When to Stop Weight Loss MedicationPosted: Jun 29 in Weight Loss Medication by Dr. Lazarus
Perhaps the most common question I get from both referring doctors and patients is, “When should weight loss medication be stopped?”
In the good old days, it was thought that if a person could lose weight and keep it off for a time, the body would accept this lower weight as a new setpoint, and that weight regain would then become increasingly unlikely. This is about as true as the notion that the earth is flat or that low-fat diets are superior for weight loss.
Obesity is NOT a 90 day disease
Obesity is now recognized as a chronic health problem much like diabetes. To date, 3 good studies on anti-obesity medications (Belviq, Saxenda and Wegovy) have demonstrated rapid regain once the medication has stopped. In one of these studies, it was after weight loss had been maintained for 3 years – when the drug was discontinued, the weight returned rapidly towards baseline.
What is Normal weight?
People want to go on medication to lose weight – to get back to their “Normal” weight. Unfortunately, the “Normal” weight is wherever the weight got up to – the lower weight is now considered the treated weight. If we used medication to help get to the treated weight, discontinuation of the medication will ultimately result in a return of the weight back up to the abnormally elevated Normal weight – for all of the reasons it got elevated in the first place! These reasons include: biology, genetics, environment, appetite dysregulation, sleep disturbance, stress, abnormal food and a host of others.
In spite of this knowledge, all to often we still see people lose the weight, stop their medication, and come back a year or two later – back at the original weight. And, as a chronic disease, obesity tends to get slowly worse over time – so not only does the weight go back to where it started, it tends to climb an additional pound or two each year.
Benefits of continuing weight loss medication chronically
Staying on an effective weight loss medication is one of your most effective tools to keep weight off. Keeping weight off is really the hardest part of all of this, but when successful it is possible to put the obesity into remission, restore health, quality of life and even lifespan. Because we know that obesity causes 236 other medical problems, 13 of which are cancers, and that it can lower the lifespan 6-8 years, keeping the weight off can have a dramatic effect on our health, but only if it is kept off chronically.
When to stop a weight loss medication
So, to get back to the original question, “When should weight loss medication be stopped?” Generally speaking, weight loss medication should be taken chronically, similar to diabetes medication. It should be stopped if the prescribing doctor and patient decide it is no longer needed, or if it is no longer appropriate. Examples of reasons we might stop a medication include:
- A medication for another medical problem which was causing weight gain is stopped and/or changed to a medication that can help with weight loss. The list of drugs that cause weight gain is quite long – often there is a good alternative that is weight neutral or can aid with weight loss.
- A situation causing weight problems is resolved – retiring from a stressful job, etc.
- A contributing medical problem is resolved – example, getting a knee replacement and being able to get active again.
- Development of a medical problem that makes continued use of the weight loss medication a bad medical decision – for example, if a person has a heart attack, they should no longer be treated with a stimulant-type weight loss medication.
- Older age – as we age, eventually the body loses the ability to gain weight. If this happens, weight loss medication can safely be discontinued without the person gaining weight.
- Other reasons – the prescriber and patient may feel that the benefits of continuing treatment do not outweigh the risks of the treatment.
On the other hand, it should not just be stopped because a person runs out! Treat anti-obesity medications like medications for other chronic diseases. This will help you keep the weight off so you feel better, have more energy, and are free to do all the things you want to do, not held back by extra weight!