There has been a lot of conversation around Mounjaro recently and, interestingly, it was actually the hot weather that got me thinking about it. With temperatures rising, there has been discussion around the storage and delivery of these injections, because Mounjaro needs to be kept within specific temperature ranges. The medication is normally stored refrigerated between 2°C and 8°C and, once a KwikPen is in use, it can be kept below 30°C for up to 30 days. So yes, when we have unusually hot weather, the practical side of getting these medications safely to people becomes another consideration. But it also made me think about the much bigger conversation we’re having around these injections and weight loss generally.
Because whilst Mounjaro was originally developed as a medication for type 2 diabetes and is now also used for weight management in specific circumstances, I’m seeing more and more people talking about these injections as a way to lose weight quickly. And I completely understand why. When you’ve spent years dieting, restricting food, exercising, watching the scales refuse to move and feeling like your body isn’t responding the way it once did, the idea of something that can finally make the weight come off can feel incredibly appealing. And I am not here to tell anyone that Mounjaro doesn’t work. It does. Tirzepatide has demonstrated significant weight loss in clinical trials and, for people living with obesity or weight related health conditions, it can be a genuinely important treatment option. NICE currently recommends tirzepatide alongside dietary and physical activity support for adults who meet specific clinical criteria for weight management. (Ref 1)
But this is where I think we need to have a much bigger conversation, because my concern isn’t really about the injection itself. It’s about what happens when we make weight loss the whole conversation. Perhaps the question shouldn’t simply be, “How quickly can I lose the weight?” Perhaps we should also be asking, “Why did my body gain the weight in the first place?” Those are two very different questions, and the second one is the conversation I think we’re missing.
What if the weight is the symptom?
This is something I talk about with women all the time. We have become incredibly good at looking at the number on the scales and deciding that the number itself is the problem. You weigh more than you want to, so the mission becomes getting that number down. We count calories, cut carbohydrates, join another challenge, buy another programme, increase the cardio and, increasingly, reach for medication that can reduce appetite and help us lose weight. But what if the weight is actually telling us something? What if your body is responding to years of stress, poor sleep, hormonal change, emotional eating, under fuelling, inactivity, overtraining or simply the fact that your physiology isn’t the same as it was twenty years ago?
And this becomes particularly interesting for women as we move through our forties and into perimenopause and menopause. The menopausal transition is associated with changes in body composition, including a tendency towards greater abdominal and visceral fat, although ageing, genetics, physical activity, diet, sleep and many other factors are involved too. It is therefore far too simplistic to say that every change in body shape is “just hormones”, but equally, I think we do women a disservice when we pretend that hormonal change has nothing to do with what is happening to their bodies. (Ref 2)
So when a woman tells me, “I’ve never had this belly before,” I’m not immediately interested in telling her to eat less. I want to know what has changed. Has she started sleeping badly? Is she under more pressure? Has her training changed? Is she eating enough protein? Has her activity reduced because she is exhausted? Is she experiencing perimenopausal symptoms? Is there a metabolic issue that needs investigating? Is she eating because she is genuinely hungry, or because food has become a source of comfort at the end of a stressful day? There could be one factor, or there could be ten.
And that is exactly why I don’t believe we can reduce the entire conversation to weight.
We’ve become obsessed with the scales
I also think we need to rethink the way we measure health. BMI has become almost synonymous with weight management, but BMI is simply a measure of weight in relation to height. It doesn’t tell us how much of that weight is muscle, where body fat is stored or what someone’s overall metabolic health looks like. That doesn’t mean BMI is useless. It remains a useful clinical tool and NICE continues to use it when assessing overweight and obesity. But it has limitations, and NICE specifically recommends considering waist to height ratio alongside BMI when assessing central associated health risks. (Ref 3)
This makes much more sense to me. I don’t just want to know what a woman weighs. I want to know how strong she is, how much muscle she has, where she is carrying fat, what her waist to height ratio looks like, what her blood pressure and blood glucose are doing, how she sleeps, how she moves, how she recovers and, actually, how she feels. How do her clothes fit? Does she have energy? Can she carry her shopping? Can she get up from the floor? Can she run around with her children or grandchildren? Can she do the things she wants to do? That is a much bigger picture of health than simply stepping on a set of scales and deciding whether you’ve had a “good” or “bad” day.
Women aren’t small men
There is another part of this conversation that I think gets missed, and it is something Stacy Sims has spoken about extensively: women aren’t small men. Our physiology is different, and it changes throughout our lives. What worked for us at 25 isn’t necessarily what our bodies need at 45 or 50. Hormones change, muscle mass can decline with age, recovery can change and the transition through menopause can alter body composition and the way we experience training and nutrition.
This is why I’m increasingly passionate about women understanding how to train for the body they have now, rather than constantly trying to recreate the body they had twenty years ago. For me, strength training becomes non-negotiable as we age, not because women need to punish themselves into becoming smaller, but because maintaining and building muscle supports strength, physical function and healthy ageing. Cardiovascular fitness absolutely matters too, but more isn’t necessarily better, and spending endless hours doing cardio because we think we need to burn off what we’ve eaten isn’t the answer either.
We need to think about the whole picture: resistance training, appropriate cardiovascular exercise, intervals where suitable, nutrition, adequate protein, recovery and sleep. We also need to recognise the role that stress plays in all of this. We’re not trying to punish the body into becoming smaller. We’re trying to build a body that is stronger, healthier and more resilient.
But what happens when you stop Mounjaro?
This is probably one of the most important parts of the conversation, because we now have evidence showing that weight regain is common after stopping tirzepatide. In the SURMOUNT-4 trial, participants initially lost substantial amounts of weight while taking tirzepatide. Those who were subsequently switched to placebo regained a significant proportion of the weight they had lost, while those who continued treatment maintained their reduction and lost additional weight.
Now, let’s be careful here, because social media has a habit of turning research into dramatic headlines. It does not mean that everyone who stops Mounjaro will automatically regain all their weight and then gain even more. That would be an inaccurate interpretation of the evidence. What the research does show is that the biological drive to regain weight can be strong and that substantial weight regain can occur after treatment is withdrawn. NICE therefore recognises that tirzepatide may be used as a long term treatment, and recommends ongoing support around diet, physical activity and healthy behaviours, including when medication is stopped.
And this brings me back to the bigger question. If medication is doing the heavy lifting when it comes to appetite and weight loss, what happens when the medication stops? What has changed underneath it? Have we changed the way we eat? Have we built muscle? Have we changed our relationship with food? Have we addressed the stress and emotional patterns that may have contributed to our eating? Have we learned how to fuel and move our bodies in a way that supports us for the long term?
This isn’t an argument against medication
I want to make that really clear, because there is a tendency for conversations around weight loss medication to become incredibly polarised. You are either “pro Mounjaro” or “anti Mounjaro”. I don’t think it needs to be that simple.
Mounjaro is an effective medication, and for people who meet the appropriate clinical criteria, it can be an important part of their healthcare. There is strong evidence for its effectiveness in weight management, and longer term trial data are continuing to emerge. We also now have evidence showing benefits beyond the number on the scales, including reduced progression to type 2 diabetes in people with obesity and prediabetes in the three year SURMOUNT-1 analysis.
But medication doesn’t automatically teach you how to manage stress. It doesn’t build your muscles. It doesn’t teach you how to fuel your body. It doesn’t change your sleep. It doesn’t necessarily resolve emotional eating or years of restrictive dieting. And it doesn’t tell you why you were eating the way you were eating in the first place.
Interestingly, NICE itself recognises this. Its guidance describes “wraparound care” alongside weight management medication, including support around diet, nutrition and physical activity. So even within the medical model, the injection isn’t supposed to exist in isolation. (Ref 4.)
The part we don’t talk about enough
Because sometimes women aren’t simply carrying weight. They’re carrying life.
They’re carrying work, children, ageing parents, relationships, financial pressure, responsibility, expectations and years of putting everybody else first. They’re exhausted. They’re overwhelmed. They’re trying to keep everything going, and sometimes food becomes one of the easiest sources of comfort available.
Maybe you’re eating because you’re stressed. Maybe you’re eating because you’re exhausted. Maybe you’ve spent the entire day looking after everyone else and food is the one thing you get for yourself. Maybe there is an emotional pattern underneath it. Maybe there isn’t. Maybe there is a metabolic issue that needs investigating. Maybe it is menopause. Maybe it is poor sleep. Maybe it is a combination of several things.
The point is, we don’t know until we look.
And this is where I think the conversation needs to move beyond simply “calories in, calories out”. Yes, energy balance matters. Of course it does. But human beings aren’t spreadsheets. Our behaviour, appetite, hormones, sleep, stress, environment, emotions and physiology all interact with one another. If we want sustainable change, we need to understand the whole person rather than simply trying to make the number on the scales smaller.
This is where I turn the whole thing on its head
When a woman comes to me wanting to lose weight, I don’t want our entire conversation to be about how many pounds she wants to lose. I want to understand what is actually driving the change in her body. What’s happening hormonally? How is she eating? How is she moving? How is she sleeping? How much stress is she carrying? How does she feel? What’s her relationship with food? What has she tried before? What does her body actually need at this stage of her life?
Because the woman standing in front of me at 48 isn’t the same woman she was at 28, and she shouldn’t be expected to eat, train and live as though she is.
This is particularly important during perimenopause and menopause. We need to stop treating women as though they have somehow failed because the diet that worked in their twenties no longer works in their forties. We need to understand the changing female body and learn how to work with it rather than constantly fighting against it.
And that means looking at the physical body, absolutely, but also the mental and emotional body. Because sometimes the weight we carry isn’t just physical. It can be the outward expression of a life that has become too much.
So, am I anti-Mounjaro?
No. I’m anti one size fits all thinking.
I’m anti the idea that every woman who doesn’t like her weight simply needs to eat less. I’m anti making a woman’s worth about the number on a scale. And I’m anti pretending that weight is always the actual problem.
Mounjaro has an important place in modern medicine. For the right person, under appropriate medical supervision, it can be an incredibly useful tool. But a tool is still a tool, and I believe we need to use it within a much bigger conversation about nutrition, movement, strength, hormones, sleep, stress, behaviour and emotional wellbeing.
Because perhaps the goal shouldn’t simply be to make the body smaller. Perhaps the goal is to make the woman stronger: physically, mentally and emotionally. To help her understand her changing body, feel more confident in what it needs and create habits that support her for the long term, whether medication forms part of that journey or not.
When we stop asking only, “How much weight do you want to lose?” and start asking, “Why is your body carrying this weight?”, the conversation changes completely.
And that, for me, is where the real transformation begins.
Because this isn’t simply about the weight we want to lose.
It’s about understanding the woman who is carrying it.
A final thought
We have never had more conversations about weight loss, yet I wonder whether we’re sometimes looking at the wrong end of the problem. The scales can tell us what is happening, but they don’t necessarily tell us why. Perhaps women don’t need another diet, another six week challenge or another reason to feel that their body has failed them. Perhaps what we really need is to understand our bodies, our hormones, our behaviours, our relationship with food, our stress and the lives we’re actually living.
Because the answer isn’t always about becoming smaller.
Sometimes it’s about becoming stronger, healthier and more at home in your own body.
This isn’t simply about the weight we want to lose. It’s about understanding the woman who is carrying it.
With love,
Zoë x
Women’s Transformation Architect
Creator of The HER Method™
Please Note
This article is for information and education only and is not medical advice. Mounjaro/tirzepatide should only be started, changed or stopped under the guidance of an appropriate healthcare professional.
Sources and further reading
Ref 1. NICE – Tirzepatide for managing overweight and obesity (TA1026): Current UK recommendations and eligibility criteria for tirzepatide. NICE guidance
Ref 2.National Library of Medicine: Research on menopause and body composition
Ref 3. NICE – Overweight and obesity management (NG246): Guidance covering assessment of overweight and obesity, BMI, central adiposity and waist to height ratio. NICE guidance
Ref 4. Nice- NICE: Wraparound care alongside medicines for weight management
SURMOUNT-1 – Three year tirzepatide outcomes: Longer term evidence examining weight loss and progression to type 2 diabetes in adults with obesity and prediabetes. PubMed
SURMOUNT-4 – Tirzepatide and maintenance of weight reduction: Clinical trial evidence examining what happened when tirzepatide was continued versus withdrawn. PubMed
Mounjaro KwikPen – UK Patient Information Leaflet:
Storage, administration and safety information. Medicines.org.uk
