What Happens When Patients Stop Weight-Loss Medications?

 Ania Jastreboff, MD, PhD, a professor at Yale School of Medicine and director of weight management and obesity prevention at Yale Stress Center in New Haven, Connecticut, discusses what to expect when stopping obesity medications like semaglutide (Wegovy).

The following is a transcript of her remarks:

Semaglutide, like other medications that are used for obesity treatment, have to be taken long term. Just as for any other chronic disease, if a medication is stopped for any reason, the disease is no longer being treated. So, for example, if somebody is taking a medication for hypertension, if you stop that anti-hypertensive medication, the blood pressure goes up and we're not surprised.

In the same way, if someone is taking a medication for obesity treatment, when it is stopped, weight gain occurs -- or weight regain occurs, more accurately.

Why is this? Obesity is a chronic disease. It's a neurometabolic disease, meaning that our body and our brain talk to each other. What happens is our body is very, very smart. It wants to carry a certain amount of fuel, and the way that our body does this is by carrying fat. Our body does not want to carry too little fat because then we would starve, and our body also doesn't want to carry too much fat because then we would not be able to do the things that we need to do and have our body function well.

So there's a sweet spot, and we call that sweet spot the "defended fat mass set point." It's basically the amount of fuel or the amount of fat that your body wants to carry.

Now, within the context of our current obesogenic environment -- an environment with all of these highly palatable and highly processed foods, the lack of sleep, the lack of movement and physical activity, stress -- all these different things in our obesogenic environment has pushed up the defended fat mass set point on a population level.

What do these medications like semaglutide do? They decrease that defended fat mass set point, and a consequence of that is that we lose weight.

So what happens when someone takes an anti-obesity medication and then stops taking that medication? Let's say they've lost 40 or 50 pounds and the medication is stopped. Well, what happens is that the defended fat mass set point goes back up and the weight follows.

During the course of our body wanting to regain that weight because the treatment was stopped, patients can be very hungry, they can have cravings, and basically their body is wanting to go back up to that higher defended fat mass set point again because the treatment was discontinued.

The key and the take-home message here is that in order to maintain that lower or re-regulated defended fat mass set point, the medication has to be continued. In order to maintain that weight reduction, the medication has to be continued, and that is because obesity is a chronic disease. For any chronic disease, we have to treat it lifelong.

https://www.medpagetoday.com/endocrinology/obesity/102894