In the News: Maintenance After Stopping Ozempic and Other Anti-Obesity Medications

Preface

Note: There is a lot of personal history in this post. If you want to get straight to the facts, skip the following paragraphs in blue and start with The Struggle Is Real.

As you may know, when I began my last diet, I went to a Bariatric Center at The Mayo Clinic in hopes of getting started on Wegovy, a weight loss medication which is injected. This drug wasn’t my idea – a doctor had suggested it for me. At that time, there was a shortage of the drug, which persists today. My bariatrician instead prescribed a similar but slightly less effective injectable called Saxenda. After struggling with insurance for months, we abandoned this idea.

My doctor then scheduled another appointment to set up a prescription for Qsymia, an oral pill which combines Phentermine and Topiramate. I wasn’t too excited by this medication as I knew from a family member that Topiramate can have some unpleasant side effects. Plus the thought of taking Phentermine with my medical history of a transient ischemic attack (mini stroke) seemed concerning.

By the time this appointment rolled around, I had already met my first goal weight of 175 pounds and was just below a 27 BMI. So ideas of medication were dropped and I was told to maintain this weight for 6-12 months before losing my final 15 pounds.

Despite the success of my diet and exercise programs, I felt annoyed and frustrated – I had wanted that magic injection that would quickly end my weight struggles. I wanted something easy – what I had been doing was hard. But with the current news stories on problems with maintenance after stopping diet medications, I now wonder if I should be thanking my insurance company instead of complaining about them! The challenges dieters face in getting off diet drugs are significant.

The Struggle Is Real

Whether or not you choose to take a diet medication, it is very difficult to maintain weight loss. According to the Cleveland Clinic, “as many as 80 to 95% of dieters gain back the weight they’ve worked so hard to lose” (1). I’ve already written about this in several blog posts, but basically your body works very hard to defend its previous, higher weight. There are other factors as well, and the combination makes maintenance a daunting challenge.

Unfortunately, the same problems occur if the dieter has used medications, and often these dieters are less equipped to handle the new situation without the pills or shots they relied upon. When the drugs are discontinued, the weight is generally regained – often quickly.

Regarding Ozempic/Wegovy (semaglutide), a study recently found that:

“One year after withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss, with similar changes in cardiometabolic variables. Findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health” (2).

In another Ozempic/Wegovy drug trial, it was found that these drugs also become less effective over time (3). So even if you continue to have access to these costly and scarce drugs, you may regain your weight.

This medication is working in you biologically, but the physical changes you experience are often not due to purposely modified behaviors. Take the magic away, and what is left? What is the foundation of this weight loss? A medication.

Here is an example of what makes these medications concerning:

“Artemis Bayandor, 40, has been trying to lose weight for the last 20 years. She didn’t find success until her doctor prescribed Wegovy…She lost 15 pounds in about six months. But it all stopped in February, when Bayandor’s health insurance denied her coverage, forcing her to stop taking the medication. A month later, she had gained the 15 pounds back, followed by 10 more pounds six months later” (4).

Unfortunately, this anecdotal evidence is all too common. Although it’s Wegovy and Ozempic that are in the headlines right now, the same weight gain pattern applies to other medications.

When you consider one of the main effects of semaglutide and its sister drugs, it’s no surprise that weight maintenance is so difficult after stopping the medication. It imitates the GLP-1 satiety hormone that is normally released when we eat. This hormone tells us that we are full. So with a steady state of this simulated hormone in our bodies, we don’t feel the need to eat (5).

Interested in other posts about Wegovy and similar injectables? Try https://lindawbrowning.com/2023/01/05/60-minutes-on-obesity/ and https://lindawbrowning.com/2023/01/06/follow-up-60-minutes-on-obesity/ .

If you take this or other diet medications that decrease hunger, you may not actually learning to deal with your own appetite (6). It’s possible that you haven’t learned the behavior modification techniques that are practiced by those dieting without such assistance. When you discontinue the medication and your appetite returns, you would have to be even more careful or you may quickly regain your weight. You may not have the same level of experience to help you through the transition to maintenance. Given how difficult maintenance is on its own, imagine how much harder it would be to be get off a medication at the same time.

With diet pills that are in the stimulant category, an analogous relationship occurs – often with exercise. The stimulant helps you to work out harder and longer than what you’d normally be capable of. But when that extra energy is gone, you may find it more challenging to keep up with your exercise routine (6). And we also know how much easier it is to go for your favorite comfort foods when you’re lacking the energy to make home cooked, healthy foods.

Even though diet medications seem like the magic pills or injections we’d all love to take, there are no real shortcuts. The foundations we lay in losing weight slowly and mindfully are more likely to lead to long term success than going with a quick fix.

But whether or not you’ve chosen to use medications, maintenance is challenging – not impossible. Keep looking for solutions along with me and others. We can maintain our healthy weight!

(1). https://health.clevelandclinic.org/why-people-diet-lose-weight-and-gain-it-all-back/amp/

(2). https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725

(3). https://parade.com/.amp/health/what-happens-when-stop-taking-ozempic

(4). https://www.nbcnews.com/news/amp/rcna66282

(5). https://www.advisory.com/daily-briefing/2023/01/31/wegovy-rebound

(6). https://www.livestrong.com/article/486510-weight-gain-after-using-diet-pills/