Quitting weight-loss jabs like Ozempic and Mounjaro leads to rapid weight regain in 1.5 years, says new BMJ study

Can you discontinue the new weight-loss therapies?

“It is too premature to say that people cannot stop taking the medicines. However, it is clear that just like any other chronic condition such as hypertension or diabetes, the medicines only work as long as you continue to take them,” says Dr Ambrish Mithal, Chairman and Head of Endocrinology and Diabetes at Max Healthcare.

He goes on to explain: “If you look at the previous generation of GLP-1 drugs such as liraglutide and dulaglutide — both meant for the treatment of diabetes — patients continued to take them just as they would any other diabetes medicine. Questions about stopping the treatment have come up only with these new generation GLP-1 medicines because of how much weight people lose when on them, which you cannot continue to do forever.”

So, how do doctors balance the benefits and the consequences of excessive weight loss?

As scientific evidence continues to catch up — the current study had data for the new GLP-1 drugs for only a year after discontinuation, with the rest being extrapolated — doctors have been managing patients’ weights and expectations. Dr Mithal says that there are certain guiding principles that he follows when prescribing the new weight-loss drugs: One, going completely off the medicine is not a solution, especially those severely obese, living with diabetes and other co-morbid conditions. “If the weight loss is too much — and there will be proportional muscle loss as well — then the dose will have to be reduced and adjusted accordingly. The key is to taper the dose gradually, with people continuing on a maintenance dose long term,” said Dr Mithal. ALong with diet and exercise.

Two, the target should not be the ideal weight. “Despite setting expectations with the patients, when they start losing weight, many look to reach their ideal body weight. This, however, is not possible for those who started off morbidly obese. When it comes to a weight loss journey, it always plateaus at some point. Earlier, it would plateau at around six months with diet and exercise. Now, we see weight loss up to a year, and in very few up to 2 years. The important thing is, even if you do not achieve the ideal weight, your health is much better with whatever weight you have lost.”

Three, there is a challenge when it comes to moderately obese younger patients and women trying to conceive. Dr Mithal says that diabetics and morbidly obese persons will continue to need the medicine long term, but deciding when to scale back for a moderately obese, young patient is a challenge. “And, if the drug is used for weight-loss to help with PCOS (polycystic ovary syndrome) and conception, the challenge is that it cannot be continued during pregnancy and even lactation. We don’t yet know what to do in these cases and we have to take it as it comes.”

What were the key takeaways from the study?

The recent findings are based on the analysis of 37 studies with over 9,000 participants who have undergone behavioural weight management programmes, have been put on weight-loss therapies, including the new blockbuster therapy. The key points:

• People on any kind of weight-loss therapy started regaining 0.4 kg a month on average after discontinuing the treatment, returning to their initial weight 1.7 years later. The study also noted that there was no difference in the weight of those who discontinued these therapies and those who never went on these after a period of 1.4 years.
• The extrapolated weight-gain after discontinuing the newer generation GLP-1 therapies such as semaglutide and tirzepatide was faster — at a rate of 0.8 kg per month. Those who discontinued these medicines returned to their initial weight in 1.5 years.
• Moreover, the study found that the benefits to heart health also weakened over time. These benefits were measured through cardiometabolic markers such as HbA1c or average blood glucose level over three, fasting glucose, cholesterol, triglycerides, systolic and diastolic blood pressure returned to their initial levels.

What does the study say about heart health?

The study projected that all the cardiometabolic markers would return to their initial levels in around 1.4 years after people discontinued their weight-loss therapy. The study found active treatment decreased systolic blood pressure by 5.8 mm Hg, which then increased at a monthly rate of 0.5 mm Hg after stopping treatment. Diastolic blood pressure decreased by 3.7 mm Hg by the end of active treatment and then increased at a monthly rate of 0.2 mm Hg after stopping treatment. Cholesterol concentrations decreased by 0.2 mmol/L and then increased at a monthly rate of 0.05 mmol/L, triglyceride concentrations decreased by 0.2 mmol/L and then increased at a monthly rate of 0.03 mmol/L, the study found.

A previous study by the group had shown that when people lost weight through behavioural weight management programmes, the impact did weaken but the benefits lasted at least five years. “It is possible that following a behavioural weight management programme provides people with practical coping skills that they can continue to implement past the end of the intervention to help with weight loss maintenance,” the study said.