Millions of Americans who have dropped pounds and boosted their health using popular obesity drugs like semaglutide (Wegovy) are facing a new dilemma: What happens if they stop taking them?
Many worry, rightly, that they’ll regain weight and revert to old habits. In clinical trials, patients who paused the drugs put back on most of the weight they lost.
But others are gambling on a do-it-yourself strategy to ease off the drugs and stay slim by stretching out doses, taking the medication intermittently or stopping and starting again only if needed.
“To me, it’s a help, it’s an aid,” said Donna Cooper, 62, of Front Royal, Virginia, who lost nearly 40 pounds in 9 months using semaglutide along with diet and exercise. “At some point you have to come off of them. I don’t want to be on them forever.”
More than 3 million prescriptions for the new medications are dispensed each month in the U.S., according to recent data from the health technology company IQVIA. They include semaglutide, the drug in Ozempic and Wegovy, and tirzepatide, the drug in Mounjaro and Zepbound.
But many people don’t stick with it. One recent study published in the journal Obesity found that just 40% of patients who filled a prescription for semaglutide in 2021 or 2022 were still taking it a year later.
Doctors who treat obesity stress that the disease is a chronic condition that must be managed indefinitely, like heart disease or high blood pressure. The new injection drugs work by mimicking hormones in the gut and the 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 Andres Acosta, MD, PhD, an obesity researcher and medical adviser at the Mayo Clinic. “I don’t think they should be used in intermittent fashion. It’s not approved for that. They don’t work like that.”
Despite that directive, some patients who achieved their health and weight goals with the drugs are looking for an off-ramp, said Amy Rothberg, MD, a University of Michigan endocrinologist who directs a weight-management and diabetes treatment program.
“Many of them want to step down or de-escalate their dose,” she said. “And they’re also wanting to ultimately discontinue the medication.”
Taking ‘a Breather’
The reasons for pausing the drugs can vary, said Katherine Saunders, MD, an obesity expert at Weill Cornell Medicine and co-founder of the obesity treatment company Intellihealth. Some patients don’t like side effects such as nausea and constipation. Others want to stop for holidays or special occasions — or just because they don’t want to take the weekly shots indefinitely.
One of Saunders’ patients, a 53-year-old New York man, lost 70 pounds last year using tirzepatide. He told Saunders he wanted to take “a breather” from the medication to see how his body reacted. On her advice, he has been stretching out injections to every 10 days or 2 weeks, instead of weekly, since December.
Other patients have been forced to ration or halt doses because the drugs are costly — $1,000 to $1,300 per month — and insurance coverage varies or because demand has far outstripped supply, Rothberg noted.
“It’s being imposed on them,” she said. “By necessity, they have to go off the medication and kind of figure it out.”
But hoping the drugs’ benefits will 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 it to accumulate weight. The new drugs alter that process and when patients stop, the disease returns, often with a vengeance.
Many people dropping off the medications report a sharp rise in symptoms of obesity. They include so-called food noise or intrusive thoughts of food, raging hunger, and decreased feelings of fullness when they eat.
“These drugs are just a super-suppressor of these native signals,” Rothberg said. “And we should expect that’s going to occur.”
Tara Rothenhoefer, 48, of Trinity, Florida, lost more than 200 pounds after joining a clinical trial for tirzepatide nearly 4 years ago. She now takes the lowest dose of the drug every 4 to 8 weeks, but she worries when her weight fluctuates by a few pounds.
“It scares the daylights out of me to see the numbers on the scale going up,” she said.
Some patients who stop the drugs and start again find they can’t tolerate the medication, winding up with severe gastrointestinal side effects, Acosta said. Others find the drugs don’t work as well when they restart them, Saunders added. But there’s no data on the long-term effects of intermittent use.
“I don’t think it’s a strategy that will work for most individuals, but it could be an option for select patients,” Saunders said.
Donna Cooper has heard that people gain back weight when they stop the drugs, but she hopes to be an exception. She’s on her last box of semaglutide injections. Once she’s done, Cooper said she’ll just continue with a strict diet and exercise plan.
“I just needed a crutch to get everything back in order,” said Cooper, who has gone from a size 16 to a size 10. “And I am excited to be done.”
Source : MedPageToday