Susana Parks was delighted when she lost 40 pounds on Eli Lilly’s obesity drug, Zepbound. But now that she is at her goal weight, she has questions: Can she stop taking the drug? And if she does, how can she maintain her weight loss?
“I can’t stop cold turkey, or I will gain it back — that is clear,” said Parks, 60, of Bend, Oregon. “Do I go to a lower dosage? Do I take it every two weeks instead of weekly? How do I maintain?”
These questions are becoming common, obesity medicine specialists say, as more and more people lose weight with obesity drugs. Some struggle to pay for the medicine, have difficulty finding it to purchase or just don’t want to stay on a drug longer than they believe they need to.
When doctors are confronted with these queries, here is what they advise — and what they can’t say.
What will happen if I stop taking the new weight-loss drugs after losing weight?
Dr. David Cummings, a weight-loss specialist at the University of Washington, has been asked this question by many patients. He explains that the makers of the drugs conducted large studies in which people took the drugs and then stopped.
“On average, everyone’s weight rapidly returned,” Cummings said. And, he said, other medical conditions, like elevated blood sugar and lipid levels, return to their previous levels after improving.
He also tells patients that while on average, weight is regained when the drugs are stopped, individuals vary in how much weight and how quickly it returns.
Hearing that, Cummings said, some patients want to take a chance that they will not need the drugs once they lose enough weight. He says some tell him, “I will be the one. I just need some help to get the weight off.”
So far, though, Cummings has not seen patients who have succeeded.
Will lowering my dose help me keep the weight off?
Doctors say they have no data to guide an answer to that question.
It “has not been studied in a systematic fashion,” said Allison Schneider, a spokesperson for Novo Nordisk, the maker of Wegovy. The drug is based on the medication semaglutide, which the company also sells for diabetes treatment as Ozempic.
The same is true for tirzepatide, which Eli Lilly sells as Zepbound for weight loss and Mounjaro for diabetes.
When doctors do offer advice, it tends to be tentative.
“There is no magic bullet,” said Dr. Mitchell A. Lazar of the University of Pennsylvania’s Perelman School of Medicine.
What might happen if I experiment with my dose?
Parks said she was not interested in continuing to lose weight. For her, a 40-pound weight loss was perfect.
She’s grateful she got Zepbound. Her doctor, she said, resisted prescribing it, her insurance would not pay for it, and the drug was in such short supply that she called pharmacy after pharmacy each month to refill her prescription, paying out of pocket each time.
While Lazar does not treat Parks, when he heard about her case, he said she could try reducing her dose.
Or, he said, “she can monitor what she is eating now and do her best to eat the same amounts after she lowers or stops her dose.”
But, he added, that may be difficult without the help of the drug.
For the moment, Parks is adjusting her dose. When her weight fell to 150 pounds — she’s 5 feet, 8 inches tall — she decided to try taking Zepbound every other week, instead of every week. She told her doctor what she was doing. Her doctor, Parks said, “had no opinion one way or another.”
Her new dosing schedule, Parks added, also saves her money.
After a week without the drug, she said, she gets hungry. It happens every time, predictably. Then she takes her next dose.
So far it is working — her weight has been steady.
Dr. Caroline Apovian, a weight-loss specialist at Brigham and Women’s Hospital, said there’s a lesson here for people struggling with their weight.
“It teaches patients that it’s really not under your control,” said Apovian, who used to consult for Novo Nordisk.
Does that mean I have to take Wegovy or Zepbound forever?
“Most patients want to lose as much as they can but don’t want to be stuck on the medicine for the rest of their lives,” Cummings said. “The most common question is, ‘How long do I have to take it?’
“The proper answer is probably forever,” he said.
Some patients tell Cummings that it sounds like he is giving them a life sentence, and others simply do not believe him.
In a study of electronic health records by Truveta, a health care data company, more than half of patients without diabetes stopped taking the drugs within a year. But about a third who stopped restarted.
Faced with these concerns, doctors stress that obesity is a chronic disease and, like high blood pressure and other chronic diseases, must be treated for life. But beliefs persist that obesity is different from a disease like high blood pressure — the perception is that weight can be controlled by lifestyle and willpower.
Is there any risk of losing too much weight on the drugs?
Patients also want to know if they risk losing weight indefinitely, becoming dangerously thin.
Unlikely, obesity medicine experts said.
Eventually, with the new weight-loss drugs, patients reach a plateau where they stop losing weight.
Schneider of Novo Nordisk said that in the Wegovy trials, weight loss stopped after about 60 weeks.
When that happens, said Dr. Ania Jastreboff of Yale, who is on advisory boards for Novo Nordisk and Eli Lilly, hunger returns. So do food cravings, even though patients are still taking the drugs. But the person will naturally eat only enough to maintain the lower weight.
Do side effects return if people stop and then restart the drugs?
Many describe experiencing side effects like nausea and vomiting when they first start taking Wegovy or Zepbound. For most, but not all, patients, the side effects diminish as they adjust to the drugs.
But, Apovian warned, those side effects may return if patients stop and then restart the drugs. The longer they are off the drug, she added, the more likely it is that the side effects will return.
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