By Claire Bugos Published on April 13, 2023 Fact checked by Nick Blackmer Source: Very Well Health
Photo Source: Unsplash,
Semaglutide, the active ingredient in Ozempic and Wegovy, can be a powerful medication for treating diabetes and obesity.
Semaglutide must be taken consistently to see long-term weight loss effects. As soon as someone stops taking the drug, their body fat and former appetite tend to return.
Experts recommend working with a provider versed in obesity medicine to create a plan for improved lifestyle and long-term adherence to the drug.
Semaglutide, the active ingredient in Ozempic and Wegovy, can be a powerful tool for promoting weight loss and treating diabetes. It’s been hailed as a “miracle” weight loss drug for people living with obesity. But, as with many medications, it only works for as long as it’s used. As soon as someone stops their regular course of semaglutide, their weight is likely to come right back. Over the last year, prescriptions skyrocketed for Wegovy, which is indicated for obesity, and for Ozempic, a diabetes medication given off-label for weight loss. People looking to lose weight—whether for obesity treatment or just to shed a few extra pounds—are flocking to doctors and telehealth providers to ask for a prescription. But starting the drug without caution can be harmful in the long term, according to Steven Heymsfield, MD, a professor of metabolism and body composition at Louisiana State University. He said it’s “almost a paradigm” in obesity medicine that when a person stops an effective weight loss treatment, whether it be pharmacologic or behavioral, their weight tends to rebound. “There’s a warning here: You take this drug and you lose a lot of weight. But you need to stay on it for the rest of your life. Are you willing to do that? And if you get off of it, the chances are really good you’re going to go right back to where you were,” Heymsfield told Verywell. In a large study published last spring, people who stopped taking semaglutide after regular use gained back an average of two-thirds of the weight they lost in a year. The trial was funded by Novo Nordisk, the company that makes Ozempic and Wegovy.1 “My excitement is balanced with the experience that these drugs are potentially dangerous and they’re very powerful and they should be treated with respect,” Heymsfield said. “This rebound phenomenon is more than I’ve seen in the past. Relapse is universal when people stop obesity treatment, but this one seems to be associated with a more rapid rebound.” What's the Difference Between Ozempic, Wegovy, and Mounjaro? What Happens to Your Body When You Take Ozempic or Wegovy? Semaglutide works by boosting the body’s level of the hormone glucagon-like peptide 1 (GLP-1). This hormone stimulates the release of insulin. GLP-1 drugs help to lower blood sugar and delay stomach emptying, making people feel full longer.2 “A lot of people will tell you if they start taking one of these medications that they finally know what it feels like to feel full,” Angela Fitch, MD, FACP, FOMA, president of the Obesity Medicine Association, told Verywell. “It’s hard for you to regulate your own your own eating behaviors if you don’t know what it feels like to feel full.” When a person takes semaglutide, they are able to eat less food without the body entering starvation mode. Once the person stops taking the drug, their body will process that calorie deficit as a sign of malnourishment and will try to put the weight back on. This could mean that the person’s previous appetite will return and that their metabolism will decrease again, Fitch said. All the behaviors that the person experienced before taking semaglutide, be it insatiable appetite or high blood sugar, are likely to return. There are many reasons why someone might halt their semaglutide treatment, such as high out-of-pocket cost or inaccessibility due to drug shortage. Some people who take semaglutide report unsavory side effects like the loss of appetite, a newfound disgust for alcohol, and unusual cravings. In the weeks after a person stops taking semaglutide, those reactions should go away. “Biologically, it affects your drive to consume alcohol in addition to consuming food. When you stop it, that drive to go back to that behavior goes back to normal. We don’t have data to show that it gets worse,” Fitch said. It’s possible that it’s effective for a person to take a break from semaglutide use and return to it if the weight creeps back in, Fitch said, but there’s no data to support that yet. What Is 'Ozempic Face'? What Should You Do If You Want to Stop Taking the Drug? If someone chooses to stop taking semaglutide, there’s no need to gradually reduce their dose or cadence. Once a person stops regularly taking the medication, their body will naturally cycle through the remaining drug, Fitch said. If someone is taking the highest dose of Wegovy, for instance, it can take between five and seven weeks to completely leave the body. To be on the safe side, the label recommends stopping for at least two months before trying to get pregnant.2 Each person’s health picture post-semaglutide will look different depending on how much weight they lost, how quickly they lost it, whether it was fat or muscle, and whether they are exercising or taking other lifestyle precautions, Fitch said. She recommends that those seeking weight loss treatment check in often with a trusted provider so they can adjust their lifestyle and care. When a person takes semaglutide and loses weight, it’s important that they continue eating enough protein and exercising, Fitch said. If not, they could be losing muscle rather than shedding pounds of fat. In some instances, it may make sense for the patient to reduce their semaglutide dosage to see whether they can maintain the weight loss at a lower dose before committing to going off the medication. “I’m worried somewhat about some of the episodic care that’s being delivered quickly with these sorts of medications that isn’t being supported in a long-term fashion,” Fitch said. Can You Take Ozempic With Other Medications? Is Ozempic a Sustainable Weight Loss Solution? Losing weight, even if only temporarily, can have health benefits. The Novo Nordisk study followed people who took semaglutide for 68 weeks and then stopped. Over the following year, cardiometabolic risk factors—including blood pressure, blood sugar, and cholesterol levels—rose in participants who stopped taking semaglutide but remained lower than those in the placebo group.1 However, regaining weight is usually not as beneficial as keeping it off. Weight cycling is when a person fluctuates between high weight and relatively lower weight multiple times. There is some evidence to indicate that the more a person weight cycles, the harder it becomes to keep weight off.3 Semaglutide and other drugs that promote weight loss should always be coupled with lifestyle changes, like eating a healthy diet and exercising more, Heymsfield said. That way, if someone decides to stop taking the medication, they won’t then have to deal with more severe health issues. Besides, for some people, the experience of losing weight only to regain it can be psychologically trying. Heymsfield said that people living with obesity who have tried many weight loss approaches often feel desperate to use a treatment that works. If someone experiences depression or other mental health problems associated with their weight loss, a rebound could be detrimental. Prioritizing semaglutide for treating obesity, rather than catering to vanity, can ensure that people who can most benefit from the medication can readily access it. Ozempic and Wegovy have been on the Food and Drug Administration’s list of drug shortages for months. “I’m very concerned about this rage for these GLP-1 agonists,” Heymsfield said. “These drugs should be used for people who really need them and have health risks from obesity who’ve tried many times to lose weight, and not by Hollywood actors and actresses who are trying to lose 10 pounds.” Weight loss problems generally don’t resolve after a few years, Heymsfield said. For people living with obesity, it’s a lifetime consideration. Semaglutide may be just one part of a long-term health plan. “Keep focusing on those lifestyle changes. Try and learn as much as you can while you’re on the drug,” Heymsfield said. “Then when you go off the drug, maybe engage yourself in a more formal weight control program—whatever is successful to you.”
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