Weight-loss drugs like Wegovy require a lifetime commitment. Stop taking them, and you’ll almost always gain back the weight you lost.
But many patients don’t want to hear that. Dr. Padmaja Akkireddy, an endocrinologist at Nebraska Medicine, estimated that more than half of her patients don’t want to stay on a weight-loss drug long term. And data shows that most Americans quit the drugs within a year of starting them.
Even Oprah Winfrey said that she stopped taking a weight-loss drug “cold turkey” for a year, then gained back 20 pounds. “I tried to beat the medication,” she told People magazine. It was then that she realized “It’s going to be a lifetime thing,” she told the magazine.
Many people have to stop taking the drugs because they can no longer afford them. Others grow tired of side effects like fatigue, nausea and constipation. Some just don’t want to rely on a drug forever.
Frequently, patients believe they will be the exception, said Dr. Michelle Hauser, the obesity medicine director of the Stanford Lifestyle and Weight Management Center. They seem to think, “That’s not going to be me, I’m not going to take them forever,” Dr. Hauser said.
Medical authorities at the highest level have pushed that misconception. Health Secretary Robert F. Kennedy Jr., for one, has said weight-loss drugs can allow people to “reset,” suggesting they are a temporary bridge, not a long-term tool.
But research has repeatedly shown that most people need to stay on the drugs to maintain weight loss or other health benefits. This month, the latest big study to demonstrate people regain weight showed that the average person who used weight-loss drugs returned to their starting weight around a year and a half after stopping them.
People who go off the medications typically follow a pattern: When the medication wears off, food cravings and appetite can surge back. And, as with any diet regimen, when people lose a lot of weight quickly, their metabolism slows down, raising the risk they will regain weight. Even people who attempt to maintain a careful regimen of diet and exercise after going off the drugs can struggle to keep the weight off.
It’s not impossible, but it is extremely difficult. Dr. Hauser estimates that fewer than 10 of her patients have successfully kept off 75 percent or more of the weight they lost after going on a GLP-1, without turning to another weight-loss medication or undergoing bariatric surgery.
“Those are people that are working out two hours a day, tracking what they’re eating, they’re really working hard,” she said. “I haven’t had anyone that just tapers off, isn’t really putting that much thought into it, and just keeps the weight off. I’ve never seen that happen.”
Because people frequently lose muscle on weight-loss drugs, when they do regain weight, it is often in the form of fat, Dr. Hauser said. That means that if people cycle on and off these medications, they can end up being essentially less healthy, even at the same or a slightly lower weight than before they started the drugs.
In many cases, patients want to stay on the medications — but have to go off the drugs when their insurance stops covering them.
Jeremy Busche, 53, was effectively forced to stop taking Ozempic this past fall. He is prediabetic, and his insurance company moved to cover the medication only for people with Type 2 diabetes. Over six months on the medication, he had lost around 40 pounds, and his blood sugar levels were improving. But when he went off the drug, he was hungry again — furiously and constantly.
In the two weeks after he stopped the medication, he regained around 15 pounds.
“I just told myself I can’t do this,” he said. After about a month’s interruption, he decided to get back on Ozempic, this time paying for it himself.
Some patients don’t want to take that risk and decide it is worth it to stay on the drug long term.
Ariel Neumann, 34, started Wegovy in 2023, after she gained weight during law school and while treating a thyroid condition. After around four months, she had lost 25 pounds.
“Maybe you’ll go off it,” she recalled her doctor at the time saying.
Ms. Neumann wasn’t convinced. “For the first time that I can remember, since childhood, I have so much mental capacity for other things,” Ms. Neumann said.
“Why wouldn’t I stay on it?” she added.
Part of why Ms. Neumann wanted to continue taking the medication is a growing body of evidence that these drugs have health benefits beyond weight loss. Wegovy and Ozempic have been shown to reduce the risk of heart issues independent of how much weight they lose, and to improve kidney and liver disease.
Even if someone is no longer losing weight while on these drugs, the medication may still confer cardiovascular and other benefits, said Dr. Nils Krüger, a researcher at Harvard Medical School.
Last month, the World Health Organization released new guidelines suggesting that adults with obesity should stay on them long term to maintain weight loss. Currently, there are no guidelines for de-prescribing these medications.
Doctors are caught in a de facto experiment, trying to modulate between patients’ desires or financial need to stop taking the drugs and the reality that they will most likely gain back weight when they do.
“You ask five different obesity medicine doctors, you get five different answers,” Dr. Hauser said.
Dani Blum is a health reporter for The Times.
The post The Hard Truth of Weight-Loss Drugs: You Probably Need Them Forever appeared first on New York Times.
