Getting off GLP-1 Weight Loss Medication (Wegovy & Zepbound)

With all the headlines surrounding the effectiveness and benefits of weight loss medications like Wegovy and Zepbound, as well as other GLP-1 receptor agonists prescribed off-label like Ozempic and Mounjaro, you may be wondering why we are already talking about getting off them. So, let’s dive in and discuss why you should have an exit plan.

Weight Loss Potential Limitations

While the headlines will tell you that you can lose up to 20% of your body weight, they rarely mention that in the clinical trials, the number of patients achieving this was just a fraction of all the patients on the medication. Meaning that while a third or so hit these lofty goals, many more did not. This may be fine for someone with relatively less weight to lose. However, for most patients, especially those with significant obesity, weight loss medication may not offer the degree of weight loss that they need or expect.

This dovetails into our example of their suitability, depending somewhat on BMI. Even at the maximum weight loss potential of 20%, more is needed to get patients to achieve the improvement in obesity-related diseases they need. Let’s take a patient who is 400 pounds, but their ideal weight is 200 pounds. Losing 20% of their body weight is approximately 80 pounds, leaving them still 120 pounds overweight. While some metabolic concerns may be improved, this is not a long-term option.

For Many, the Medication Only Works While They Are on It.

It’s important to remember that, as with most medications, the positive effect, for most, is only enjoyed while the patient is on it. Upon coming off the medication, the patient may regain weight, and that’s one reason we always want you to have a plan for what’s next. You never know. While you may be comfortable staying on the medication for the rest of your life, you never know what supply chain issues or insurance coverage problems may preclude you from continuing.

The Side Effects

Along with all the sensational headlines about its effectiveness, there are plenty of warnings about the side effects of these medications. For many, the side effects are relatively mild and gastrointestinal. However, we have heard of the longer-term potential for gastroparesis or stomach paralysis, as well as the potential for suicidal ideation and other concerns that were not seen during the clinical trials.

A Post-Medication Plan

Given the above, it makes good sense to have a plan for when they come off the medications. This planning begins before they even start the medication.

• Understanding your goals and how you plan to maintain them is essential. In the end, just like any weight loss modality, this GLP-1 medication is a tool, and you have to make the most of it by changing your dietary and exercise habits after starting the medication. What does that look like? Eliminating empty, refined carbs, including added sugar, is so important. Transitioning to lean meats, whole fruits, and leafy greens is a great way to maintain the results that the GLP-1s have started. From an exercise perspective, patients must prioritize strength training to ensure that they aren’t dropping too much muscle mass as they lose a significant amount of weight so quickly. Maintaining muscle mass offers a vital boost in caloric burn, even at rest over the long term. Losing too much muscle mass can also increase the risk of osteoporosis and muscle wasting, which has both aesthetic and medical ramifications.
• Consider GLP-1s a stepping stone. We certainly do not blame patients at any BMI for trying weight loss medications. They’re very accessible and easy to administer. It is certainly less daunting than having surgery. However, patients must also know that GLP-1s may not get them where they want to be. Instead, they can be considered an excellent stepping stone toward bariatric surgery, allowing patients to lose significant weight and reduce their surgical risk in anticipation of the procedure that will take them to the finish line. Similarly, bariatric patients who need that little bit of extra weight loss or boost or may have fallen off the wagon once or twice and lost their drive may find that medication gets them back on track after surgery.

What’s the Correct Answer?

Ultimately, the correct answer revolves around something we’ve known forever: It takes hard work to lose weight, no matter what tool you use to help you—bariatric surgery, medication, psychotherapy, or otherwise. Patients must understand that everything they do, including their weight loss goals, revolves around strict diet and exercise.

We look forward to seeing your fantastic results and encourage you to share them with us via social media or the next time you come into the office for a follow-up or support group.