Some on weight-loss drugs try DIY approaches to curbing use
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’ll 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.
“To me, it’s a help, it’s an aid,” said Donna Cooper, 62, of Front Royal, Virginia, who lost nearly 40 pounds in nine months using Wegovy along with diet and exercise. “At some point you have to come off of them. I don’t want to be on them forever.”
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 — and tested — to be taken continuously, experts said.
“We are not an injection shop,” said Dr. Andres Acosta, an obesity researcher and medical adviser at the Mayo Clinic. “I don’t think they should be used in intermittent fashion. It’s not approved for that. They don’t work like that.”
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.
“Many of them want to step down or de-escalate their dose,” she said. “And they’re also wanting to ultimately discontinue the medication.”
Taking a ‘breather’
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’t like side effects such as nausea and constipation. Others want to stop for holidays or special occasions, or just because they don’t want to take the weekly shots indefinitely.
One of Saunders’ patients, a 53-year-old New York man, lost 70 pounds last year using Mounjaro. He told Saunders he wanted to take “a breather” 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 — $1,000 to $1,300 per month — and insurance coverage varies or because demand has far outstripped
supply, Rothberg noted.
“It’s being imposed on them,” she said. “By necessity they have to go off the medication and kind of figure it out.”
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.
“These drugs are just a super-suppressor of these native signals,” Rothberg said. “And we should expect that’s going to occur.”