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Millions of Americans who have lost weight and improved their health using popular obesity medications like Wegovy face a new dilemma: What happens if they stop taking them?
Many are rightly concerned about regaining weight and returning to old habits. In clinical trials, patients who stopped treatment resumed taking it. most of the weight they lost.
But others are betting on a do-it-yourself strategy to get off the medications and stay slim, spreading out doses, taking the medication intermittently, or stopping it and starting again only if necessary.
“For me, it’s a help, it’s a help,” said Donna Cooper, 62, of Front Royal, Virginia, who lost nearly 40 pounds in nine months using Wegovy along with diet and exercise. “At some point you have to leave them. “I don’t want to be with them forever.”
More than 3 million recipes for the new medications are dispensed every month in the US, according to recent data from health technology company IQVIA. They include semaglutide, the drug from Ozempic and Wegovy, and tirzepatide, the drug from Mounjaro and Zepbound.
But many people don’t follow it. A recent study published in the journal Obesity found that only 40% of patients who filled a Wegovy prescription in 2021 or 2022 they were still taking it a year later.
Doctors who treat obesity emphasize that the disease is a chronic condition that must be treated indefinitely, like heart disease or high blood pressure. New injectable medications work by mimicking hormones in the gut and brain to regulate appetite and feelings of fullness. They were designed (and tested) to be taken continuously, experts said.
“We are not an injection shop,” said Dr. Andrés Acosta, an obesity researcher and medical advisor at the Mayo Clinic. “I don’t think they should be used intermittently. It’s not approved for that. “They don’t work like that.”
Despite that directive, some patients who achieved their health and weight goals on medications are looking for a way out, said Dr. Amy Rothberg, an endocrinologist at the University of Michigan who runs a weight management and diabetes treatment program. .
“Many of them want to reduce or reduce their dosage,” he said. “And they also want to ultimately stop the medication.”
TAKING ‘A BREATH’
Reasons for stopping medications can vary, said Dr. Katherine Saunders, an obesity expert at Weill Cornell Medicine and co-founder of the obesity treatment company Intellihealth. Some patients do not like the side effects such as nausea and constipation. Others want to stop during holidays or special occasions, or simply because they don’t want to take weekly photos indefinitely.
One of Saunders’ patients, a 53-year-old New York man, lost 70 pounds last year using Mounjaro. He told Saunders that he wanted to take “a break” from the medication to see how his body reacted. Following his advice, since December he has been expanding the injections to every 10 days or two weeks, instead of weekly.
Other patients have been forced to ration or stop doses because the drugs are expensive ($1,000 to $1,300 a month) and insurance coverage varies or because demand has far outstripped supply, Rothberg said.
“It is being imposed on them,” he said. “Out of necessity they have to stop the medication and figure it out.”
But expecting the drugs’ benefits to last even after stopping them ignores the fundamental biology of obesity, experts said. The disease affects the way the body processes and stores energy, causing weight to accumulate. New medications disrupt that process, and when patients stop, the disease returns, often with a vengeance.
Many people who stop taking the medications report a sharp increase in obesity symptoms. They include the so-called food noise or intrusive thoughts about food; furious hunger; and decreased feeling of satiety when eating.
“These drugs are simply a supersuppressor of these native signals,” Rothberg said. “And we should expect that to happen.”
Tara Rothenhoefer, 48, of Trinity, Florida, lost more than 200 pounds after joining a Mounjaro clinical trial nearly four years ago. She now takes the lowest dose of the medication every four to eight weeks, but worries when her weight fluctuates by a few pounds.
“It scares me to death to see the numbers on the scale going up,” he said.
Some patients who stop the medications and start again find that they can’t tolerate them, which ends up with serious gastrointestinal side effects, Acosta said. Others find that the medications don’t work as well when they restart them, Saunders added. But there is no data on the long-term effects of intermittent use.
“I don’t think it’s a strategy that works for most people, but it could be an option for select patients,” Saunders said.
Donna Cooper has heard that people regain weight when they stop taking medications, but she hopes to be an exception. She is taking her last box of Wegovy injections. Once she’s done, Cooper said she will continue with a strict diet and exercise plan.
“I just needed a crutch to get everything back together,” said Cooper, who went from a size 16 to a size 10. “And I’m excited to be done.”
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