A new study suggests that people who stop taking a drug like Ozympic lose about 25 percent of their weight after a year. But here’s the catch: It doesn’t know if that weight loss is muscle rather than fat.
This medical mystery sheds light on the undiscovered side effects of semaglutide, terzapatide, and other drugs prescribed for type 2 diabetes or weight management. Some preliminary research shows that 40 to 60 percent of the weight lost during treatment can be built on muscle mass.
While it is well documented that patients regain weight after discontinuing this medication, it is not clear what the pounds are.
“If the regained weight is disproportionately fat, people will eventually have a worse fat-to-skin mass ratio than before, which may have negative consequences for their health,” explains medical researcher Brajan Badini, co-first author of the study by a team from the University of Cambridge in England.
Their published paper provides a comprehensive review of the evidence on weight gain after cessation of treatment, and is also the first to model its approach up to 52 weeks after cessation of treatment.
Weight management after stopping treatment is important, as more than one billion people worldwide live with obesity. GLP-1 drugs have shown to be very effective, sometimes helping individuals lose 20 percent or more of their body weight.
The drug mimics a natural hormone called glucagon-like peptide-1 (GLP-1), which helps control blood sugar and suppress appetite. Yet due to gastrointestinal and other side effects, as well as high prices or prescription complications, about half of patients stop using GLP-1 drugs within the first year.
“Drugs like Ozympic and Vigoi work like brakes on our appetite, we feel full sooner, which means we eat less and lose weight,” says Bodini.
“When people stop taking them, they’re essentially taking their foot off the brake, and that can lead to rapid weight regain.”
To model how much weight patients regain after stopping treatment, the researchers examined 48 relevant studies. Their limitations and contradictions soon became apparent.
Some studies only tracked patient weight results for a few weeks, and there was significant change when patients were followed up after stopping the medication. Overall, weight gain after GLP-1 “is largely underreported in the literature,” the authors say.
Therefore, the researchers selected only a few high-quality publications that met certain criteria. These studies must be randomized, include more than 100 participants each, report a weight loss of at least 3 kilograms (6.6 pounds), and include at least one follow-up 12 weeks after stopping the medication.
As a result, they filtered their systematic review to only six randomized controlled trials (RCTs) involving more than 3,200 people. This particularly rigorous study followed participants for up to 52 weeks after stopping the weight loss medication.
This (somewhat small) meta-analysis revealed that after GLP-1 patients experienced rapid initial weight regain that gradually slowed. A year after stopping the drug, they regained 60 percent of the weight they had lost during treatment.
The researchers then used this data to estimate the effects after 52 weeks. They predicted that weight would resume at 60 weeks and decrease after patients regained 75 percent of the weight lost during treatment. But why?
It is possible that the drug can help patients develop healthy eating habits or induce physiological changes, such as changing hormone levels or hypothalamic activity.
However, a large portion of the weight lost is muscle, and it is unlikely that lean mass will recover as quickly as fat mass after treatment. In addition, newer, more effective drugs such as semaglutide and tirzepatide are less effective in maintaining lean mass – that is, they help in weight loss regardless of the source.
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Therefore, prescribing strategies that lower the dose can help patients maintain minimal fat loss. It’s also helpful for doctors to encourage patients to adopt a healthy diet and exercise, which are vital to continued well-being.
“It is important to advise people to improve their diet and exercise, rather than relying solely on drugs, as this can help them maintain good habits once they stop taking them.”
This study was published in 1991 eClinical Medicine.
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