What Happens When Patients Stop Weight-Loss Medication?
In this video, Anya Jastrebov, MD, PhD, professor at Yale School of Medicine and director of weight management and obesity prevention at Yale Stress Center in New Haven, Connecticut, discusses what to expect when stopping obesity medications like semaglutide (Wegovy).
Below is a transcript of her notes:
Semaglutide, like other medicines used to treat obesity, must be taken long-term. Just like with any other chronic disease, if the medication is stopped for any reason, the disease will not be cured. So, for example, if someone is taking medication for high blood pressure, if they stop taking that anti-hypertensive medication, their blood pressure goes up and we’re not surprised.
In the same way, if someone is on an obesity medication, when they stop it they experience weight gain – or more precisely, they experience weight gain.
why is that? Obesity is a chronic disease. It is a neuro-metabolic disease, which means that our bodies and minds talk to each other. What happens is that our body is very, very smart. It wants to carry a certain amount of fuel, and the way our body does that is by carrying fat. Our body doesn’t want to carry around too little fat because we will starve, and our bodies don’t want to carry around too much fat because then we won’t be able to do the things we need to do and get our body functions. we will.
So there’s a sweet spot, and we call that sweet spot the “protected fat mass set point.” It is basically the amount of fuel or the amount of fat that your body wants to carry.
Now, in the context of our current obese environment — an environment with all these highly tasting, highly processed foods, lack of sleep, lack of movement and physical activity, stress — all of these different things in our obese environment have a population-level protected fat mass set-point push.
What do these drugs like semaglutide do? It lowers the set point for protected fat mass, and as a result we lose weight.
So what happens when someone takes an anti-obesity drug and then stops taking that drug? Let’s say they lose 40 or 50 pounds and the medication stops. Well, what happens is that the set point for protected fat mass comes back up and weight follows suit.
During the course of our bodies wanting to put that weight back on because treatment has stopped, patients can get very hungry, they can have cravings, and basically their body wants to get back to its higher fat mass set point again because treatment has stopped.
The key and take-home message here is that in order to maintain the defended or realigned fat mass set point, medication must be continued. In order to maintain this weight reduction, you must continue taking the medication, because obesity is a chronic disease. For any chronic disease, we have to treat it for life.