Just How Long?

We have all read the stories...people come off semaglutide (Wegovy/Ozempic) or Tirzepatide (Zepbound/Mounjaro) only to gain back all the weight they lost.  It is a fact, well documented in the medical literature.  So the obesity specialists believe  these medications may be for life.  

When we think about obesity as a chronic illness, which it is, it has the potential to relapse.  So we lose weight with diet, exercise, or medications, only to find the scale creeping right back to where it began.  This is the relapse.  It is not falling off the bandwagon.  And it's NOT YOUR FAULT.  

Our body has (just like temperature, blood pressure, pulse, respiration rate) a "weight set point" that it wants to return to when it has been changed.  So when we are set for 250, we tend to gravitate back to that set point.  Some specialists believe that if we change that set point, and keep it there for a while, we can recalibrate it.  And that may work for some after being at that point for a period of time.  

So the answer is going to require more studies in the future.  

If we consider other chronic diseases such as diabetes, high cholesterol, high blood pressure to name a few, just because we get normal numbers (labs, vital signs) we as physicians would never consider taking our patients off the medications that help them control the disease.  Obesity is no different.  The number on the scale reflects when the disease is being managed, and that number can go back to abnormal if medication is stopped.  

I think shared decision making with patients is important.  So when I have a patient want to try to come off medications, I tell them the data, and ask them to stay open to going back on a maintenance dose if the food chatter returns, if the appetite goes back to being "hangry", or if the weight starts to creep back.  All it may take is a maintenance dose to keep that under wraps.  

Ultimately, it's all about finding a healthy place to live, finding what works best for each person as an individual, and living well!