What happens when patients stop taking weight-loss drugs?

The perils of going off weight-loss drugs

Lesson summary

Hi everyone, it’s Jeff once again…and you are getting ready for another Plain English lesson. Here at Plain English, we help you upgrade your skills in English with stories about current events and trending topics.

For the last year, weight-loss drugs have been extremely popular. We first talked about them in Lesson 556. For patients struggling with obesity, the drugs can really help. They can reduce body weight by fifteen to twenty percent. But there’s a catch: go off the drug, and you might gain all the weight back, just as fast as you lost it. That’s what we’ll talk about in today’s story.

In the second half of the lesson, I’ll show you how to use the English expression “slow down.” You probably know how to use “slow down” without an object—like, if you tell someone to slow down—but today I’ll show you how to use it with an object.

This is lesson 660 of Plain English. JR is our producer and he has uploaded the full lesson content to PlainEnglish.com/660. That includes the transcript, the quiz, and all the other exercises. And just as a reminder, the quiz is free now. We added that to the free membership just recently. So for each lesson, free members get access to a review quiz right inside the transcript. Check it out: Go to PlainEnglish.com/660. Click the link for today’s story. And then find the tab called “Activities .”

All right, I think we’re ready to get going.

The perils of going off weight-loss drugs

When we last talked about weight-loss drugs , almost a year ago exactly, the question was about whether it was a good idea to go on the drugs.

You probably remember that these new drugs were originally developed to treat diabetes. But diabetes patients discovered a pleasant side effect: they lost a lot of weight. Word started to spread, and doctors began prescribing these diabetes drugs, called GLP-1 agonists, to patients who wanted to lose weight. Eventually, drugmakers released new versions of these drugs specifically for weight loss.

GLP-1 agonists do a few things. They trigger the release of insulin, which helps your body use the food you eat for energy. They lower your blood sugar. They slow your digestion down . And they make you feel full after eating. Put together, these effects can lead to significant and rapid weight loss. On average, the drugs help obese patients lose between fifteen and twenty percent of their body weight.

For people who struggle with obesity, the drugs can make a big difference. Some people decide to use the drugs to slim down for a special event or to get a jump start on weight-loss goals. But many people who start these treatments don’t have a clear idea of what will happen when they stop.

That’s because weight-loss drugs are not like taking antibiotics for an infection. They’re not intended to get a quick result over a short period of time. It’s more like taking statins for cholesterol or medication for high blood pressure. When you go off the medication, the effect stops and the original problem often returns.

Many patients who have gone off the drug say that they regained almost all the weight they lost. They said that their appetite and cravings returned to the same levels as before. And they regained the weight even after making adjustments to their diet and exercise routines.

This has been confirmed by several medical studies. One from August 2022 found that patients who stopped taking GLP-1 drugs regained about two-thirds of the weight they had lost on the drug.

A study from December last year dug even deeper. This study looked at 670 participants. All went on a weight-loss drug for 36 weeks, or about nine months. On average, participants lost 20 percent of their body weight. Then, half the group continued a high-dose of the drug for another year. The other half got a placebo.

After a year, the group that got the drug lost an additional 5 percent of their body weight. But the group that got the placebo regained 14 percent of their body weight.

This confirms what many doctors suspected: that for most people, going on a weight-loss drug means they either have to stay on it, possibly for life, or they risk gaining back most or all of the weight they lost.

So if the weight comes back, why would patients stop treatment?

First, some patients start treatment without making a long-term plan. After a lifetime of struggling with obesity, some people just want the immediate relief from cravings. And they start treatment, thinking they’ll worry about the future later. When the future arrives, they find they don’t like the side effects or can’t afford the drugs, so they stop treatment.

Second, staying on the drugs isn’t as easy as it sounds. Insurance plans don’t always cover the drugs. Patients paying out-of-pocket might not be able to continue to pay for their treatment forever. Over time, some patients may find the drugs cause or aggravate other medical conditions, so they have to stop their treatment. And the drugs—at least for now—are injectable. Not everyone wants to self-administer an injection once a week for life.

That presents potential patients with a difficult choice. Either go on the drugs and commit to staying on the treatment, possibly for life, or forego the benefit the drugs can offer.

Right now, there is no safe or recommended way to transition off the drugs, without risking regaining the weight. However, experts say patients should work with their doctors to get to their target weight, and then experiment with the lowest possible dose needed to maintain that target weight. For some patients, it might be the full dose of the drug. For others, it might be a lower dose. A lucky few might even be able to transition off entirely.

Older medications are also an option. Though they’re less effective in helping people lose weight, older formulas can help patients of the newer treatments keep weight off, if they can’t afford to stay on the newer drugs.

Either way, doctors don’t recommend abruptly cancelling the drugs. For patients who have to stop taking them, they recommend tapering it off as gradually as possible, exercising six times per week, and including as much protein as possible into their diets.

Jeff’s take

I generally think the drugs are good for people who need them, for people who are prescribed the drugs by a doctor. Taking them for three months because of someone on TikTok is…well, do that at your own risk.

Anyway, this is shaping up to be a major trend in business and health for the next—I mean, for the foreseeable future. This could be as big as cholesterol drugs have been. So I had a lot of questions about these drugs, starting with “how do you take them?” And so on Thursday, we’ll talk about four common questions about these weight-loss drugs: How do you take them? Where are they covered by insurance? How much do they cost? And why are there shortages? That’s all coming up on Thursday, Lesson 661.