44:42]Um okay. Right. Let me see. The next question, how can I reset? I've been on it a long time, 18 months, lost 7 stone. Wow.

[00:44:51]Okay, great. Wants to lose another six.

[00:44:53]Okay. Uh suppression just isn't there, and the food noise is huge. Any tips?

[00:44:57]Should I stop, have a break, start again? Has my body just got used to it now it's not working? Just feel lost with it, really. Okay. So, um I would ask, are you on the highest dose? Have you Are you on Mounjaro or Wegovy or something else? Um have you tried switching to a different GLP-1? That might be if you're not on the top dose of what you're on, you might want to switch to a different one to see if it it works better for you. Um you've done brilliantly. Um but if you are noticing that you are not having the appetite suppression that you had before, the food noise is back, etc., it could be that your body has got used to it. Unfortunately, we do see this. Like some people do seem to experience this that it stops working as well after some time. Um it they seem to be fairly unusual cases so far, but I you know, as more people start to use it, maybe we'll be seeing more. A lot of what we're telling you about these GLP-1s are things that we have experienced in our clinical practice because we've been seeing patients for so long now, and and you know, really it's the bulk of our work.

[00:45:57]It I can understand how frustrating that must be. Um so, I would So, my advice to you would be to um look at the dose you're on. Can you increase the dose?

[00:46:07]Um, are you in a plateau? I don't know Well, no, you're not in a plateau cuz the uh the suppression just isn't there anymore. So you might want to think about switching to a different agent. So I'd go and let your provider know what's going on for you and see if you can be switched over.

[00:46:21]Um you know, and really focus again on the things that Ruth has been saying, you know, the protein, fiber, hydration in every meal just so that you cuz we make our own GLP as well in our bodies, right? We have and by by balancing our plate, we are making our own GLP-1, our own We are naturally um satisfying our hunger, okay? And also looking at those other those other triggers around emotional eating, um stress eating, um and if they're all things that need to be unpacked and processed, then to take the opportunity to to do so.

[00:46:54]Okay.

[00:46:55]Um people are saying some of the links don't appear to be working. We will send out the links um after today's webinar in an email to you with a recording of today's or a link to the recording of today's webinars. So do feel reassured that you will get those links and hopefully they will work from an email. We have tested the links cuz we've had this recently in webinars and when we've tested them, they have all worked. So we're not quite sure. It might be the browser that you're opening them Maybe try clearing your cache in case if there's errors cuz we we do check that the links work. Um the the mo The exercise videos um exercises for those that aren't so mobile, so do um be reassured there. So we we do realize that everyone here has different levels of of mobility. Let's keep cracking through these questions cuz we're running down on time. Um somebody is saying what can they say to friends because there's a lot of negativity and judgment. We have noticed that is beginning to creep in and I'm really sorry. Please don't feel ashamed to be on them. You are in a huge group of people. Many of people here today will be taking them and this is not about anyone else's journey. I would say tell them that being overweight is a really complex story and actually being able to lose weight brings a whole load of complexity with it, too. So, you know, it isn't just about calories in, it isn't just about calories out, it's about body composition, it's about your dieting history, your emotional history, um any trauma that you've experienced in your life will have an impact on all of these things. So, and I really if they're your friends, they will support you and I know that sounds very glib, but I really think people need to just get grips with the fact that these medications are here for a reason and they're here to stay.

[00:48:41]Maybe you need to say this medication is here, it's been prescribed by a doctor, I'm taking it for my health, you know, end of story. It really is the most important thing that you don't take on board that judgment because you need to do this for you, for your own story and I I know how hard that can be. So, please, you know, we are we are trying to create more support around that aspect of it because we know that this story is beginning to happen.

[00:49:12]So, I'm saying sorry that you're experiencing that.

[00:49:18]Um someone's saying they feel constantly cold. Is that a potential side effect?

[00:49:23]We have a link to all of the common side effects, Ramone. I'm not sure if you could share that, that might be quite helpful. Sam, I think that can be cold, it can be that your metabolism is maybe being affected.

[00:49:35]Um what's your thinking, Sam? It could be that you've lost some weight and you're feeling colder than you would previously.

[00:49:42]Um I have I have noticed a couple of people mention that on messages, not for a little while.

[00:49:48]Um I don't think it's a particularly common side effect, but is there any if there is any sort of like skin discomfort, do let let your health care provider know if it's um sort of cold intolerance, there are several things that that could be. I would actually let your health your provider know about it just in case just to check for things like thyroid issues etc. which means you can really feel the cold just in case.

[00:50:13]Definitely. And people coming off Mounjaro um happy with weight, what's your opinion on taking berberine to support? And there's some really interesting research around berberine.

[00:50:24]Again, that's just a type of it's um I'm a sort of herbal product, but with almost medicinal qualities. So, it would really need that you would have to talk to a health care provider around that.

[00:50:38]That's not something we could say categorically everybody would be safe to take because it has such strong properties. Um if you're taking medication, it may be completely contraindicated for you. So, again, you need to be looking at your health and your safety as a whole. So, sorry to not be able to say yes outright because it is very much more individualized than that, but it is worth having that conversation.

[00:51:03]What's the best way to manage the diminishing effects of a of the dose towards the end of the week? Really good question. So, are you one is it that you need to increase the dose? That would make it easier. I don't know if you can because of side effects etc. But, I would generally say part part of me wants to say I don't want your appetite to be completely suppressed and actually having a bit of that um appetite return towards the end of the week maybe actually gives you a more realistic view of okay, what's happening here? Like how am I going to I'm going to build my plate today to really balance my blood sugar so I have a nice natural a nice sort of um gentle gentle wave of blood sugar over the day that it's not going to be big ups and downs, big blood sugar spikes and at peaks and troughs over the day. I'm going to have protein and fiber in every meal. I'm going to hydrate really well.

[00:51:56]I'm going to, you know, really look at at my snacking behavior, whether I'm putting sugar in my tea, all of those things to manage my blood sugar over the day for the, you know, maybe the last 2 days of the week where I know my GLP-1 isn't as strong as usual.

[00:52:10]I just see how I get on. If it is truly terrible and, you know, you you really can't manage those 2 days and and that's not helping that I would look at increasing the dose if you can and and talking to your provider about that. But really, baby, take that opportunity depending on where you are in your journey, of course, as well. I'm sorry, I don't know very much about where you are, but just stimulate almost your natural GLP-1 in that in those last 2 days by building your plate, by having those three meals consistently, by sleeping well, by really looking at all those habits that you're building that you want to keep in place for the long term during GLP-1 use and after, long into the your healthy future.

[00:52:51]Just almost taking it as like a practice steps.

[00:52:55]Yeah. Somebody's asking about a sweet tooth in the evening and I think this is to do with our reward pathways and what's happened earlier in the day.

[00:53:03]So, really and we we talked a little bit about the how and the when to eat over the last couple of weeks in the webinars. And actually, there's some really interesting research about the circadian rhythm. So, this probably all fits very nicely into our circadian rhythm when things are maybe less acutely working for us. We may notice that sweet tooth creeping in.

[00:53:23]Things I think you can do is really make sure that you are nailing that protein with breakfast. Quite often, we put a lot of protein with our evening meals or lunches.

[00:53:33]And actually, getting breakfast right can really help the sweet tooth in the evening.

[00:53:38]It also can be a habit. So, we do have a whole webinar on habits, and we have a whole webinar on emotional aspects of eating as well. And these two factors do fit quite closely with that pattern of evening cravings. It's almost becomes an evening habit that you allow yourself a sweet treat cuz you've made it through another day, or you know, we sit down and we watch TV, and out come maybe the chocolates, or you know, just something that we perhaps want to avoid as much as possible, have less of.

[00:54:11]Um so, there can be a psychological element as well. So, maybe find some other form of reward. So, maybe even sparkling water with some fruit in which sounds completely crazy and very different, but it's just switching one reward for another, or a delicious drink that you really enjoy, like a hot drink, a beverage of some description without those sort of syrups in, hopefully, cuz they're full of sugar. But, it is really interesting, and people on GLP-1s do report this. So, it may just be that your physiology is working a little bit against you, and you need to be prepared, I would say.

[00:54:47]Um let's move on. Uh if I Where are you going, Sam? Oh, yeah, there's just someone here who's just asked on wegovy having really good effect with no side effect. If this continues, yeah, just stay at your dose.

[00:55:00]There's no need to increase. That was what we would do at Boots Online Doctor.

[00:55:03]Your health care provider may say differently. I would say lowest effective dose is is always the way that we would go. Yeah. And somebody's saying, "How come they're on a high dose of Mounjaro, they're on 15 mg, but it's not suppressing their appetite?" The research suggests that that suppressant effect does wear off slightly. So, this is where why this lifestyle element of getting it right as much as you possibly can. No one's going to be perfect. We talk a lot about consistency, which we've not mentioned today. So, getting it right 80% of the time is all we're asking for. You can have some wiggle room. We don't have to be anything other than human on our journeys. But, um you know, really, really thinking, "Where's my protein coming from? Have I had enough today? Am I filling up on the right foods which are really going to help me feel a sense of balance in terms of my energy and help me to keep that weight loss going forwards?"

[00:55:57]Because it is a partnership between both the GLP-1 and your habits, and I think we cannot overstate that. It's not oversimplifying it, but we know that the medication isn't going to be the only thing. And if it some people will find it becomes a little bit less effective.

[00:56:14]It's still working, but maybe the edge has gone, and you're finding you're a little bit hungrier, you're finding a little bit of food noise creeping back in.

[00:56:23]These are the things you need to do.

[00:56:24]Really, really, you know, look after your stress, look after your sleep, look after your food, look after your emotional health as well.

[00:56:33]And the hydration.

[00:56:36]Yeah.

[00:56:37]Um how long do you need to wait for upping the dose? At least 4 weeks. Okay?

[00:56:41]Or you cannot increase the dose in under three in under 4 weeks. Okay? So, you need to have four doses over 4 weeks, and then if you feel you need it to be increased, then you can increase it.

[00:56:52]Obviously, if you think it's doing a great job already and you're and you're losing weight at the sort of rate of average 1 to 2 lb a week, then it sounds like that dose is great for you, and you don't need to increase. We don't want you to be losing weight faster than that, because we don't want you to lose muscle mass, we don't want your metabolism to slow. Yeah, exactly.

[00:57:09]A really interesting question, is it true that Mounjaro acts as an anti-inflammatory? There is some really interesting research that's coming out that suggests that for many people it can have an anti-inflammatory effect. So, the the nature of the impact is more wide-reaching in terms of your physiology. Um it's true for many, many people. It's not going to be true for everyone, unfortunately. It's not a miracle drug.

[00:57:33]Otherwise, I think we'd all be drip-fed.

[00:57:36]We'd all be feeling amazing all the time. Unfortunately, it's not that simple.

[00:57:42]Uh says long story here. Thank you from the person who's written this. I'm very close to your goal weight. Lost 60 lbs and weight has gone from 44 to 29.

[00:57:52]That's amazing. No side effects.

[00:57:55]Combination of Saxenda and Wegovy.

[00:57:59]Um some cravings and portion issues.

[00:58:01]Gained 10 lbs and lost five. Bit up and down. That's okay. Up and down is okay.

[00:58:06]Let's also nail that fact. When you hit your maintenance weight or you hit your goal weight, you are going to see some up and down. Up and down is very normal.

[00:58:17]Your weight is not just going to sit on the scales in the same level. You want to be thinking what your window is.

[00:58:23]Maybe a half a stone to 7 lbs or three or four kilos is your window that you want to stay between. So, and really it's about adjusting your expectation that it doesn't just sit at that particular number.

[00:58:38]That you allow yourself that wiggle room. You don't get overwhelmed. We know that it's very common to regain up to 10% of your weight when you come off any medication or any dietary approach to weight loss. You need to be prepared for that and do all of the things we've talked about today.

[00:58:55]So, you are doing great to have gained regained 10 lbs and have lost five again is fantastic. I think we also need to learn to actually recognize that that is success. So, well done and keep it going, I would say.

[00:59:11]I would say don't worry about changing currently to any other medication. It sounds like it's working for you.

[00:59:17]Yeah. Um one last question for you for for our audience and then we're going to have to go, I'm afraid, everyone.

[00:59:24]>> [gasps] >> Hair loss has come up quite a lot. Have you got anything you'd like to add about that?

[00:59:29]Hair loss I think is recognized as a side effect of the medication, but I wonder if if because we're not eating as much or as as varied a diet as we perhaps were before, that might be another reason for it. Maybe we're you know maybe looking at that is a is a is a way to help. I know hair loss can be really distressing, so I do I do sympathize.

[00:59:50]Um Ruth, have you got any things to add sort of in terms of you know maybe speaking I was thinking maybe speak to the boot staff about you know hair loss kind of hair supplements, that sort of thing. I mean it sounds like you've had making sure you've had your iron levels checked, thyroid checked, that kind of thing just to make sure that and make sure your iron is in the higher range of the normal, not sort of hovering around the bottom end. You want to be in the higher range of the that spectrum.

[01:00:18]Um I believe there's some research around biotin potentially being helpful for hair loss. So that may be something to consider. Again, if you're on a medication, which any GLP-1 is, do write in to your medication provider. Send them a message and just say are you happy for me to start taking a supplement. Um we will absolutely if you're a Boots online doctor customer, we'll absolutely pick up those messages and reply to you. And the message reply rate is quite quick, so we normally get back to you within a couple of days I would say. So please do write in.

[01:00:50]Someone's just asked if we're going to answer all of the overspill questions that we've not come to today in the um email. No, I don't think we're going to be able to do that. We are back to our normal aspect of work. But we'll see if there's anything we can speak to in future webinars. I think that is the best we can do. So if there's anything here, I will go through the questions.

[01:01:13]If there's anything that's coming up as a a sort of regular area, we can pick those up in webinars.

[01:01:20]Yeah. Yeah, just to yeah, there's you know, we have quite a few hundred of you here today. So there's been a lot of questions and thank you so much. They've been fantastic questions. I'm sorry we haven't got to them all but we cannot possibly but there's been a lot of useful chat as well in the in the chat box and I think that's really helpful.

[01:01:40]None of us is alone on this journey and and that's why we run these webinars to make sure that you guys have got hopefully some evidence-based simple to understand support for your individual weight loss journeys because we know that they can present challenge.

[01:01:55]webinars we are here now every week on a Monday, on a Tuesday, on that bank holiday week and we love being here. We love answering as many questions as we can. And we would do we have got a session coming up somewhere in the next couple of months which is just a question session and it will be Sam and I and we will just be bombarded by you questions. Hopefully we'll get through as many as we can in an hour.

[01:02:20]And do the best that the up voting system seems to work. So sorry if your question we do it by the number of thumbs up on the questions just to try and hit everything that everyone is worried about as many as we can. Anyway, we'll let you get on with your afternoons.

[01:02:33]Thanks everybody.

[01:02:34]Thanks Ruth. Thanks Ramandeep.

[01:02:37]Bye. Bye Sam. Thank you. Bye. Bye.

[01:02:39]Thanks.