Weight reduction medicine have surged in recognition — partially as a result of they work. Sufferers on glucagon-like peptide 1 (GLP-1) agonists like liraglutide, semaglutide, and tirzepatide (which is technically additionally a glucose-dependent insulinotropic polypeptide agonist) can lose 10%, 20%, and even 25% of their physique weight.

But when these sufferers cease taking GLP-1s, they have an inclination to regain most of that weight inside a 12 months, research confirmed.

“These medicine work contained in the particular person from a biologic standpoint to change urge for food,” stated Robert Kushner, MD, an endocrinologist and professor at Northwestern College Feinberg Faculty of Medication, Chicago, Illinois, who focuses on weight problems drugs. “And when the drug is gone, that illness comes again.” 

Ongoing remedy might appear to be the apparent answer, however actuality can complicate that. Excessive prices, provide shortages, and faltering insurance coverage protection can render the medicine inaccessible.

Usually, “sufferers are informed by their insurers that they’re not going to cowl a GLP-1 for weight problems,” stated Carolyn Bramante, MD, MPH, an assistant professor on the College of Minnesota Medical Faculty, Minneapolis, Minnesota, who sees sufferers on the M Well being Fairview weight administration clinic.

Different boundaries embody negative effects like nausea, diarrhea, abdomen ache, and vomiting. Some sufferers merely do not need to take a drugs perpetually, as an alternative selecting to take their probabilities holding the burden off sans drug.

In case your affected person should cease GLP-1s, or actually needs to, here is tips on how to assist.

• Discover out why the affected person needs to go off the GLP-1. Ask them that can assist you perceive, steered Jaime Almandoz, MD, affiliate professor of inner drugs and medical director of the College of Texas Southwestern Medical Heart’s Weight Wellness Program. Generally, the affected person or relations fear about security, Almandoz stated. “They could be involved concerning the dangers and will not have had a chance to ask questions.” Almandoz evaluations the drug security information and tells sufferers that research present, on common, individuals achieve again two thirds of the burden they’ve misplaced inside a 12 months. You are not making an attempt to influence them, solely to equip them to make a well-informed alternative.
• Do not let bias have an effect on remedy choices. Sufferers on GLP-1s usually ask: How lengthy will I’ve to take this? The explanation: “We’re biased to consider that this isn’t a illness state, that this can be a character flaw,” stated Sean Wharton, MD, PharmD, medical director of the Wharton Medical Clinic for weight administration in Burlington, Ontario, Canada. Remind your affected person that weight problems just isn’t a private failure however slightly a posh mixture of genetic and organic elements.
• Give sufferers a primer on the biology of weight problems. Science reveals that once we drop some pounds, our our bodies combat again, making an attempt to return to our highest-ever fats mass. Modifications in neurohormones, intestine hormones, satiety mechanisms, metabolism, and muscle operate all converge to advertise weight recurrence, Almandoz stated. To clarify this to sufferers, Almandoz compares gaining fats to depositing cash in a financial savings account. “After we attempt to drop some pounds, it is not so simple as withdrawing this cash,” he’ll inform them. “It’s nearly like the cash that we put into the financial savings account is now tied up in investments that we won’t liquidate simply.”
• Put together sufferers for an uptick in urge for food. When sufferers cease GLP-1s, their starvation and meals cravings have a tendency to extend. “I clarify that GLP-1 medicines mimic a hormone that’s launched from our intestines once they sense now we have eaten,” stated Almandoz. This indicators the mind and physique that meals is on board, lowering urge for food and cravings. Ask sufferers what hungry and full really feel like on the treatment, Almandoz steered. “Many will report that their starvation and cravings are low, that they now have an indifference to meals,” stated Almandoz. Such probing questions may help sufferers be extra conscious of the treatment’s results. “This positions a extra knowledgeable dialog if medicines are to be discontinued,” Almandoz stated.
• Assist their physique modify. “Slowly wean down on the dose, if potential, to keep away from an enormous rebound in starvation,” stated Bramante. In case your affected person has the time — say, they obtained a letter from their insurance coverage that protection will finish in 3 months — use it to taper the dose as little as potential earlier than stopping. The slower and extra gradual, the higher. Almandoz checks in with sufferers each 4-8 weeks. In the event that they’re sustaining weight nicely, he considers lowering the dose once more and repeating with follow-up visits.
• Substitute one intervention for an additional. Normally, sustaining weight reduction requires some intervention, Wharton stated. “However that intervention doesn’t should be the identical because the intervention that obtained the burden down.” If the affected person cannot proceed a GLP-1, take into account an alternate treatment, cognitive behavioral remedy, or a mix of the 2. When sufferers lose protection for GLP-1s, Bramante typically prescribes an older, less-expensive weight reduction drug, equivalent to phentermine, topiramate, or metformin. And typically, insurers that do not cowl GLP-1s (like Medicare), do cowl bariatric surgical procedure, a possible choice relying on the affected person’s physique mass index, general well being, and comorbidities, stated Almandoz.
• Create a behavior template. Kushner asks sufferers who’ve efficiently misplaced weight to take a list of every thing they’re doing to help their efforts. He’ll have them describe how they plan their food regimen, what forms of meals they’re consuming, how a lot they eat, and once they eat it. He’ll additionally ask about bodily exercise, train patterns, and sleep. He logs all of the habits right into a bulleted checklist within the affected person’s after-visit abstract and palms them a printout earlier than they go away. “That is your template,” he’ll inform them. “That is what you are going to attempt to preserve to the perfect of your capacity as a result of it is working for you.”
• Prescribe train. “Rising train just isn’t often efficient for preliminary weight reduction, however it can be crucial for sustaining weight reduction,” stated Bramante. Inform sufferers to start out instantly, ideally whereas they’re nonetheless on the drug. In a research printed final month, sufferers on liraglutide (Saxenda) who exercised 4 days every week had been more likely to maintain weight off after stopping the drug than those that did not work out. (The research was partially funded by Novo Nordisk Basis, the charitable arm of Saxenda’s maker, additionally the maker of semaglutide meds Ozempic and Wegovy.) By establishing sturdy train habits whereas on the treatment, they had been in a position to maintain greater bodily exercise ranges after they stopped. Ask your affected person to establish somebody or one thing to assist them persist with their plan, “whether or not it is seeing a private coach or being accountable to a pal or member of the family or to themself by way of file holding,” stated Kushner. Study extra about tips on how to prescribe train to sufferers right here.
• Assist them create a “microenvironment” for fulfillment. Kushner asks sufferers which of the advisable dietary habits for weight reduction are hardest to comply with: Consuming extra plant-based meals? Reducing again on ultra-processed meals, fatty meals, quick meals, and/or sugary drinks? Relying on the affected person’s solutions, he tries to advocate methods — perhaps going meatless a number of days every week or holding tempting meals out of the home. “For those who go off treatment, meals might turn into extra engaging, and you could not really feel as content material consuming much less,” Kushner stated. “Be sure that your personal what we name microenvironment, your own home atmosphere, is full of wholesome meals.”
• Depend on multidisciplinary experience. Weight problems is a posh, multifactorial illness, so name in reinforcements. “After I see somebody, I am all the time evaluating what different crew members they’d profit from,” stated Kushner. If the affected person lacks diet data, he refers them to a registered dietician. In the event that they battle with self-blame, low shallowness, and emotional consuming, he’ll refer them to a psychologist. It will possibly make a distinction: A 2023 research confirmed that individuals who misplaced weight and obtained help from professionals like trainers, dietitians, and psychological well being therapists regained much less weight over 2 years than those that didn’t obtain the identical assist.
• Reassure sufferers you’ll assist them it doesn’t matter what. Ask sufferers to follow-up inside the first month of quitting treatment or to name again sooner in the event that they achieve 5 kilos. Individuals who cease taking GLP-1s usually report much less satisfaction with consuming, or that they give thought to meals extra. That is when Kushner asks whether or not they need to return on the treatment or concentrate on different methods. Generally, sufferers who achieve weight really feel embarrassed and delay their follow-up visits. If that occurs, welcome them again and allow them to know that every one power circumstances ebb and circulate. “I continuously remind them that I’m right here that can assist you, and there are various instruments or sources that can allow you to,” Kushner stated. “And dispel the notion that it is by some means your fault.”

Kushner reported participation on the medical advisory board or consultancy with Novo Nordisk, WeightWatchers, Eli Lilly and Firm, Boehringer Ingelheim, Construction Therapeutics, and Altimmune. He added he doesn’t personal inventory or take part in any speaker’s bureau. Almandoz reported participation on advisory boards with Novo Nordisk, Boehringer Ingelheim, and Eli Lilly and Firm. Wharton reported participation on advisory boards and honoraria for educational talks and scientific analysis with Novo Nordisk, Eli Lilly and Firm, Boehringer Ingelheim, Amgen, Regeneron, and BioHaven.