When to Stop Weight Loss Medication

Posted: Jun 29 in Weight Loss Medication by
prescription pill bottle

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!


163 Responses to “When to Stop Weight Loss Medication”
  • Sarina says:

    Just a quick shout out! I appreciate your newsletters. I have been very busy lately and they help keep me focused on my health and happiness.

    Kudos to the team and all you do

  • Mary Szullo says:

    Dr Lazarus,
    Your newsletters are phenomenal! Really enjoy the information
    and it spurs me to “keep to it.” Enjoy reading about the habits to keep weight off or maintain and the types of medication that are available.

  • Doren Asad says:

    On weight management meds

    Lost weight on a high protein diet and regained it and more

    • Dr. Lazarus says:

      Congratulations on successfully losing weight on a high protein diet. Unfortunately, many people who lose weight on a diet struggle to maintain the weight loss. The body is very good, through lowering metabolism and alterations in gut hormones, at sustaining its fat mass so most who lose end up back where they started. That’s why we can’t rely on diet alone. We need to continue not only a healthy eating program, but add physical activity (1-2 hours per day), intensive lifestyle intervention (modifying the environment/ stress / sleep to make it more conducive to sustaining weight loss), and pharmacotherapy to successfully treat obesity. See other articles on this blog regarding metabolic adaptation and you will have an idea why obesity has been recognized as a chronic disease, and any treatments used must therefore also be chronic.

  • TCE says:

    I recently came off wegovy after about six months on the drug. I had a lot of success with it. I have read multiple reviews saying that weight gain is rapid after you stop the drug. Looking for some information about whether or not this would hold true if I was eating healthy, nutrient dense foods and staying active. Thank you.

    • Dr. Lazarus says:

      Medications for chronic health conditions including obesity only work so long as they are continued. You are correct – If Wegovy is used for weight loss for 6 months, then stopped, it is likely that the weight will return to pre-treatment levels. The indication in Wegovy label is for “Chronic weight management.” The old thinking that you could treat with weight loss medication for a few months and then stop it and the weight will stay off has been found to be inconsistent with what we now know about body weight regulation. Weight loss is met with something we call “Adaptive thermogenesis.” The metabolism slows, and the gut hormones change favoring weight regain. It is certainly possible to sustain weight loss without medication – but it takes a lot more than just a change in the way you are eating. Combine that with significant physical activity (1-2 hours / day), eliminate stress from your life, improve sleep hygiene, address any other medical issues including getting off any medications that contribute to weight gain, intensive lifestyle intervention, etc. I like to joke that if you quit your job, win the lottery and become a vegan yoga instructor in Maui that we can probably stop the medication 🙂 That’s why we generally need to continue medications chronically. Hope this helps!

  • Keriann says:

    So my insurance just denied my wegovy scrip after a PA that my pharmacy did.( I work for a healthcare facility that provides weight and wellness doctors) I have been on ozempic for 1 yr this month and lost over 40lbs. But our new insurance will not cover ozempic anymore it will only cover wegovy now. The denial said they denied it because my BMI is not over 30. Well my BMI was over 30 but I have been on ozempic and my doctor said I can stay on it for life for weight maintenance. ( how did my pharmacy get my weight to give it to my insurance company?) Anyways…I am going to call the insurance company in the am. I will be out of my ozempic in 2wks. . Ok example say u have hypertension and take Blood pressure medicine to lower it… you don’t stop the medication because it lowered it. This is not including weight loss and diet to lower it. The medication helps with the medical condition. Example you have depression and u are on Zoloft… u don’t stop taking Zoloft because u feel better?!? My anxiety is so high right now.

    • Dr. Lazarus says:

      Ask your provider to re-submit using the original BMI that was treated. I believe this is appropriate, similar to the example you are citing with blood pressure – a person with treated stage 3 hypertension that is now in the normal range still has stage 3 hypertension. Most providers I know code the original BMI, not the treated BMI.

  • Keriann says:

    Thank you , I will contact them

  • Michelle Ryan says:

    My daughter is on Saxenda and it’s helped her lose 4 stone. She’s reaching a weight she is happy with. Is it OK for her to stay on Saxenda indefinitely even as a slimmer person?

    • Dr. Lazarus says:

      Yes – Saxenda (and Wegovy) is approved for chronic weight management in adults, and now also in kids down to age 12. Chronic means that it can safely be used indefinitely. In fact, current thinking is that obesity is a chronic illness requiring lifelong treatment. All of the new anti-obesity medications are studied for long-term use. Saxenda has been shown not to have any increase in cardiac risk as well.

  • Carolynn says:

    Hi! I have been on Mounjaro for about a week. The weight loss and absence of cravings already is incredible. If my weight gain originally was due to pregnancy and breastfeeding and I’m done having kids, do I now still likely have chronic obesity and need to stay on it indefinitely? Thanks.

    • Dr. Lazarus says:

      What a great question! Everybody is different – I usually take this one on a case by case basis. But no, I would not diagnose obesity based on a post-partum weight. I think how long to treat would be a highly individualized decision.

  • Heather says:

    Hi, I have been using saxenda continuous for about 4 years now after being successful loosing 80 pounds…and now I have been sadly gaining at a rather rapid pace that is just devastating me! I have kept the weight off for 3 full years and not making any diet changes and still giving myself the injection, and I have searched and scoured for an answer or solution. Is it possible to build up a tolerance and if so how do I break that? Would it be possible or safe to try one of the other medications? I believe my obesity is genetic and have always struggled hard to loose and Saxenda and Ozempic were the best things that I have ever done. I knew for once what it was like to not be over weight and I loved it!!!! 🙂

    • Dr. Lazarus says:

      This is a very good question. I can not give medical advice in a blog, but generally speaking, people gain weight over time – whether or not on medication, after bariatric surgery, etc. However, if I had a patient in this situation, I’d consider adding another medication although this is considered “off-label” or changing to a stronger weight loss medication – Wegovy when available again later this year, or Mounjaro (off-label for weight loss). This is definitely a question for an obesity medicine specialist! I presume you are working with one? If not, where do you live? Perhaps I can recommend somebody (or check the find a clinician tab at http://www.obesitymedicine.org and search for ABOM certified physicians).

  • Evgenia Protogeraki says:

    I am on ozempic for the last 3 months. I have never been obese. I am 168 cm and used to weigh my max 75 kg. but according to my doctor i was 4 kg overweight. i lost 20+ pounds and i have one more week to go. i am dreading that i ll regain my kilos. I have ALWAYS been exercising apart from a period of 3 months last year when i was also on cypralex.That resulted on my weight gain. i have always been concious with what i eat. i generally eat clean and protein oriented. But i have always had a big apetite and have been trying to control it. Gym (cardio and weight lifting) is also part of my life at least 4/week. If i stop ozempic that is recently causing me a lot of tireness and palpitations, am i very likely to regain??

    • Dr. Lazarus says:

      Generally, weight is regained if a medication is used to take the weight off and the medication is later stopped. There are many more cost-effective options besides ozempic and the other GLP-1 injections. Since the weight was gained on an anti-depressant, why not consider a weight loss medication based around that pathway? Wellbutrin or Contrave? Again, this is a question for an obesity medicine specialist, and the use of contrave in a person without obesity would be construed as “Off-label.” However, Wellbutrin for depression recurrence would be “on-label.” It is my experience that keeping weight off is harder than losing it in the first place! However, since weight gained not that long ago and over short time, I’d think about trying to treat for ~12 months, then gradually wean treatment and see if your exercise and healthy eating are adequate to keep the weight off…

  • Heather says:

    Thank you for your response I am so appreciative of this. I live in
    Saskatchewan, Canada. Seeking specialist advice in my part of the world
    Is so frustrating! I will check the link you posted and the other 2 medications you mentioned. I was very lucky I think to have found this blog post, making sense of obesity, morbid obese ect, that it is considered chronic and medication should be taken as such, just like a diabetic. Thank you so much again for your time and information.!!!

  • Kellie says:

    I have been on Wegovy for about 6 to 7 months. I have lost about 20 lbs. My weight gain was due to stress, and I believe a slight imbalance in my hormones since I had my gallbladder removed in 2016. I am generally physically fit. I run marathons and have my entire life. I am in my mid-forties. I want to get off the Wegovy because my hair is starting to fall out. If I get off the Wegovy at this point will I gain those 20 lbs back? I still have about 10 pounds to lose to get back to the original weight which I was most of my life. If not, is there something I can do about the hair loss? I have been increasing my vitamins, is there anything else I can do? Thank you so much.

    • Dr. Lazarus says:

      Wegovy is FDA-approved for chronic weight management. Hair loss may be related simply to losing weight with or without Wegovy – it can take 6-12 months for the hair to regrow after what is called telogen effluvium. I have not seen hair loss persist as a result of Wegovy in my patients. Data suggests that stopping the Wegovy will result in regaining the weight lost due to Wegovy. Further, the first 3 doses of Wegovy remain unavailable nationwide, so if you go off of it and start regaining weight, it is unlikely you will be able to go back on it any time soon. If you are otherwise doing well, and especially if you still have more weight to lose, I’d consider continuing the Wegovy, and see if hair comes back over next 6 months. Please review these suggestions with the prescribing obesity medicine physician.

  • Bridget says:

    I have been on ozempic for 6 month and lost 40lbs by combining the medication and using WW and exercise. I had gained weight due to having a baby and then I sustained and I injury. If I’m not chronically obese, will I gain all my weight back? This is all so confusing. Asking my provider they state patients who gain their weight back it’s usually due to returning to poor lifestyle habits…but reading more it sounds like that’s not the case???

    • Dr. Lazarus says:

      While the provider is technically correct, it is believed that lifestyle is mostly driven by our body hormones, not by willpower – telling you it is because of poor lifestyle habits blames the patient for the disease of obesity – it is like telling a person with depression to think happy thoughts. Pregnancy is a whole different ballgame. No – I think if weight returns to the pre-pregnancy weight, that is desirable. However, because medication is being used to facilitate the return to pre-pregnancy weight, I would be inclined to continue the medication for some time! Most mom’s I work with find it more challenging, not less, once there is a little one in the house!

  • April says:

    I’ve been very successful on Wegovy and I’ve reached by goal weight and now have a BMI of 24. I’m afraid that if I continue at the highest dosage I will continue to lose weight and lose too much weight. I understand that I must stay on the medication for the rest of my life, but is it possible to keep my weight loss if I reduce the dosage to the 1.7 or 1 mg dose?

    • Dr. Lazarus says:

      Great question – we are writing an article about this – it will publish in the free open-access journal obesity pillars soon. You can speak to your doctor about lowering the dose to 1.7 or 1 mg; however, only the 2.4 mg dose is approved by the FDA for chronic weight management. It is possible this could cause issues with insurance coverage. I have heard of people spacing the shots further as well, but if space too far, can cause more GI side effects. I never thought in my career I’d have problems with a medication causing too much weight loss!

  • Stella says:

    I have been obese 30 years with up to 115 pounds wt loss with diet and exercise the weight came back over 5 years . Thats been 10 years ago. Started mounjaro in process of getting ready for gastric sleeve . Lost 40 pds so far, switched to whole food plant based diet during this time. Now time to schedule sleeve im questioning what will happen when i stop the medication suddenly and have had the sleeve. Do surgeries do better than medication for long term weight loss.if i were to just quit the medication and kept eating the way i am would i maintain? I have quit surger, soda, fast food, etc. If have sleeve how successful long term. The medicine expensive and not coveted by insurance. You have to eat to gain right?

    • Dr. Lazarus says:

      It is true that weight is related to eating, but appetite regulation is incredibly complex, and for one with obesity, generally not under the control of willpower alone. It is regulated by hormones. Yes, bariatric surgery is considered the most effective weight loss option today. That being said, Mounjaro may give surgery a run for the money. Mounjaro does not have long term data for weight loss yet – surgery does. Data shows that people who stop anti-obesity medication regain any weight that was lost as a result of the medication – again, this is far more complex than choosing what to eat, using willpower, or trying to balance calories in / calories out.

  • Cristina says:

    I just started Mounjaro on 10/24/22 and I’m excited but very concerned. I started eating at a deficit and working out 4-5 times a week since 8/29 and I did see some slight changes in my body but in the belly not so much. My Doc said it’s due to Insulin Resistance so they started me on Mounjaro but I keep reading about weight gain after you stop taking the meds. My goal is to keep it off forever and I don’t want to take this forever. I almost think I want to stop and keep doing it on my own even if it takes longer. Will I really gain all this weight back even if I have changed my eating and lifestyle habits? Any info is greatly appreciated.

    • Dr. Lazarus says:

      Cristina – like other chronic diseases, obesity only responds to medication so long as the medication is continued. The idea that we can lose weight with medication then keep it off with willpower is about 20 years out of date. Mounjaro should only be used for weight management chronically, and only if the obesity was at a BMI that posed a significant risk to the health. Further, Mounjaro at this time is “off – label” for weight loss, but I understand that the manufacturer has submitted a fast track request to the FDA for chronic weight management, so hopefully it will get approved for that sometime in late 2023. That being the case, if you lose the weight with behavior alone and are successful at keeping it off – great! You could go that route, and add the Mounjaro back if unable to lose the desired weight, or if start to regain; however, assuming you are getting the Mounjaro with the coupon, the cost once the coupon expires could be a significant issue! I’d definitely discuss with your prescribing doctor the risks your weight has to your health, and then the pros / cons not only of Mounjaro but also of other available treatments. If you are not working with a doctor certified in Obesity, this would be a good time to find one – head over to obesitymedicine.org, click find a clinician, and search for doctors certified by ABOM (American Board of Obesity Medicine).

  • Eileen says:

    I started Wegovy on October 21, 2021 and by June 2022 I reached my goal by losing a total of 49 pounds. My doctor recommended that I stay on Wegovy indefinitely however as of today, November 6, 2022 I am 112 pounds. I do not want to lose any more weight or regain the amount I lost! My doctor admits that there is very little information regarding this dilemma. I suggested we titrate down in mg from 2.4 mg to 1.7 mg etc until I could stop. Is it possible to wean off the medication while paying strict attention to diet and exercise? I would appreciate your advice. Thank you.

    • Dr. Lazarus says:

      We are going to press with an article about this at obesity pillars. Dr. Angela Fitch is the author. It has not published yet, but keep an eye on this site: https://www.journals.elsevier.com/obesity-pillars. Wegovy is indicated for chronic weight management. Generally if tolerated well, the recommendation would be to continue treatment. If weight loss is considered excessive, recommendation would be to stop treatment. If can convince insurance to cover the 1.7, I think good choice, but it is not approved for chronic use at that dose, so insurance may give you a hard time. I’ve heard of people staying on 2.4, but widening the interval – for example, 10 days vs. 7. All of these ideas are “off-label.” Again, please do not take medical advice from a blog – whatever decisions you make need to be discussed with your prescribing physician!

  • Andrea says:

    I have been on Wegovy for over a year, with manufacturers issues and insurance needing a prior auth I went 4 weeks without the shot. Finally received my medication took the first shot at the 2.4 dose ,which I had previously been on) and within 4 hours was vomiting every 30 minutes for 20 hours and ended up in the emergency room to get IV fluids and anti nausea medication. My question is since I missed 4 weeks of shots should I have started on a lower dose? Should I ask my provider to change the dose to the 1.7 and titrate back up?

    • Dr. Lazarus says:

      Yes – if you missed 4 weeks, definitely do not start back at 2.4 mg. I’m not sure where I’d start – 1.7 is also probably still too high. Unfortunately, it may require starting back at the initiation dose (.25) or second dose (.5) to avoid getting so sick. this is an issue, because they still do not have the lower doses of wegovy available at this time. Definitely discuss with your doctor.

  • Helen says:

    Hi! Why would not one choose a vertical sleeve gastrectomy over lifelong
    Glp-1 agonist as the weight regain after stopping the latter is essentially universal and relatively quick. With surgery if one maintains healthy habits, people keep weight off for years and often lifelong without additional medications. Thank you!

    • Dr. Lazarus says:

      This is a great question, and there is a lot to consider. First, the sleeve tends to be somewhat more effective than the GLP-1. Second, we have 10+ years of data on surgery showing it to be safe, effective, and lower risk of things like cancer death (43%) and heart attack (49%). We do not have these data with GLP-1 (yet). Third, cost. Some people have coverage for surgery but not for GLP-1, some people have coverage for GLP-1 but not surgery. Some people have both, some have neither. The cost can greatly impact the decision. Fourth is side effects – both surgery and medication. Fifth is other medical problems / medications – for example, for somebody with tough to control type 2 diabetes in spite of GLP-1, the diabetes may go in to remission with surgery. You are correct that medication is for chronic use – it should not be discontinued, any more than you would stop the glp-1 for diabetes. You are not correct that people keep the weight off with a sleeve – there is significant regain over 10 years, with most people regaining at least a third of what they lost. For many people with a lot to lose, we can add glp-1 or other medication to prevent this –> surgery + medication, not surgery or medication. There are a lot of other considerations! That’s why it’s important to have this discussion with a board-certified obesity medicine physician!!! Thanks for asking.

  • Melissa says:

    I have been on Ozempic for 10 months, I’m now on the 1 mg dose a week. I had to take a 2 month break because I had surgery and was feeling sick, (Ozempic would cause vomiting and diarrhea so I didn’t think It would be right to be sick while recovering from a surgery) now that I’m better I want to restart it. Do I go back to my 1mg dose or do I restart at the initial 0.25 mg dose ?

    Thank you

    • Dr. Lazarus says:

      Please make sure to get the advice of the prescribing physician, but in my practice and experience, I restart at the .25 mg dose x 4 week, then .5 mg x 4 weeks, then the 1 mg.

  • Breanna says:

    Where can I find the reference for the studies showing 3 years benefit of staying on weightloss drugs?

  • Annie says:

    I started Wegovy 8/21 for six months on the savings card program since my insurance didn’t cover it. Over the course of the 6 months, I lost about 40 pounds then continue to lose another 10 pounds by 6/21 without Wegovy. Then in July-August, my menstrual cycle changed to 19-22 days from 28. (I’m 50), it’s back to 28 days now. I have watch the scale slowly increase each week despite my calorie deficit, logging/weighing my food and increase physical activity. It’s quite depressing and frustrating. Since June I am up ten pounds. I am at at loss. ( I was taken off Wegovy because my doctor didn’t feel comfortable prescribing it since I had a healthy BMI).

    • Dr. Lazarus says:

      Assuming your presenting BMI was in the range where treatment was indicated, I would advise finding a doctor skilled in obesity management. The indication for Wegovy is based on the starting BMI, not the resulting BMI. We do not stop a blood pressure medication because we normalize the blood pressure, or a diabetes medication because we normalize the diabetes. If the BMI was high enough (>30, or >27 with comorbidity) then the Wegovy is indicated for chronic weight management.

  • Anne says:

    My husband is around 450lb starting weight and has been on saxenda for probably a month and a half, lost about 25lbs. However, he is having extreme heartburn!! He has been popping tums, rolaids, pepcid ac like it’s going out of style. He spoke to another doctor (not or regular one who is currently off) and he suggested he follow a GERD diet. Which means i have to learn what that is to make it… short story long, despite side effects, saxenda has been doing ok for him (I think?) and our father in law is on wegivy and still seems to have not slowed his eating AT ALL. Do you think my husband might have less side effects on wegovy? I think he sees his Dad who doesn’t seem to have any change in his appetite with wegovy, and this will make him resistant to wegovy… but he really has terrible heartburn. It must be really painful . I have had it in the past and found it crazymaking to gave heartburn constantly, which is making me question trying one of these drugs myself. I’m also quite overweight unfortunately.
    Thank you for a really interesting read and some great answers.

    • Dr. Lazarus says:

      Suggest frequent small meals, protein in each. Avoid large meals, avoid fatty meals. Avoid other things that cause heartburn. Yes – I’d ask the treating physician re the heartburn – may want to manage it with a PPI and see if it resolves over time, and also ask re Wegovy – Wegovy should be available again for new starts in January 2023. Again, please get the advice of the prescribing obesity medicine / weight loss physician!

  • Bob says:

    I was on Saxenda for about 8 months and sadly only lost a few pounds. My Dr suggested I switch to Wegovy, but of course, supply chain issues made it impossible to start at the lowest dosage. So after months of waiting, and frustration, my Dr prescribed me with Wegovy but with a starting dose of 1.7. She was confident that my body wouldnt require the slower titration due to the long term use of Saxenda. I’ve taken two injections of Wegovy so far and tolerated the 1.7 dose fine. By starting at the higher dose is it possible I’ve short changed myself the length of time it will remain effective? If I started at the low dose and slowly titrated my way up would each new level have boosted my weight loss for some time? I think a more poignant question is,; are you seeing Wegovy no longer being effective after the 2.4 dose has been administered and adapted to?

    • Dr. Lazarus says:

      Bob – no, I don’t think you are short-changing yourself by starting at the 1.7 mg dose. That being said, Novo has announced the broad availability of all dosages of the Wegovy (including the .25, .5, and 1 mg) to pharmacies starting January 1st, 2023. It may be a few weeks for pharmacies to all actually receive it. Regarding being effective, studies show that the Wegovy is the most efficacious anti-obesity medication currently on the market with the average percentage of weight loss around 16-17% of the total body weight. Discontinuation of an anti-obesity medication usually leads to a regain of around 2/3rds of the lost weight the year following discontinuation. Remember that the medication is approved for chronic weight management. Weight loss does not continue – once you achieve the maximum weight loss, the medication helps you keep that off. Not continuing to lose is not a sign that the medication is no longer working. So your question “no longer being effective” is confusing – it is effective at helping keep off whatever amount of weight that it helped you lose, but not at taking off additional weight at that point. This is similar to medications for other diseases – for example, high cholessterol. When started on a medication, it lowers your cholesterol over a couple months timespan, then the cholesterol stays reduced, although may come up somewhat as a result of aging, lifestyle, etc. This does not mean that the medication is no longer working – it is doing exactly what it is supposed to! The cholesterol does not keep coming down after the maximal effect of the medication is reached. In the Wegovy trials, maximum effect was at about 1 year. Good luck, and thanks for an amazing question!

  • Katelynn Webster says:

    I just started wegovy and only wanting to loose 20 pounds so i can be at a healthy weight when i get pregnant. is this a bad idea? i dont want to get extra fat doing this? if i develop better eating habits and stuff does that help keep the weight off? i just want to get pregnant at. a healthier weight so im nota whale when i get pregnant but im hoping this isnt going to cause me to just gain extra that i dont need .

    • Dr. Lazarus says:

      Whether or not a good idea between you and the prescribing physician; however, just keep in mind that the label for Wegovy recommends discontinuing it at least 2 months before a planned pregnancy — 8.3 Females and Males of Reproductive Potential
      Because of the potential for fetal harm, discontinue WEGOVY® in patients at least 2 months before
      they plan to become pregnant to account for the long half-life of semaglutide [see Use in Specific
      Populations (8.1)].

  • Katelynn Webster says:

    Yes i knew that about discontinuing it but you really didnt answer my question. is it true that you regain all your weight back after stopping wegovy.

    • Dr. Lazarus says:

      Medications only work so long as they are continued – Wegovy is indicated for chronic weight management. It is okay to lose weight to be at a healthier weight for pregnancy, try to control weight gain to a healthy amount of weight during pregnancy, then take it back down to a healthy weight after pregnancy. While the statement is true – one regains weight upon discontinuation of treatment, I do recommend losing weight to get to the healthiest weight prior to pregnancy, and then after completing breastfeeding, to resume treatment. If the goal is pregnancy soon, I tend to use the oral medications (but NOT Qsymia – contains topiramate, which can cause neural tube defects in fetus) because they can be stopped quickly vs. needing a 2 month window. They also don’t have a 5 month ramp-up titration. Alternatively, Saxenda (daily injection) doesn’t require a 2 month window either. I haven’t used Wegovy in somebody desiring pregnancy, but in part this is because it hasn’t been available at the starting dosages for nearly a year. Sorry – hope that is a better answer!

  • Anna Smith says:

    I’ve been on Mounjaro off label for weight loss and it’s working great. There may be possible issues this time processing their coupon savings card which is the only way I can afford it. When Wegovy is available again can an individual start at the highest maintenance dose of Wegovy if I’ve been on Mounjaro?

    • Dr. Lazarus says:

      That’s a tricky question – the safest thing to do is stop mounjaro, wait a week or two, then start Wegovy at .25 mg weekly and follow regular titration. I have sometimes started at a higher dose, but you would need to discuss this with your doctor, and this would be considered “Off-label.” I have seen many people have more side effects on Wegovy compared with Mounjaro, so if going to a higher dose, would probably not do the highest (2.4 mg). But if on one of the higher dosages of Mounjaro, might consider trying to start at 1.0 mg Wegovy. Just keep in mind if starting higher dose, if get side effects (nausea, vomiting, etc) could be pretty severe and the half life of the injection is a full week! In my clinical experience, always better safe than sorry!

  • Megan says:

    Is being overweight (BMI 25-29.9) a chronic condition like obesity? I started on GLP-1 with a 29.2 BMI and prediabetes. My current BMI is now 22, and I am concerned about the safety of continuing this medication as I do not want to become underweight.

    • Dr. Lazarus says:

      Congratulations on an amazing weight loss. That’s a great question. Although product labels are written based on BMI, it is not a great surrogate of health risk. Given that you have pre-diabetes, this suggests a higher health risk, and therefore potentially greater benefits for sustaining a weight loss of > 20%. This amount of weight loss has been shown to lower diabetes risk, heart attack risk, and cancer risk. I think the benefits of staying on likely outweigh the risks. Of course, this is a question you should review with the prescribing physician.

  • Wall says:

    I have tried both saxenda daily the wegovy weekly sadly I have not lost as most have. I am 66 ,thyroid disorder currently controlled…follow rules of 1200 calories low carbs. Intermittent fasting of 12 hours a day without success. My BMI is not that high 29.5 but I had gained 23 lds over the past 3 year’s any ideas. Yes I do try n walk and drink water. Have u heard about about a study where they use both of the above drugs. A friend mentioned this testing do you think it would be safe?

    • Dr. Lazarus says:

      You would definitely benefit from evaluation and treatment by a board-certified obesity medicine physician to look at all of the components, not just the medication. No, I would not recommend using two medications in the same class (GLP-1 – wegovy / saxenda). If inadequate response to GLP-1, could consider oral options if appropriate combined with properly supervised intensive lifestyle intervention.

  • Tess says:

    I am 5‘ 3” tall and for my entire adult life I weighed between 110-120 pounds, even after having five children. I had a sixth baby at the age of 39 and I gained 60 pounds. I was able to get back down to around 125 pounds with diet and exercise twice. However, I gained the weight back when I didn’t stay on a good diet and exercise routine. I am now about 60 pounds overweight again. My doctor prescribed Wegovy and I just started it, so I haven’t seen any results yet. However, I really only want to take it until I get to my goal weight, which is more like 130-140 pounds. I am wondering if, because I was always thin until that last pregnancy, and then able to lose the excess weight with diet and exercise, if it’s possible to be successful again after stopping the Wegovy if I maintain a good diet and exercise routine. I really don’t like the idea of staying on it forever. I am most concerned about long-term side effects. I am now 54 years old , and entering menopause.

    • Dr. Lazarus says:

      Great question – why not start Wegovy, see how it goes, then reassess? We generally regard obesity as a chronic disease and use AOM like Wegovy over the long haul, but I would agree pregnancy is a unique circumstance. I’d say if you can get the weight off within a year or two of having a child, then your suggestion is good. However, if it’s been years and you still have extra body fat, that is obesity, and chronic use would be recommended.

  • Julie says:

    I know several people who had the sleeve and gained 3/4 of it back within a year. Now they are taking GLPs ‍♀️

  • Kayla says:

    This is such a helpful forum.
    If one is having success on a traditional weight loss program through a reduced calorie diet and exercise, (7 pounds in 4 weeks), with about 20-25 more pounds to go, would you recommend holding off on seeking pharmaceutical/medication assistance.
    It is tempting to think one could lose weight more quickly, but worried about becoming dependent on pharmaceutical support that would need to take for several years, if it is not necessary.

    • Dr. Lazarus says:

      In my experience, sustaining weight loss is much harder than losing weight, and obesity is progressive getting worse as the years go by. If ones BMI is high enough that pharmacotherapy is indicated, I’d consider discussing the options with your doctor and seeing which one may be the best fit.

  • Jenna says:

    Over the last 4 years, I have gained roughly 35lbs, and it feels like it has come out of nowhere, with no real lifestyle changes. I have always maintained my weight between 155lbs and 160lbs. I am 5’6” and am pretty muscular. I work out 4-5 days a week and eat pretty healthy. When I crept up into the 170s, I worked with a nutritionist and we couldn’t figure out why I wasn’t losing weight. I do suffer from chronic constipation and SIBO and it’s an ongoing battle. I have done many blood tests and most of my numbers are normal. The only red flags would be that there is inflammation in my body, my bad cholesterol is high and increasing, and my RBC is slightly high (one point above normal). I visited my endocrinologist last November, and I weighed in at 192lbs!! I am not obese per se, but my BMI currently says 30. She gave me the option of phentermine and wegovy, so I decided to try phentermine first. I have never been a binge eater or had an unhealthy relationship with food, so yes, the phentermine suppressed my appetite, but it wasn’t until I started a 28 day detox that I started to see the numbers move.

    I am currently weighing in at 186, and just finished month 2 on phentermine. My doctor recommends starting wegovy, but I am very hesitant. I am a very athletic 34 year old woman. The last thing I want to do is become dependent on a medication for weight loss. With my active and healthy lifestyle, is wegovy a good option for me? I just want to get back to my normal 150-160lb range I have always been at, and then want to be off of any medication. Would love your thoughts!

    • Dr. Lazarus says:

      Thanks for the comments – one is not dependent on a medication, for obesity, for hypertension, or for diabetes – one chooses to take a medication because they believe the benefits of treatment outweight both the risks of treatment, and the risks of non-treatment. Pharmacotherapy for obesity is only effective if continued on a chronic basis. So, if you don’t want to be on a medication chronically, then I would not consider phentermine or wegovy. That being the case, how do you plan to lose 30 pounds? That is a high percentage of weight loss, and unlikely to be attained by lifestyle intervention alone. Definitely speak with an obesity medicine specialist to help guide you on the best treatment path forward. Thanks for the message.

  • Karen says:

    I have been taking Saxenda for a month. I always feel nauseous and barely eat. I get occasional heartburn and just don’t feel like myself. Does this feeling ever go away? My Dr mentioned maybe switching Wegovy but I’m afraid I will have the same symptoms.

    • Dr. Lazarus says:

      Good question. Options could include a lower dose of saxenda, or change to Wegovy. My patients tend to do a bit better on Wegovy than Saxenda with regards to side effects. Further, eat frequent small healthy portions of protein, avoid large meals and really fatty meals – that can help tolerate the medications better. If not tolerated, can ask if one of the oral options may be better tolerated for you. Sorry you are having so much trouble! About 1 in 10 patients does not tolerate these new injectable medications.

  • Alice says:

    Hi, I was on Ozempic for 1year and lost the majority of my weight getting to a healthy bmi of 22. But when I stopped I felt out of control and I was starting to eat more so I promptly got another script. However, ozempic was not available so I went on Saxenda. I’m not living the daily injections as opposed to weekly but it works. My problem is Acne, it’s really bad- I have never experienced this before; I did get some bad acne pimples when on ozempic too. So I’m not sure what to do; I went off Saxenda and my skin is looking great but I feel the weight creeping on again; I’m definitely eating a bit more and wanting to eat more but it seems like very rapid weight gain compared to what I’m eating…… what can I do to manage weight maintenance and keep good skin …. is it possible to not be on the medication?
    Height: 163cm Age: 44
    Starting weight: 76kg
    Weight when stopped Saxenda because of acne: 54kgs
    2 weeks later – Current weight: 56kg (going up ..,.)

    • Dr. Lazarus says:

      Not sure re acne – I’d discuss treatment options with your doctor. It may be that weight loss has changed your hormones resulting in slightly more expression of androgenizing progesterone or testosterone. I’d think you’d be a good candidate for something like spironolactone to offset this. Again, recommend review with the prescribing doctor. Also, ozempic is now generally available again, if that was a better option for you.

  • Kimberly says:

    I was on Saxenda for about a year and then stopped taking due to it not being effective anymore. I lost a significant amount of weight (15lns) but gained it all back. I was able to convince my GP to prescribe me Wegovy and I’ve been on it for a year now. As expected, I’ve lost about 1/5th of my weight going from 245 down to 191. Also, for the record, I’m 6’1 and 51 years old. I love the weight-loss but I don’t want to loose anymore. I’m having a hard time with meals with only having an appetite for barely 1 or maybe two meals a day (MAYBE) and feel like I am going to have to start taking additional supplements to make up for the lack of nutrients I’m not receiving because I’m not eating. I’m hoping that I can figure out how to eat more (who says that?) My question is would it be okay to space my dosage injections out in order to slow the weight-loss down, firstly. Also would this help with getting my appetite at a better place? I know that there would be the choice to lower the dosage as an option but there is now the issue of availability of lower dosages as I’m at the 2.4 dosage. Thanks for taking the time to read this post. Your thoughts are appreciated.

    • Dr. Lazarus says:

      I have had patients do this, but it would be considered “off-label.” I’ve also had patients go on the 1.7 mg dose, although that too is considered “off-label.” Over time, most of my patients seem to get used to it and do well. If problems persist, it is likely mounjaro will be approved for weight loss later this year – it is a similar medication. I am hopeful we will get more than 1 dose approved on the mounjaro for chronic weight management…

  • Diane says:

    I’m so sad! I have recently (over the last 12 months) lost 65 pounds while on the Calibrate program using Metformin and Ozempic – switched to Mounjaro during the shortage. I was not obese for my whole life. My weight problem came after quitting smoking 17 years ago. Traded one problem for another, I guess. I have made a lot of lifestyle changes while on the program and will do my best to maintain those changes. Today, I received an email from my pharmacy telling me that they can no longer apply the discount card to my Mounjaro prescription. Not sure where this leaves me and reading that the weight is re-gained really makes me want to cry. I have worked so hard to get to a place where I feel comfortable in my body again.

    • Dr. Lazarus says:

      Yes – we have gotten the same call on all our Mounjaro coupons. This is a great example why you need an obesity medicine physician that can give you all the options and not just a virtual program. I’d recommend visiting obesitymedicine.org and click find a clinician – find a board-certified obesity medicine physician in your area that you can see in-person. You can discuss all of the available anti-obesity medication options, including the oral medications and the injectables. You can also check to see if you have insurance coverage for Wegovy in the mean time. You could also consider Ozempic (off-label for weight management). You could discuss these options with your physician. If you let me know where you live, I can check and see if there is anybody I know nearby. Sorry for the trials and tribulations, but in all honesty, I’ve about had it with coupon programs that put patients on a bridge to nowhere. Congratulations on your success, but I’m sorry for all the frustrations and challenges!

  • Diane says:

    Thank you for your reply! I ran across your website last night and will be reading your content. I am trying to educate myself as much as possible. I live in Louisville, Ky.

  • Michele says:

    Why aren’t the pharmacy’s able to continue to apply the coupons? Are they past the allotted number of prescription amount? Mine say it is good until 6/30/23.
    Or 12 refills.

    • Dr. Lazarus says:

      I believe that the manufacturer is no longer honoring the coupon for “off-label” use. Our phones have been ringing off the hooks this week by patients stating their coupons stopped working.

  • Mary Turner says:

    I have been on Wegovy for 12 months and have been continually losing weight but very slowly. I am 52 years old and 5’6. I was at my highest ever 241, when I started Wegovy. I used to weight 160 but gained weight rapidly as the result of a medication. I am no longer on the medication but was unable to get rid of the weight gained. My goal weight is 170. I would like to lose about 30 more pounds. However, I am confused if stopping the medication means I will definitely gain the weight back. In addition to the mediction, I have changed my eating habits and now exercise regularly. Is the weight more apt to come back for those who lose the weight quickly and did not change their eating and exercise habits? Now, I am feeling discouraged because I did not plan to need this medication forever.

    • Dr. Lazarus says:

      Congratulations on your progress. Obesity is a chronic medical condition, similar to hypertension. If the health benefits of weight loss exceed any known risks of the medication, the medication should be used chronically, just like medications for hypertension and diabetes. Don’t be discouraged – be encouraged. This medication gives you hope for long-term success with chronic weight management.

  • Marie says:

    I have been on Mounjaro for the past 3 months and lost about 15lbs. Side effects have been minimal but the past 2 weeks I’ve been experiencing terrible nausea that lasts all day, every day. I started on 2.5mg for a month and then increased to 5mg and have not changed from that dose. Is it possible that my body is no longer tolerating the medication? Should I go back to the starting dose of 2.5mg? This is really disheartening as I was tolerating it so well. It’s also confusing to develop these strong side effects after being on the same dose for a while.

    • Dr. Lazarus says:

      Again, you should only take medical advice from the prescribing physician. However, generally speaking, yes – If I have a patient with side effects on the GLP-1 and can go to a lower dose, that’s exactly what I would try first. I also recommend eating sort of like during pregnancy – don’t let the stomach get empty – wake up, immediately nibble on something, and have frequent small meals throughout the day, and avoid higher fat foods. This seems to help people tolerate GLP-1 better. If persists, may need to try something else.

  • Indira says:

    Great articles and responses. The CEO of Eli Lilly specifically stated they are honoring all $25 coupons until expiration. Some pharmacists were confused when told the coupon had changed into thinking the old coupons were no longer valid rather than there are new coupons with different terms, but old coupons are gradfathered in. They talked my pharmacist through the process (was shocked she called) and she was able to get the $25 coupon to work in Feb 2023. It creates tremendous stresd and I hope when Mounjaro approved for chronic obesity there is a simpler coupon and education to providers to use the starting BMI not the treated one. I love how you explain that we dont use the treated BP and discontinue the HTN meds or use the treated serum glucose when continuing the diabetic medications.

    • Dr. Lazarus says:

      Thank you for this comment. I have not found this to be true – virtually all of our patients using the coupon can no longer get it to work 🙁 Thanks for the post. I too am excited for this new treatment to become available, but as with the other new treatments, I think we got the cart in front of the horse on this one. I’m going to wait for the actual approval, and for the company to ramp up manufacturing capacity so they can meet the demand, which I believe will be very high for this drug when approved for chronic weight management.

  • Lori says:

    I was on 12.5 of Mounjaro. I ended up getting a staph infection and sepsis, I was extremely ill and one of the meds that was stopped while I was in the hospital was my Mounjaro. Can I restart at 12.5 now?? About 4 weeks have passed.

  • Shannon says:

    Hi. I’m wondering if Mounjaro slows down the digestion process (emptying of the stomach), does that affect how quickly my oral medications will be absorbed? I was thinking oral medications are absorbed while in the stomach, but a friend of mine is having knee surgery and she said she’s stopping her Mounjaro for a couple of weeks because she wants her post op pain meds to work faster. That seems off to me. Thanks in advance for an answer! 🙂

    • Dr. Lazarus says:

      There is a warning about oral contraceptives during the mounjaro titration period, but I don’t believe there are other warnings. I do not believe it is recommended to stop in this fashion – I’d suggest she review recommendations with the surgeon / anesthesiologist / prescribing physician.

  • Missy says:

    If taking Mounjaro as well as using a CGM and I want to go off of Mounjaro would I benefit from continuing my CGM to see how my blood glucose is affected after stopping the Mounjaro?

    • Dr. Lazarus says:

      Assuming you are using the Mounjaro for control of type 2 diabetes, then yes, I’d continue the CGM and monitor your glucose. If you are using Mounjaro for weight loss, then I see no benefit of using the CGM in the absence of type 2 diabetes.

  • Mary says:

    Dr Lazarus, I am so happy to have found your forum! What a treasure it is and such a helpful and safe space for others to discuss their weight loss concerns. Thank you. I have lost two stone on Saxenda over 4 months. BMI now reduced from 30 to 27 and hoping to come off shortly. Reading here, it seems I may need to stay on it long-term or else risking gaining all the weight I lost. I exercise regularly and have been able to maintain a healthy diet on Saxenda. Do I really need to take Saxenda long-term? Or might I try maintaining my lifestyle changes (not extreme) and see how I go. Additionally, if I decide to continue taking Saxenda is it likely to be effective at a lower dose? I’m worried about cost and long term effects. I also take HRT. Thank you.

    • Dr. Lazarus says:

      Hi Mary – sustaining weight loss is harder than losing it due to metabolic adaptation – hunger hormones increase, satisfaction decreases, and metabolism decreases. There are no studies showing that weight loss will persist if Saxenda is discontinued or if it is continued but at a lower dose. In my experience, most patients need more help, not less, as time goes on. Even in their maintenance trial, patients slowly regained on Saxenda (~1% / year over 3 years). If Saxenda is too expensive, you could discuss changing to an oral medication with your doctor, or discuss with your employer adding coverage for anti-obesity medications. I treat obesity as a chronic disease – similar to hypertension or diabetes.

  • Laura Stoneman says:

    Hi, lam hoping you will be able to offer me some advice even though I am writing from the uk. I have been taking Saxenda and ozempic for the last three years on and off. I have tried on numerous occasions to stop, have a break and kickstart myself as I have struggled to lose weight recently. I see from that you can stay on this indefinitely and would very much like do this but have been scared todo this as In the uk I don’t need a prescription and can just buy this on line if I can pay for it I would very much appreciate any advice you can offer

    • Dr. Lazarus says:

      Hi Laura – obesity is a chronic disease, and intermittent treatment has not been shown to be effective. If you lose significant weight with saxenda OR ozempic (ozempic is off-label, and only one or the other, not both concurrently), and in your physician’s estimation the health benefits of the weight loss outweigh any known risks of the medication, it is indicated that it should be continued. Studies have shown return to the pre-treatment weight when the medication is stopped for most people. You could certainly also ask about any other options that may be approved for use in the UK; however, many of the less expensive options available here in the US are not approved / available for use in the UK. All the best.

  • Lisa Schultz says:

    I was slender all my life at about 150 and 5’6” but due to major life event in mid 50s, I gained weight up to 240. I lost 90 lbs on my own over 2 years but when I stopped dieting, I gained 80 lbs. back. I started semaglatude injections about 7 weeks ago. I have lost 15 lbs. I still need to lose 65 lbs. because I have shrunk down to 5’4 1/2” due to degenerative disc disease which has flattened out my discs. I do not want to gain this weight back once lost as so many articles I have read state. If I keep my portions small like I’m eating now and start walking 30 minutes a day, will that stop me from regaining the weight? At the age of 73, I’m pretty much a couch potato now.

    • Dr. Lazarus says:

      No – if you stop the semaglutide, you are likely to regain the lost weight. Further, setting a goal of losing 80 pounds is a goal of losing 30% of the body weight. This is double the expected result of Wegovy, and above the expected result from bariatric surgery. Losing excessive weight can also trigger regain due to metabolic adaptation. I’d suggest continuing the medication (Wegovy). If really need to lose that much weight and your BMI is in the range where it is indicated, you might consider consulting with a bariatric and metabolic surgeon and seeing if that is an option. Alternatively, since already on Wegovy, if you can lose 15% of your body weight (35 – 40 pounds), see if that is enough weight loss that you feel better.

  • Melissa H. says:

    Hello! I am on Rybelsus 7pm tablets for weight loss (I am not diabetic) and have am at my goal weight now. How can I maintain my current weight? I don’t want to melt away! Should I try to eat more high calorie foods? Should I drop down to the 3mg Rybelsus tablets? I don’t want to go off Rybelsus completely for all the reasons you say above. I did read the article you mentioned above, “Excessive weight reduction with highly effective anti-obesity medications (heAOMs)” by Harold Edward Bays, Karli Burridge, Jesse Richards, Angela Fitch. Obesity Pillars 4 (2022). I’m not in the situation of a lot of those patients. I have always eaten very healthy foods, I’m not subject to family/peer pressures, and I have a realistic idea of what the right weigh is for me. My problem was overeating, compulsive eating, and binge eating healthy foods. With Rybeslus there is no more of that and I am very happy. But if I continue in my current path I will soon be underweight. I would love to hear your advice. Thanks so much!

    • Dr. Lazarus says:

      Interesting – sounds like you are very sensitive to the Rybelsus! The oral semaglutide in development for weight loss is 50 mg! Certainly you could ask your prescriber for the lower dose (3 mg), or possibly for a less potent medication (you could discuss tenuate, wellbutrin as a couple examples).

  • Charlotte Martin says:

    I have been taking Mounjaro since November 2022. I had gestational diabetes during all 3 of my pregnancies, and my doctor put me on Metformin years ago. It kept my A1C in the normal range but was really hard on my GI system. My doctor and I decided I should go off the Metformin and see if my A1C would stay in the normal range. It steadily went up and I also gained 30 lbs. We decided I should try Mounjaro and I have lost 40 pounds since November. I really don’t want to lose anymore weight but I am afraid to go off of it. Also Medicare doesn’t pay for Mounjaro so I have been paying out of pocket. Medicare does pay for Trulicity. Do you think switching to Trulicity is a good option to keep the weight off and maintain a normal A1C level? If so, what is a good dose? I am currently on 10 mg Mounjaro. Thanks!!

    • Dr. Lazarus says:

      Hi Charlotte – congratulations on your success with Mounjaro. trulicity is a reasonable substitution for the Mounjaro, but not associated with nearly the magnitude of weight loss. Ozempic would also be a reasonable substitute, offering better weight loss than Trulicity, in my opinion. There are other factors involved – heart safety, side effect profiles, insurance coverage, etc. I’d definitely review with your insurance plan all of the options, and then discuss which option would be the best for you.

  • Tom says:

    Thank you for all of the wonderful information Dr. Lazarus! My question relates to the reversal of tolerance to Semaglutide. In other words if an individual had to (for whatever reason) stop taking Semaglutide for a significant period of time (say 6-8 weeks), would thier tolerance to the drug “reset”, allowing them to start over at the initial “starter” dosage (0.25 mg/wk for most, right)? I know that after ramping up to the max maintenance dosage the drug would be active for roughly one month, but wondering how this plays out in real life. I also know that each person/case is unique and must be navagated by a physician, just looking for general info related to the tolerance. Thank you!

    • Dr. Lazarus says:

      Everybody is different. The label recommends restart at .6 and increase weekly back to 3, but in clinical practice I’ve had patients titrate up to the 3 much quicker. Really the limitation is just whether or not you are having side effects.

  • Yvonne says:

    Hello, I was on Ocempic for 6 months for weight loss due to being pre diabetic, I lost no weight. Started Mounjaro a month ago still no weight loss.
    I am 63 and have made adjustments to my diet. Is it possible that these meds don’t work for everyone? I am so frustrated.
    I would appreciate a response.
    Thank you,

    • Dr. Lazarus says:

      Yes it is possible, but unusual. That’s why working with a doctor certified by the American Board of Obesity Medicine is important – we can look at all the issues making it hard to lose weight. It is much harder to lose weight when one has diabetes / pre-diabetes, and many medications make it hard to lose weight. I’d recommend an evaluation by an ABOM certified physician. Visit obesitymedicine.org and click on find a clinician – or, let me know where you are located and I can let you know if there are any good board-certified doctors nearby…

  • Lee says:

    I had been on Saxenda for about 2 1/2 years (lost around 40 pounds but had put 20 of it back on) and back in December my doctor changed me to Wegovy starting at 1.7. It went very well and loved the once a week injection. Lost about 10 pounds and then my insurance sent a denial after being on it for 4 months with a re-evaluation of the benefit available in July. I still had a box of Saxenda in my refrigerator, so my doctor advised to start it again at the 1.2 dose. I didn’t know if I should give my body a rest and wait to have Wegovy benefit re-evaluated by my insurance in July or should I go ahead and switch to Saxenda during this time?

    • Dr. Lazarus says:

      This is of course between you and the prescribing physician, but I would stay on something or worried about regaining all of the weight – Saxenda, or could see if you are a good fit for any of the oral medications.

  • Eliza Mosby says:

    About 2 years ago I started metformin and did a gastric balloon to go from
    245 lbs to 175 lbs. A few months after the balloon came out I got pregnant at around 190 lbs, went off metformin and adderall, and have gained 100 lbs in pregnancy putting me at a new high of 290 lbs. My question is: How soon after delivering the baby can I get on GLP-1 (I do not plan to breastfeed) or have surgery? Is there any formal recommendation or would it be up to my HCP to decide? Originally the PA at my clinic said she would only see me 6 months postpartum but I advocated to be seen sooner given the severity of my weight gain and now my appointment is 2 months postpartum. If they say it’s clinic policy to not do any medical weight loss until 6 months postpartum then I want to understand if that’s standard practice or if I should continue to push for what’s best for my health and/or find a clinic that will treat me sooner? I go back to work in 4 months so would ideally like a treatment plan in place in advance of that.

    • Dr. Lazarus says:

      I generally recommend not doing aggressive weight loss for the first 6 months post-partum as well. I was taught somewhere along the way that a woman’s bones are at risk during the immediate post-partum period and that one should wait about 6 months before doing more aggressive weight management strategies. That being the case, starting a slower weight loss program would be reasonable in my opinion. Of course, this would be up to the treating provider.

  • Emma B says:


    I am overweight and am exploring options with starting ozempic. My grandma (diagnosed with type 2 diabetes) was on it for about 6 months and then went on Trulicity (her endo thought it would be a better option since she refused to eat on ozempic). She lost 80 pounds (she was over weight most of her life) in a 9 month period. She did exhibit signs of depression, anxiety, and fatigue as well. Eventually we put her back on insulin, because she was full blown not eating and saying everything taste bad so we were concerned (endo, our family) that she was not receiving any nutrients. She kept the weight off only gained maybe 5 pounds total after 3 months. She did get to the point where she didn’t need to take her blood pressure medication which is great, but otherwise her entire personality changed. I am concerned that will happen to me. I also do not want to stay on it forever. My friend is currently on it and doesn’t really eat which is great but she now has concerns that she shouldn’t have started this drug as she is afraid of rapid weight gain when she goes off it (she wants to have a kid in the next year). Is it worth going on it, if I want to have a kid in the next 3-5 years? I am overweight and I am terrified that I will gain the weight back and exhibit side effects. Should this be an ultimate last option?

    Thank you!

    • Dr. Lazarus says:

      I would consider other options first – there are a variety of safe, effective and inexpensive oral medications that are simpler to start and stop. Avoid Qsymia / topiramate as you are considering having kids. Further, if you go the ozempic route, be sure to stop the medication 2 months prior to beginning trying to get pregnant. Obesity is a chronic health problem requiring chronic treatment – I generally recommend “On-label” treatments first. Ozempic is “Off-label” and there are significant supply chain issues and costs associated with Ozempic at this time. You could consider Wegovy if you have insurance coverage, but again, would need to be off 2 months prior to planned pregnancy. As always, a good practice would be to visit obesitymedicine.org, click find a clinician, and find an ABOM certified physician to consult with so that you can make the best choice for your health. It may have benefits to achieve a healthier bmi prior to pregnancy, and to have a physician to work with on getting the baby weight off ~6-12 months after delivery, depending on breastfeeding plans. Hope this helps.

  • Angie Johnson says:

    I’m taking Mounjaro. Currently halfway through the 10 mg course. I have not lost any weight. Is it normal to stay at original weight this long? I have hypothyroidism and have become morbidly obese and tried every diet imaginable. Due to aging, weight gain and emphysema I am unable to do almost any exercise. Can I expect Mounjaro to actually help eventually or give it up? The doc wants to do surgery if this doesn’t work but I don’t see how that would help if this doesn’t. My food intake has been diminished on Mounjaro; if I eat more than I should I am totally miserable for hours. Thank you.

    • Dr. Lazarus says:

      Thanks Angie for the comment. If no weight loss at 10 mg, and engaged in a lifestyle program, I’d tend to agree with your treating physician. That being said, I’d recommend being evaluated by an experienced physician who is board-certified by the ABOM. For a current list of physicians in your area, click obesitymedicine.org, click find a clinician, then filter for ABOM certified physicians. Might be good to review all possible medical / behavioral options, make sure we aren’t missing anything. In the interim, could certainly continue the titration on Mounjaro to 12.5 mg weekly, then 15 mg weekly. In clinical studies, the average patient on 15 mg lost 22% of their body weight; however, the weight loss begins on the first dose – not after getting to the full dose.

  • Mary Ann says:

    Can I take saxenda on days I don’t take Manjarao for weight loss

  • Peggy says:

    My ins approved wegovy for 6 months. I completed the .25 and .50 with zero side effects. Can’t get the 1.0 filled due to supply issues. Have missed one week of the next round (1.0). If I can find a pharmacy with the 1.7 available would it be ok to skip the 1.0 since I did not have any of the reported side effects on the earlier doses.
    If not, then looks like I will have to stop and wait for possibly September or supply chains to be able to fill then have to start all over. Ugh. Thank you so much for all you do to help us.

    • Dr. Lazarus says:

      This would be up to your doctor – I probably would not. I see a lot of side effects going from 1 to 1.7, so from .5 to 1.7 is likely to make you pretty sick. Another option would be transition to Saxenda, titrate to full dose saxenda for a couple months, then try to move to the 1.7 – if your doctor feels this would be appropriate.

  • Christopher says:

    I am just starting 1.7mg Wegovy and was there once before before switching to Mounjarno in September 2023. This was a disaster as I had terrible anxiety and rashes all over my legs and chests. It was absolute Hell.

    So, I’m back on the Wegovy again which in August of 2022 was up at the 2.4mg dosing and had lost 20 lbs.

    The effects of Mounjarno’s dual receptor interactions was not right for me, I’m not diabetic just overweight.

    So my question is, I’ve been treated for ADD and Anxiety / Depression for 30 years and wondering if Wegovy at higher dosing has any adverse effects on the DexMethylphenidate and Trintellix I have been taking for years now?
    One thing I’ve noticed is I wake up after 2-3 hours of sleep and go to kitchen looking for food.

    My Doctor started me on Apple Cider Vinegar before bed and when wake up for snack, 1-2 Tablespoons.

    Any thoughts on mood, energy levels with adding the Wegovy appreciated.

    I’ve researched thoroughly and can find nothing?



    • Dr. Lazarus says:

      To the best of my knowledge, no interaction between Wetgovy and the listed meds, but Wegovy can affect slow down gastric emptying and potentially affect absorption. Not sure why apple cider vinegar? This was popular 100 years ago, I know of no evidence this is helpful. Could ask about something else for nighttime eating – perhaps topiramate would be an option? Again, this would need to be discussed with the treating psychiatrist (or, if not being treated by a psychiatrist, might be worth asking for a referral). I have not seen significant effects on mood – label warns of worsening depression / suicidality, but states this was not seen in the clinical trials of Wegovy. I sometimes see Wegovy make people tired, but this is usually just the day or two after the shot, and seems to fade over time. Hope this help.

  • Kmrista says:

    I have been on Wegovy for 13 weeks now. I have only lost 13 pounds. I have 3 more doses of the 1.7 before starting the maintenance dose. Can I expect to still lose weight on the maintenance dose or does that dosage just maintain what was lost previous to the 2.4 dose?
    I am just discouraged at the slow weight loss. My calorie intake has decreased significantly and my cravings now are for salads and fruit compared to chips and chocolate before. Have you heard of people losing weight this slowly on Wegovy?

    • Dr. Lazarus says:

      Thanks for the question. Wegovy is not a “Quick fix.” Looking at their data from their pivotal trial, weight loss at 13 weeks averages ~7%. Their average patient starting weight was 220 pound. 7% of 220 is 15.4 pounds. So, depending on your starting weight, your result is consistent with this average. Further, weight loss proceeded for about 12 months, to an average of 15-16% weight loss, or 35 pounds. Again, the better a person does with healthy eating and increasing minutes of physical activity, the better result. Assuming tolerating well, why not continue up to the full dose and see if you continue to progress? Thanks again for asking this great question.

  • David says:

    Hello Dr Lazarus. In your response this woman, you told her to have her provider re-submit her original BMI which was over 30 and qualified her for Ozempic. Who is the provider? The health insurance company? And who would the provider submit the BMI to? The woman implied that her insurance company denied her request for a continued prescription because of her BMI. And if the provider is the insurance company, who denied coverage of the prescription why would they resubmit to themselves the old BMI? I guess I’m confused. The woman was wondering how her pharmacy knew her weight and BMI number. My wife has been on Mounjaro for about four about five months and she was trying to get her script renewed and the clinic she uses for Mounjaro said they wouldn’t renew her script because her BMI wasn’t high enough now. She was required to get new blood work and she said the lab weighed her. Is that normal? And we are wondering if the lab sent the weight to the doctor and clinic she has been using to get Mounjaro and is it was the doctors office that called and said she couldn’t get the renewed script due to her BMI. So it wasn’t the doctor that denied this or was at the pharmacy or her insurance company because of her BMI? And again, my question is who denied this the insurance company or the Pharmacy or the doctor?

    • Dr. Lazarus says:

      Hello – lots of great questions. Let me try to break this down for you. First of all, neither Ozempic nor Mounjaro are approved for weight loss – these are both only approved for the treatment of type 2 diabetes. So, coverage for these is generally dependent on the hemoglobin A1c, other medications tried, etc. Using either for weight loss is “Off-label.” Insurance carriers will not pay for the use of Ozempic or Mounjaro for weight loss. This post was dealing with medications that are FDA approved for chronic weight management. In this case, to get coverage, the prescriber needs to generally complete a prior authorization form with the insurance carrier for the medication to be covered. This form will ask for the BMI that is being treated. These drugs are typically indicated for an initial BMI of >30, or > 27 with significant weight related comorbidity. Medications like Wegovy are indicated for chronic weight management. If they are stopped, it is likely any weight that was lost will be regained. Stopping because the BMI fell below 30 or 27 is not the way these drugs are approved or intended. This all highlights why it would be beneficial to work with a doctor that is actually trained in obesity management, particularly one certified by the American Board of Obesity Medicine. For a list of doctors in your area, visit obesitymedicine.org, and click on “Find a clinician.”

  • Anna says:

    I am a 46 year old peri menopausal woman who started taking Saxenda 9 months ago. I have lost 18kg (39.8 lbs) and am almost at goal weight with a BMI of 24.7. I exercise intensively, happily, for at least an hour 6x a week and in some cases can now manage 1/2 marathons. I was exercising near as frequently prior but perhaps not as effectively/intensively or able to run as far/long. Saxenda here is $480 NZD a month but I am loathed to stop as I really don’t want to put the weight back on. Is there not a threshold where if you exercise enough you can afford to be less vigilant with your calorie intake? I have had gaps when I left a pen at home on business trips and realise, I never feel full when I haven’t had it for a few days. Would that feeling abate or would my brain need Saxenda to tell me this in future? I’d love to quit as this is expensive. I’m prepared to do the work but like others, am terrified of gaining the weight back. Is there a better medication I could take that would yield the same outcome or should I consider a longer-term approach like surgery?

    • Dr. Lazarus says:

      Congratulations on your weight loss and running successes! I’m not sure what the options are in New Zealand. In America, we have several inexpensive, generic options like phentermine and diethylpropion, but I don’t know if these are available in NZ. You may be able to order Saxenda from Canada at a lower price – check insulin outlet. Alternatively, you might consider instead of all-or-nothing, maybe try a slightly lower dose of saxenda (2.4 mg daily). I probably wouldn’t stop abruptly for fear of weight regain, but I might try weaning back a notch every few months and see if you can maintain at a lower dose due to the great exercise schedule. Unfortunately, at the end of the day though, most of my patients need to stay on treatment, even with a great exercise schedule, to keep off all the weight. And, Saxenda is approved for chronic use. Further, the price you are paying is quite a bit lower than the cost here in America (about 1/2). All the best, and again, congratulations on your success thus far.

  • Sandra says:

    Can Ozempic Stop working?
    After 3 Years my Appetit is coming back.

    • Dr. Lazarus says:

      I’d suggest considering moving to Wegovy. Remember, Ozempic is for the treatment of type 2 diabetes. Wegovy is for chronic weight management. At higher dosages, the GLP-1 medications appear more effective. The only dose of Wegovy (semaglutide, active ingredient in Ozempic) approved for chronic weight management in adults is 2.4 mg weekly. In their 2 year trial, people sustained the weight loss through year two. Also, if appetite coming back, but weight staying off, that is okay – we see that a lot, as a result of metabolic adaptation. When people sustain weight loss, the appetite does return, on all the medications. The body is trying to restore the lost weight. But, if able to maintain the weight loss with medication + lifestyle modifications, then the medication is still working.

  • Lisa says:

    I finally received my Wegovy after waiting for a little over a month because of backorder. My dr. started me at 0.50 instead of the lower starting dose of 0.25 is this unusual? I am a 60 yr old female with a starting weight of 284.

    • Dr. Lazarus says:

      Yes this is unusual. I would keep the .5 in the fridge, and ask the Doctor to send in the .25, and then follow the titration as the label states – .25 weekly x 4 weeks, then .5 weekly x 4 weeks, and so on. Going too high on the initial dose can cause an awful lot of side effects.

  • Barbara Skoglund says:

    I am desperately trying to find information about switching from Wegovy to Mournjaro. I’ve been at 2.4 of Wegovy for over a year and have been plateaued for a very long time. I didn’t start losing until I hit the 2.4 dose. My endo has switched me to MJ at the lowest dose. It will take 6 months for me to get to the top dose. I am already hungry, much hungrier than on Wegovy. I’m so afraid I’ll gain before I start losing again. I try to eat once a day and go to the Y for 2-4 hours 5 nights a week. I HAVE to lose weight to stay on the kidney transplant list. (MY CKD has nothing to do with my mild T2 diabetes, it is from 30 years of dehydration from living without a colon.) I can’t find anything about making the switch and needing to taper up on the new drug. Do you know of any guidance or studies on switching from Wegovy to the more effective MJ? Thanks

    • Dr. Lazarus says:

      There is a paper being written by an endocrinology colleague of mine looking at how to do this, but it is not published yet. What your endo did is consistent with product labels; however, I have had experience moving from Wegovy to a much higher dose of Mounjaro without triggering any additional side effects – you could ask the endo if they would be comfortable moving directly to a higher dose – I’ve gone from 2.4 wegovy straight to 15 of Mounjaro several times without causing side effects. In my experience, Mounjaro causes less side effects than Wegovy for Many. If they are not comfortable with that, perhaps they’d jump to 10 mg? The weight loss even at 10 mg Mounjaro is nearly as good as the 15…

  • N. Charles says:

    Hi. Thank you for your article.
    Asking for my mother who is 72 and struggled with weight for most of her life. She calorie controls and does exercise for 1-2 hours 4/5 times a week. She really wants to have weight loss medication but has chronic kidney disease. Are there any options that are safe for her to use?
    Thank you.

    • Dr. Lazarus says:

      Sure – most of the medications can be considered for a patient with CKD. Depending on the stage, Contrave can be used sometimes with a dose adjustment, Wegovy / Saxenda can be used cautiously, or we could even consider the older Tenuate and Phentermine (generics) at low dosage. I’d suggest having her see a doctor who is certified by the American Board of Obesity Medicine (ABOM) to see if she is a good / safe candidate for medical treatment.

  • Sandy says:

    I feel Like Ozempic Stop working for Appetit Suppression.
    I read about Antibods you can build after a while taking Glp 1
    Agonist. What can you Tell about this?

    Sorry, for my English im German

    • Dr. Lazarus says:

      Sandy, I believe that the more weight people lose, the harder the body pushes back by lowering production of satisfaction hormones like GLP-1 (Ozempic). That’s why to sustain a large weight loss, most individuals may need the higher dose of semaglutide present in Wegovy (2.4 mg weekly) vs Ozempic (often 1.0 mg weekly). The use of Ozempic for weight loss is “Off-label,” even though it is the same drug, as the dosing is not optimized for weight management. I work with each patient on a case by case basis when faced with excess hunger after weight loss. I have not read about antibodies forming to the Ozempic.

  • N Taylor says:

    Hello – if someone non diabetic takes ozempic for weight loss and then stops when they get to their goal weight. Can they become diabetic? In the sense that the bodies sugar levels etc is out of Wack or does the body itself balance itself? Thank you in advance

    • Dr. Lazarus says:

      No – one would not develop the disease of diabetes from going on and then off a glp-1 medication such as Ozempic / semaglutide. If using Ozempic / semaglutide / Wegovy for weight loss and the weight loss medication is stopped, the main risk is that the person will regain the weight that was lost as a result of the medication, not unlike stopping a blood pressure or cholesterol medication. That being the case, obesity is certainly a risk factor for diabetes, and weight loss (with or without weight loss medication) is one of the best ways to prevent type 2 diabetes.

  • Cocoa says:

    Hi — great website — thank you for answering questions! I started Wegovy the beginning of 2022. Lost 50 lbs really fast. Had knee surgery last summer — went off Wegovy. I gained 4 lbs — truly shocked I did not gain a lot of weight. 3 months later started on Mounjaro. I want to have a normal bmi (10 more lbs). I have been on Mounjaro for a year and have lost 20 lbs. I have never taken Mounjaro every week. I wait 10 days to 2 weeks between doses. I started doing that with the Wegovy about a month before I stopped taking it. The side effects can be so terrible. I feel like waiting between doses gives me more time feeling good. No matter what I slow down and feel sick after taking the medication.

    If it is expected that people will be on the drug for life why not wait longer between doses or have a lower dosage for maintenance?

    Kind of just curious. I might be just lucky because it keeps working for me. I went on vacation and forgot to bring the Mounjaro. I went 6 weeks without it. Took the highest dose yesterday— felt truly awful today. But starting to feel better now. Gained 2 lbs. in the 6 weeks. Again, maybe I am just really lucky — but wondered what your thoughts are on delaying doses or lower dosage for maintenance.

    • Dr. Lazarus says:

      Hi Cocoa – these are great questions. You are correct that these anti-obesity medications are indicated for chronic weight management. In 19 years of doing this, I’m still waiting for a study that shows weight loss is sustained when a medication used to lose the weight is discontinued – most people will regain weight and end up back at the weight they were prior to treatment within ~2 years. Wegovy has a long half life – it is still detectable in your system 5 weeks after a shot – so no, I’m not surprised by your story. Mounjaro remains off-label for weight loss, although we do expect it to be approved soon. I have had patients use it like you are (every 10-14 days) and do well, although I don’t know of any clinical studies. Mounjaro does have 6 strengths – if the one you are on is too strong, why not ask for a lower strength? I have given patients Zofran to offset nausea. You could also consider speaking with a board-certified obesity medicine physician about other non-injectable options that don’t have nausea as a side effect 🙂 (see answer to next question)

  • Cocoa says:

    After I left my first question— another occurred to me. I lost all the weight using Calibrate. Not a horrible experience. But what can a board certified obesity doctor do for me?

  • stayhealthyhere says:

    Obesity is considered a chronic disease, and current evidence suggests that intermittent treatment approaches have not proven to be effective. If you experience significant weight loss with either Saxenda or Ozempic (note that Ozempic is off-label), and your doctor determines that the health benefits of the weight loss outweigh the known risks of the medication, it is recommended to continue the treatment. Studies have demonstrated that most individuals tend to regain their pre-treatment weight once they stop taking the medication.

    If you are exploring other treatment options approved for use in the Us, it is advisable to consult with your physician. However, it’s important to note that some of the less expensive options available in the Uk may not be approved or available for use in the Us. Wishing you the best of luck in your journey.
    For more visit:[link removed]

  • Sue says:

    I am on Wegovy and löst a Lot of weight.
    Im still on Wegovy and Tracking my Calories.
    But now i start gaining. Weight Back.
    What can i so?

    • Dr. Lazarus says:

      This is a very good, albeit complex question. The average weight loss on Wegovy is ~15% of the total body weight. In year two, it improved to roughly ~16%. It is not unusual after a large weight loss to regain part of what was lost as your body tries to find a new, lower weight. But that lower weight is not always the lowest that is reached during active weight management. Nevertheless, it is important to follow-up with the prescribing doctor to review your concerns. In my practice, I review the food plan, the activity plan, the body composition analysis, the labs, other medications, sleep, stress, and consider whether or not to add an oral medication depending on whether I consider the weight loss to be appropriate vs. excessive, as discussed above.

  • CC says:

    I’ve been on Wegovy since February. Currently at 1.7 but spacing out doses due to shortage and insurance. I have always had low-normal blood sugar. My numbers are typically in the 80’s. One time I dropped to mid 50’s and I felt really horrible. Didn’t try to purposely limit sugar, I just don’t have a sweet tooth. Question is how concerned do I have to be about these meds lowering my sugar. Doc is moving me to Rybelsus since my insurance stopped covering Wegovy. I just don’t want it to drop too much.

    • Dr. Lazarus says:

      Usually we recommend frequently having small amounts of protein throughout the day to reduce symptomatic hypoglycemia. Of course, your doctor should make sure you aren’t on any other medications that lower blood sugar (glyburide, actose, amaryl, etc). I have not had a lot of experience using Rybelsus for weight loss – the max dose is 14 mg. In clinical trials, 50 mg oral dose seems to be similarly effecive to Wegovy. Definitely discuss all potential options, and there costs, with your prescribing obesity medicine physician.

  • Joanna says:

    I am currently perimenopausal. I have never really had a weight issue, but I have gained 30 pounds in the last year. Would wegovy be a good option for me to lose the weight and maintain until I’m finished with menopause?

    • Dr. Lazarus says:

      Maybe – review the article by Andreas Acosta on Obesity Phenotypes – https://onlinelibrary.wiley.com/doi/10.1002/oby.23120. In my clinical experience, many early post-menopausal women would be slow burners, and may actually benefit more from phentermine / topiramate + resistance training. Of course, phentermine / topiramate are very inexpensive vs. Wegovy. If wegovy is covered, it may be a great option, but it usually is not the only option. In our center, we would be sure to do a full history, physical exam, lab, EKG, and of course a medical grade body composition to better understand the best option for you.

  • Marj says:

    Just wondering what the maintenance dose of Ozempic is once you’ve reached your goal weight.

    • Dr. Lazarus says:

      The use of ozempic for weight loss is “off-label,” so take my answer with a grain of salt. With any medication, the dose used to achieve weight loss should be used to sustain weight loss. Lowering the dose is likely to result in a regain of some of the lost weight. Of course, there are a lot of qualifiers for this – was the BMI high enough to justify Ozempic in the first place? Is it sustainable / cost-effective? Was enough weight lost to justify any potential risks of the treatment? All of these questions should be reviewed with the prescribing obesity medicine physician, but again, typically we just talk about a “treatment” dose – not a “weight loss” vs. “maintenance” dose.

  • Lisa says:

    So I started This journey in 4/23 on .25 of Wegovy. Stayed on that dose for 2 months bc .5 wasn’t available. By June none were available so I started Saxenda. Now Saxenda is an issue too. I was on 2.4 of Saxenda for about 2.5 months and now I’m switching to Wegovy 1.7. First do I need To take my first shot of wegovy the very next day after my last shot of Saxenda? Second I saw Some comments that said this method didn’t make people sick and one saying it did. What is the probability of me getting really sick doing this? I handled .25 of wegovy and Saxenda very well with little to no side effects but I have A busy work week through Sat so I’m scared I may Get too sick to work which can’t happen. Please help! Thanks so much!

    • Dr. Lazarus says:

      This is a great question, and I haven’t been able to find a good answer for it. I usually count the doses and sometimes go down by 1. So, if on 2.4 mg Saxenda, you are on the 4th dose (.6, 1.2, 1.8, 2.4). The 4th dose of Wegovy is 1.7. 1.7 Wegovy is easy to find right now. If you could find it, I’d start at 1 to lower risk of side effects, but 1.7 is reasonable. I’d wait at least 3-5 days for the Saxenda to be out of your system before initiating with the Wegovy. Again, these are my opinions, and I’d definitely consult with the prescribing obesity medicine physician to see their thoughts!

  • m says:

    An informative article – thank you!
    I’m wondering if you have any recommendations for those going off weight loss medications because they are trying to conceive? Is there ANY way to maintain the weight loss?

    • Dr. Lazarus says:

      It is generally considered necessary to gain weight during pregnancy. The question is, how much? There is a guideline published by CNC on weight gain recommendations depending on the starting BMI. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm Further, there are different recommendations regarding stopping AOM before planning to conceieve –> 2 months for Wegovy, for example. And, Qsymia / Topiramate are known to cause birth defect so absolutely should be stopped before trying to concieeve. If you can control the weight gain (ideally working with a RDN), I usually recommend gradually losing it after pregnancy. 1 year on, 1 year off! Rapid weight loss after pregnancy can pose risk to breast milk production and to a woman’s bones. So, I recommend gradual weight loss x 6 months. After that, when no longer breastfeeding, may consider adding back in the AOM (weight loss medication). Again, these represent my opinions, and all should be discussed with the treating obesity medicine physician and obstetrition during pre-conception counseling and planning. Hope that helps!

  • charles says:

    I am currently on mounjaro at the 7.5mg. I need to switch to Wagovy. Without a stop in meds what dosing what you suggest I start the Wagovy? Should I start at .25?

    • Dr. Lazarus says:

      I haven’t seen anything published on this; nor is it addressed in the package inserts. My practice has been to count doses when going from Mounjaro to Wegovy for chronic weight management and subtract one. So, for you – you are on the third dose of Mounjaro and that it is being used off-label for chronic weight management (first is 2.5 mg, second is 5 mg, 3rd is 7.5 mg). So, I’d go to the second dose of Wegovy (.5 mg). If you’ve been on Mounjaro for a long time, you might tolerate the third dose (1.0 mg). Remember, Wegovy is only approved for chronic weight management at 1.7 and 2.4 mg doses. The .25, .5, and 1.0 mg doses are initiation doses only, so if you try and stay on one of those, generally we run into trouble with insurance coverage. And, these are the only doses that are easier to find at pharmacies right now – there are very few doses of .25, 5, and 1.0 mg available. Of course, this is my opinion, and you should consult with the prescribing physician to determine what is best for you! Another options would be to titrate higher on Mounjaro (since those doses are easier to find), then jump to Wegovy 1.7.

  • Karen Lam says:

    Before I started Ozempic my weight was 60kg. I am 1.67m. I assume that is a ok BMI. After 3 months I am now at 54kg. My question is – if I wasn’t particularly overweight to begin with, is it possible to lower my dosage or even come off Ozempic and try self-maintenence? I am ok if I can maintain around 55-56kg. Thank you!

    • Dr. Lazarus says:

      I do not recommend the use of Ozempic for weight loss in people at a normal BMI (<22 to start). You would need to discuss this with the prescribing physician. It is hard to justify it's use if we believe the risk of an adverse event is greater than the benefits provided by lowering from an already healthy BMI. I'd recommend discussing this with your prescriber and am not able to comment. I approach obesity as a health problem. This usage sounds more like cosmetic weight loss, for which I do not recommend the use of GLP-1.

  • James says:

    Started wegovy in January.
    Great reduction in weight. 180s to 150s.
    During the weight loss I ate healthier and made the gym a routine. However I noticed over time I was becoming weaker and weaker. The weight loss was effecting my muscle mass. I’m 36. I’d rather not be losing lean muscle mass. Used to be able to do 30 push ups. Now 5 is tough. Any thoughts on managing this?

    • Dr. Lazarus says:

      We monitor fat / lean / muscle mass (and loss) in all of our patients during weight loss. It is not unusual for people to lose ~70% fat, ~30% lean body weight. We consider this amount “Physiologic.” With 70/30, there is not a big change in fitness. People that do a lot of weights tend to have more like an 80/20%. Your weight loss is consistent with the expected percentage weight loss from wegovy (You are at 16.6%, average is right around 15%). I have not had a single patient complain of inability to do physical activity as a result of Wegovy treatment. I would definitely discuss with the treating physician. I’d make sure on real wegovy (not compounded semaglutide). I’d look at other medications – I’ve seen complaints like these from cholesterol medications rarely (statins). I’d consider getting a good body comp measurement and see where everything is at.

  • Margaret says:

    Saxenda is expensive in Australia. Is there a safe source in another country from where I can order online?
    You mentioned that weight gain tends to slow when we age. What age is that? I am 72years.
    I would like to think there will be an end date taking Saxenda given its cost.

  • Sandy says:

    Can Trypdergium Wilfordii( Thunder God Wine ) help for Weight loss?
    I read about in a Magazin.

    • Dr. Lazarus says:

      Sorry, but I know of no data that this has been proven to be safe and effective treatment. To the best of my knowledge, there is not conclusive data to date on any supplements that are being sold for weight loss, in terms if efficacy or safety. That being the case, I’ll keep my eye out for you on any data for Wilfordii and weight loss / obesity treatment. Thanks.

  • Lori says:

    Meant to say I did “not” have diabetes or pre diabetes or anything else beyond obesity.

  • Lori says:

    Do you have a recommendation for a good obesity doctor in the DMV (metropolitan area tied to Washington, DC)? I live in Maryland just 20 minutes outside of DC but willing to travel within the DMV. I am 5’ 3” and was 206 lbs. I lost 30 lbs on my own over 18 months doing all kinds of stuff (no medication) and gained 10 lbs in 3 weeks after being sick and unable to exercise and focus on it. I cried and my primary doctor prescribed Wegovy. My insurance covered but it was nowhere near affordable. I stumbled upon Calibrate and they got me on Metformin and Ozempic (I did not have diabetes or pre diabetes or any other medical issue besides obesity). I met my goal weight of 135 and sustained it for 3 months on both meds. Calibrate said I had to come off my GLP-1 given my new BMI. I titrated down (still on Metformin) and have already gained 8 lbs despite my best efforts to keep my same habits. It stinks. My primary doc retired and the new one does not treat obesity. I read all of the comments above and have no idea how to get someone to help beyond finding an obesity doc and I see the website you recommended. Wondering if there is any person or practice in my area you recommend specifically. I am so glad I came across this website. Wish I was in Colorado or you where in the DMV. I do not understand why those who found success are forced off this medication (I did not have side effects and for some reason I stopped losing at my goal weight despite being on the 2.0 Ozempic dose…it just worked for me so well). Please help!

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