GLP-1 withdrawal can have lasting health effects
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The surging popularity of GLP-1 drugs is beginning to obscure the health consequences if people stop taking them, physicians warn.
Why it matters: While many patients can shed up to 20% of their body weight using the injectables, the cost of the drugs and side effects like nausea and vomiting lead many to quit. In most of those cases, their weight returns.
- "A lot of people are going on these drugs and then going off, and there's not going to be a benefit from doing that," said Ethan Lazarus, an obesity medicine physician based in Colorado.
Almost half of GLP-1 users with obesity had discontinued their medication one year in, according to research published in JAMA. Other analyses show even higher discontinuation rates.
Driving the news: Concern about the long-term effects of withdrawal is intensifying as more public and private insurers clamp down on coverage of GLP-1s for weight loss.
- Physicians also note many patients start GLP-1s to treat obesity without proper counseling from a health provider about diet and exercise and how to manage side effects.
- Fewer than 1% of U.S. physicians are board-certified in obesity medicine, and medical school traditionally devoted limited training in obesity care.
- "We need to just really think about it as a chronic disease ... to make sure that we try to keep that patient in [ongoing] treatment," said Angela Fitch, chief medical officer of primary care and metabolic health clinic Knownwell.
A 2022 study of 327 participants found a mean weight loss of 17.3% after 68 weeks of injections with semaglutide, the active ingredient in Wegovy.
- But within one year of withdrawal, the participants regained two-thirds of their prior weight loss, with corresponding changes in risks for conditions like heart disease and Type 2 diabetes.
- Researchers have observed that people's hunger can return voraciously when they drop off the drugs, possibly because the body's left in a GLP-1 deficit that affects brain signaling and feelings of satiety.
Between the lines: Some obesity medicine doctors are worried long-term weight loss will become more difficult for patients who cycle on and off GLP-1s over time.
- Health providers need to give patients frank counseling that if they can't be on the medicine long term, it might not be the best treatment option, Fitch said.
Reality check: There isn't data yet to prove or disprove that obesity becomes harder to treat after discontinuing GLP-1s, said Kevin Hall, a senior investigator at the National Institutes of Health.
- But research does show that a good exercise routine and diet changes like eating more protein can help promote health even if someone doesn't have access to GLP-1s for a period of time, he said.
The bottom line: The idea of a drug meant to be taken forever is understandably daunting to some patients. Getting the message across in a way that gives patients agency is crucial, Lazarus said.
- "Usually what I will communicate to the patients is that these drugs are indicated by the [Food and Drug Administration] so that you could be on it for the rest of your life," he said.
- "But on the other hand, [I say that] if the patient were to stop the drug, really the worst thing that is going to happen is they're going to regain the weight that they lost."
