My patients very often ask me if they will be able to discontinue their weight loss medications after reaching their goal weight. The answer is complicated but could be “yes.” I emphasize that obesity is a chronic disease, not unlike hypertension. Therefore, once a person reaches a high body mass index (BMI), this condition will need to be considered and treated in some way throughout their life. As an example, if I were to treat a patient’s high blood pressure, I would not stop medication when they reached a normal blood pressure. The exception to this would be if they were able to make significant enough lifestyle changes such that the medicine is no longer needed at some time in the future.
Therefore, I emphasize that all patients should be diligent about proper lifestyle. This is particularly true for patients with elevated weight. If they do not maintain a healthy diet, exercise regularly, have restful sleep, manage their stress, avoid risky substances, and address any behaviors that prevent them from making these changes, it is unlikely that they will be successful when stopping an anti-obesity medication. In order to prevent weight gain after stopping pharmacologic treatment of obesity, aggressive lifestyle changes must be in place. Vigorous exercise, of at least one hour six times weekly, has been shown to control weight after loss (whether achieved through lifestyle alone or with medication + lifestyle). If these healthy habits have not been established during treatment with medication, such as Wegovy (semaglutide) or Zepbound (tirzepatide), then weight regain is very likely. A study of patients treated for one year with Zepbound who then received placebo for one year demonstrated that weight regain is the rule rather than the exception. While a small percentage of patients may have minimal to no regain, most patients gain at least 50% of the weight back. Of course, the benefits of healthy lifestyle are multiple in terms of cardiovascular health, decreasing risk of dementia, and perhaps most notably, cancer.
If I could recommend only one treatment to my every one of my patients, it would not be a medication, it would be exercise. Longevity is directly correlated with fitness and muscle mass. Anti-obesity medication should only be an adjunct to healthy lifestyle. So, get out there and move it, no matter who you are!
