Is Weight Loss Medication a Lifelong Commitment? Understanding the Personalized Approach

Understanding the Personalized Approach with Medications

A common question I hear in my clinic is whether weight loss medications are a temporary solution or something that requires lifelong use. The reality is that every patient’s journey is unique, with a personalized treatment plan tailored to their specific needs. However, in my clinical experience, I’ve observed that most patients maintain their results when they continue to follow the plan that helped them achieve their ideal body composition and metabolic health. This finding aligns with the experiences of my colleagues and is supported by scientific research.

It’s important to break the stigma surrounding medication use. Embracing the treatment plan that’s best suited for your body could dramatically improve—and even save—your life. Weight loss often triggers biological changes that make it difficult to maintain long-term results, which is why a medical approach is not only appropriate but essential for many people.

A Closer Look at the STEP 1 Trial Extension

A recent review of the journal article, “Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension,” offers valuable insights into this topic.

The STEP 1 trial aimed to examine changes in body weight and cardiometabolic risk factors, such as high blood pressure and cholesterol, after discontinuing the use of semaglutide—a medication used for weight loss.

In the original trial, 1961 adults were randomized to receive either semaglutide (Wegovy) 2.4 mg injections (including a 16-week dose escalation) or a placebo for 68 weeks. Both groups also received lifestyle interventions, including exercise and improved nutrition. By week 68, the group using semaglutide experienced an average weight loss of 17.3%, while the placebo group saw an average loss of just 2.0%.

The participants, who had a body mass index (BMI) of at least 30 (or 27 with at least one weight-related condition like high blood pressure, sleep apnea, high cholesterol, or heart disease), did not have diabetes.

At the end of the 68 weeks, all treatments, including lifestyle interventions, were stopped. An observational study then followed 327 of these adults for another year. After stopping semaglutide, participants regained an average of 11.6% of the weight they had lost, while those in the placebo group regained 1.9%. Additionally, the cardiometabolic markers—such as cholesterol and blood pressure—began to return to their baseline levels by week 120.

These results highlight a crucial point: obesity and excess weight are chronic conditions that require ongoing treatment to maintain improvements in both weight and overall health. After just one year of discontinuing semaglutide and lifestyle interventions, participants regained about two-thirds of the weight they had previously lost, with similar changes observed in cardiometabolic variables.

Unanswered Questions and Future Considerations

Despite these findings, several questions remain:

• Would intensive lifestyle changes (nutrition, exercise, stress management, sleep) lead to significantly different outcomes after stopping semaglutide or other weight loss medications?
• What would the results look like for patients who taper down from a high dose of semaglutide to a lower maintenance dose, such as 0.5 mg weekly?
• What are the long-term outcomes, 5 to 10 years after stopping semaglutide, in terms of weight loss and other health markers?

Remember, you are more than just a statistic. Your journey is unique, and your treatment plan should reflect that. Research and evidence are tools to guide us, but the best decisions are those made with you in mind.

In good health,
Dr. LaRocca