The Atlanta Journal-Constitution
How much weight comes back after stopping a weight-loss drug?
When to test? Where to get tests? And if it’s positive, what to do?
Zepbound, the newly approved weight loss drug, hit the market recently. People seeking out the medication may have to stay on it for the foreseeable future — potentially, for the rest of their lives — if they want to keep the weight off, new research confirms.
A study published last week followed 670 people who had taken tirzepatide, the compound in Zepbound and the diabetes drug Mounjaro, for 36 weeks. Eli Lilly, the company that makes both drugs, funded the study. Tirzepatide regulates insulin levels and slows down the emptying of the stomach. It also acts on areas of the brain that control hunger and appetite. As a result, people can lose significant weight: On average, the study participants lost around 20% of their body weight during that time.
After that, half of the participants continued to take a high dose of tirzepatide for a year while the other half received a placebo shot. Those in the study also underwent lifestyle counseling, ensuring that they were eating fewer calories and exercising regularly.
People who continued taking tirzepatide for an additional year lost, on average, another 5.5% of their body weight. Those who were switched to the placebo, however, gained 14% of their body weight on average. Those on the placebo also tended to have higher cholesterol, blood sugar and blood pressure than they did while taking tirzepatide, said Dr. Louis Aronne, the lead author on the study and the director for the Comprehensive Weight Control Center at Weill Cornell Medicine.
None of this surprises the doctors who prescribe these drugs.
“We wouldn’t give someone a blood pressure medicine and be like, ‘Great, your blood pressure’s better, you should go off it,’” said Dr. Michelle Hauser, obesity medicine director of the Stanford Lifestyle and Weight Management Center. “Somehow people have this magical thinking around obesity, like you’re going to take this drug and it’s going to cause weight loss and just stay that way.”
Research has shown similar outcomes for those who take semaglutide, the compound in the diabetes drug Ozempic and weight loss drug Wegovy.
People in the placebo group did not regain all the weight they lost in the first 36 weeks of the study. It’s not clear whether they kept some weight off because of a lingering effect of tirzepatide, Aronne said, or if the lifestyle counseling played a role.
Still, weight gain is often a reality for the many patients who want to come off these medications, said Dr. Melanie Jay, director of the NYU Langone
Comprehensive Program on Obesity. The side effects can be taxing, especially as people first begin the medications: Fifty-three people dropped out of the trial because of side effects such as nausea, diarrhea and constipation.
Cost is also a factor — insurance coverage can be spotty, and the list price of Zepbound is more than $1,000 a month, though some patients end up paying less at the pharmacy counter. Often, patients struggle to find the medications in the first place — some doses of Wegovy and Ozempic are in shortage, and Mounjaro has also faced supply challenges over the past year.
And some patients just don’t want to deal with injecting themselves indefinitely.
“Nobody wants to take medicine forever,” Jay said. “For anything.”
Some pairs have abandoned the strong jump-shift by responder for “weak jump-shifts.” If partner opens one club, bid two spades on K J 10 8 4 2, 7 6 5, 4, 6
5 4. Weak jump-shifts are descriptive and embrace the modern philosophy that obstructing the opponents is as vital as finding your own contract.
Still, I wonder whether crowding your own auction, and maybe getting too high with your first bid, is a winning approach. Moreover, strong jump-shifts facilitate slam bidding: You tell partner promptly that slam is possible, and he can cooperate or not.
Today’s North-South got to six spades, missing the best theoretical spot of seven clubs. South took the ace of diamonds, drew trumps and cashed the A-K of clubs. When West discarded, South took the ace of hearts and finessed with dummy’s jack. East won and cashed a diamond.
After South saw the 4-1 club break, he could have succeeded by taking his third high club, the ace of hearts and his last two trumps. East would save the jack of clubs and Q-10 of hearts, and
South could exit with his last club for an end play.
South’s best play requires no such guessing. He can draw trumps, take the A-K of hearts, ruff dummy’s jack, lead a club to the ace and exit with a diamond. The defender who wins must lead a club, letting South pick up the suit, or concede a ruff-sluff.
I can accept weak jumpshifts at matchpoint duplicate, but at IMPs or party bridge, where accurate bidding on game and slam hands is vital, I prefer the strong flavor.
While COVID-19 has become a regular part of respiratory virus season, community testing centers and drive-thru sites where you could determine whether it’s the source of your sniffles have all but vanished.
At-home tests are still a valuable tool to protect yourself and others from the virus, though, and they remain widely available in pharmacies and grocery stores.
Here’s what to know about how these tests work, how to get them and when to take one.
Q: Do rapid tests still work?
A: Yes. Even with a new variant, JN.1, dominating cases nationwide, rapid tests should be able to accurately capture whether you are contagious. That is because rapid tests detect a protein inside the virus rather than the spike protein on the surface of the virus that has changed across variants, said Aubree Gordon, an infectious disease public health researcher at the University of Michigan. Still, there’s a catch: You need to test at the right time.
Q: So when should I test?
A: Experts recommend testing once you develop symptoms and throughout your illness, if possible. But if you are low on tests, you may want to wait around three to four days after you have developed symptoms. “If it were me, and I knew I only had one test, and I became symptomatic this morning, I would not use that test today,” said Dr. Michael Mina, a former Harvard University public health researcher who is now the chief science officer for eMed, a health care technology company that offers COVID testing and virtual care. “I’d use it the day after tomorrow.”
If you’re negative, test again 48 hours later to rule out a false negative. If you were exposed to someone and do not develop symptoms, the Food and Drug Administration recommends waiting five full days to test.
If you’re going to spend time with people who are at high risk for severe COVID, like someone in a nursing home, you should test immediately beforehand, whether or not you have been exposed. It’s best to stay home if you have any symptoms, like a runny nose, sore throat or chills, no matter what the test says.
Q: The tests are expensive. Where can I get more free ones?
A: Experts acknowledged that it’s harder to get free tests since the COVID-19 public health emergency ended in 2023 and many insurance companies stopped covering the cost. But you can still access them.
You can order up to eight free home tests per household from the federal government through COVIDtests.gov. Another option for free tests and treatment is the National Institutes of Health’s Home Test to Treat program, which Mina is involved with. You may be eligible for free tests through the program if you are uninsured, are considered “underinsured,” are enrolled in Medicaid or Medicare, or if you receive care through the Department of Veterans Affairs or Indian Health Services.
Medicaid and the Children’s Health Insurance Program will cover home tests through September 2024. While Medicare generally doesn’t cover overthe-counter products, if you’re on Medicare and a doctor orders a PCR or rapid test for you, it should not cost you anything. Some Medicare Advantage plans may offer coverage for home tests. You can also use a health savings account or a flexible spending account to pay for them.
Some public health centers make free or low-cost COVID tests available to people who are uninsured or members of underserved communities. And some cities still distribute free COVID tests at schools and public libraries.
Q: Should I use an expired test?
A: Probably not, because it won’t be as accurate. But make sure your test kit is actually expired. The FDA has a list of tests with extended expiration dates. Search the lot number on your test box to check.
If you use an expired test and “it’s positive, believe it,” Mina said. But you shouldn’t use a negative result on an expired test to rule out an infection.
Q: I got a positive result. Do I still need to report it to public health officials?
A: A positive result means you are infected and probably contagious. You should notify close contacts and isolate yourself to avoid exposing more people. It’s also good practice to report your positive result, which can help public health officials tailor their guidance and allocate resources appropriately. You can do so through the NIH website MakeMyTestCount.org. (Tests performed at a doctor’s office, in a lab or during a telehealth appointment are reported automatically.)
Q: Could my positive result be wrong?
A: False positives are “pretty rare,” Gordon said. But if you want some peace of mind, she added, you can test again with a different kit or ask your doctor for a PCR test, which can pick up smaller amounts of virus than a rapid test.
Q: Does the darkness of your COVID test line correspond to how sick you are?
A: If you test every day of your infection, you may notice the pink test line go from faint to bright before fading again. Researchers have found that the appearance of the test line does tend to indicate how much viral protein is present. And if you have a lot of virus in your body, you may also be more likely to spread it to other people, Gordon said.
But the darkness of the line can also vary depending on how you swab, how old the test is, whether you’ve been vaccinated or previously infected or even what time of day you test.
Q: How long are you contagious after you test positive?
A: You may be spreading virus particles a day or two before your first sniffles appear; this viral shedding can peak two or three days after you develop symptoms. You become less likely to transmit your infection later on in your illness. While some people test positive for longer, most will test negative by Day 10.
Ideally, you should test throughout the course of your infection until you are negative, said Zoë McLaren, an associate professor at the University of Maryland, Baltimore County. That will let you know when it’s safe to see other people again.
Q: I had all the classic COVID symptoms, but I never tested positive. Did I do it wrong?
A: It’s possible that you didn’t swab properly or that you had another illness. We’re in the middle of RSV and flu season, after all.
But the latest variant is so contagious that if someone you live with has COVID, it’s very likely you’ll get infected, said Dr. Marc Sala, co-director of the Northwestern Medicine Comprehensive COVID-19 Center in Chicago. If you’ve been vaccinated or infected before, your immune system will recognize the pathogen and kick into gear to fight it, giving you symptoms. But the virus might not build up to high enough levels in your nose to register on a home test, meaning that even if you feel ill, your test could remain negative, and you are most likely less contagious or possibly not contagious at all.