Millions of Americans who have dropped pounds and boosted their health using popular obesity drugs like Wegovy are facing a new dilemma: What happens if they stop taking them?
Many worry, rightly, that they鈥檒l regain weight and revert to old habits. In clinical trials, patients who paused the drugs put back on most of the weight they lost.
But others are gambling on a do-it-yourself strategy to ease off the drugs and stay slim by stretching out doses, taking the medication intermittently or stopping and starting again only if needed.
鈥淭o me, it鈥檚 a help, it鈥檚 an aid,鈥 said Donna Cooper, 62, of Front Royal, Virginia, who lost nearly 40 pounds in nine months using Wegovy along with diet and exercise. 鈥淎t some point you have to come off of them. I don鈥檛 want to be on them forever.鈥
More than 3 million prescriptions for the new medications are dispensed each month in the U.S., according to recent data from the health technology company IQVIA. They include semaglutide, the drug in Ozempic and Wegovy, and tirzepatide, the drug in Mounjaro and Zepbound.
But many people don't stick with it. One recent study published in the journal Obesity found that just 40% of patients who filled a prescription for Wegovy in 2021 or 2022 were still taking it a year later.
Doctors who treat obesity stress that the disease is a chronic condition that must be managed indefinitely, like heart disease or high blood pressure. The new injection drugs work by mimicking hormones in the gut and the brain to regulate appetite and feelings of fullness. They were designed 鈥 and tested 鈥 to be taken continuously, experts said.
鈥淲e are not an injection shop,鈥 said Dr. Andres Acosta, an obesity researcher and medical adviser at the Mayo Clinic. 鈥淚 don鈥檛 think they should be used in an intermittent fashion. It鈥檚 not approved for that. They don鈥檛 work like that.鈥
Donna Cooper pets her cat Cade at her home in Front Royal, Va., March 1, 2024. (AP Photo/Amanda Andrade-Rhoades)
Despite that directive, some patients who achieved their health and weight goals with the drugs are looking for an off-ramp, said Dr. Amy Rothberg, a University of Michigan endocrinologist who directs a weight-management and diabetes treatment program.
鈥淢any of them want to step down or de-escalate their dose,鈥 she said. 鈥淎nd they鈥檙e also wanting to ultimately discontinue the medication.鈥
The reasons for pausing the drugs can vary, said Dr. Katherine Saunders, an obesity expert at Weill Cornell Medicine and co-founder of the obesity treatment company Intellihealth. Some patients don鈥檛 like side effects such as nausea and constipation. Others want to stop for holidays or special occasions 鈥 or just because they don鈥檛 want to take the weekly shots indefinitely.
One of Saunders鈥 patients, a 53-year-old New York man, lost 70 pounds last year using Mounjaro. He told Saunders he wanted to take 鈥渁 breather鈥 from the medication to see how his body reacted. On her advice, he has been stretching out injections to every 10 days or two weeks, instead of weekly, since December.
Other patients have been forced to ration or halt doses because the drugs are costly 鈥 US$1,000 to $1,300 per month 鈥 and insurance coverage varies or because demand has far outstripped supply, Rothberg noted.
鈥淚t鈥檚 being imposed on them,鈥 she said. 鈥淏y necessity, they have to go off the medication and kind of figure it out.鈥
But hoping the drugs' benefits will last even after stopping them ignores the fundamental biology of obesity, experts said. The disease affects the way the body processes and stores energy, causing it to accumulate weight. The new drugs alter that process and when patients stop, the disease returns, often with a vengeance.
Many people dropping off the medications report a sharp rise in symptoms of obesity. They include so-called food noise or intrusive thoughts of food; raging hunger; and decreased feelings of fullness when they eat.
鈥淭hese drugs are just a super-suppressor of these native signals,鈥 Rothberg said. 鈥淎nd we should expect that鈥檚 going to occur.鈥
Tara Rothenhoefer, 48, of Trinity, Florida, lost more than 200 pounds after joining a clinical trial for Mounjaro nearly four years ago. She now takes the lowest dose of the drug every four to eight weeks, but she worries when her weight fluctuates by a few pounds.
鈥淚t scares the daylights out of me to see the numbers on the scale going up,鈥 she said.
Some patients who stop the drugs and start again find they can鈥檛 tolerate the medication, winding up with severe gastrointestinal side effects, Acosta said. Others find the drugs don鈥檛 work as well when they restart them, Saunders added. But there's no data on the long-term effects of intermittent use.
鈥淚 don鈥檛 think it鈥檚 a strategy that will work for most individuals, but it could be an option for select patients,鈥 Saunders said.
Donna Cooper's cat, Cade, bats at her exercise bike at her home in Front Royal, Va., on Friday, March 1, 2024. (AP Photo/Amanda Andrade-Rhoades)
Donna Cooper has heard that people gain back weight when they stop the drugs, but she hopes to be an exception. She's on her last box of Wegovy injections. Once she's done, Cooper said she鈥檒l just continue with a strict diet and exercise plan.
鈥淚 just needed a crutch to get everything back in order,鈥 said Cooper, who has gone from a size 16 to a size 10. 鈥淎nd I am excited to be done.鈥
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute鈥檚 Science and Educational Media Group. The AP is solely responsible for all content.
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