Considering the risks I recommend a better alternative; eating less. Feel free to punch me in the nose.
What Happens When You Stop Taking Ozempic?
Many people become heavier after halting the use of semaglutide to manage weight
The popularity of Ozempic, used to lose weight or manage diabetes, has surged in recent
By Alex Janin, WSJ
Feb. 27, 2023 10:00 am ET
Hundreds of thousands of people take Wegovy or Ozempic to lose weight or manage diabetes. For some, going off the drugs is leading to unexpected outcomes.
The drugs’ main ingredient is semaglutide. It was originally prescribed for long-term diabetes management and attracted widespread attention because it can spur significant weight loss. Sales of Wegovy, the brand of semaglutide approved for weight loss in 2021, reached nearly $900 million in 2022, according to Novo Nordisk, the pharmaceutical company that manufactures both brands.
Supply-chain snags and high demand have resulted in shortages of Wegovy. And the costs, as much as $1,349 a month out of pocket for the injection pens, as well as unpleasant side effects, have prompted some patients to discontinue their use. When these patients stop, doctors say the pounds and cravings return.
People who stopped taking semaglutide gained back, on average, two-thirds of the weight they lost within a year, according to a study published in August 2022 in the journal Diabetes, Obesity, and Metabolism. Novo Nordisk funded the trial.
“Some people don’t have an awareness that this might have to be a medication that will be lifelong,” said Alexandra Sowa, an obesity medicine physician in New York. Dr. Sowa said more than half of her new patients are asking about semaglutide.
Weight Cycling
Frustratingly, even those who maintain a healthy diet and exercise regimen after Wegovy or Ozempic can expect to gain some weight back, said Gregory Dodell, an endocrinologist in New York City. He said he rarely prescribes Wegovy except for patients with polycystic ovary syndrome, or PCOS, a condition associated with an increased risk of Type 2 diabetes.
Semaglutide spurs weight loss by stimulating the release of insulin and lowering blood sugar. It also delays stomach emptying, which causes people to feel full quickly and stay sated for longer stretches. When a patient comes off the drug, their normal appetite returns.
“Most likely, you’re going to end up eating what you were before and maybe more because the body has been in something like a starvation mode and it’s trying to catch up,” said Dr. Dodell. “It’s not a matter of willpower and self-control.”
Some patients say they weren’t initially aware that they might need to take weight-loss drugs long-term.
Jenny Woods, a bartender in Nashville, Tenn., received a free five-month trial for Wegovy last July. When the trial ended, Mrs. Woods, who has PCOS, had lost roughly 17% of her starting weight.
Her insurance didn’t cover the medication, so she stopped taking it. Over the next two months, her PCOS-driven sugar cravings returned, as did about half the weight she had lost. She has since restarted the medication, working extra shifts to cover her $750 monthly out-of-pocket cost.
“I don’t think other people are aware that this is a forever thing,” she said. “This isn’t something you’re going to take for 10 to 15 vanity pounds because it’s going to come right back.”
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Of roughly 110 million Americans with obesity, 40 million have access to Wegovy through commercial coverage or Medicaid, according to Novo Nordisk, which said it is working to expand coverage.
Physicians prescribe long-term semaglutide use for diabetics and recommend the same for obese patients to avoid weight cycling, or repeated weight loss and gain. (Ozempic isn’t approved to treat obesity in non-diabetics, but some doctors prescribe it off-label.)
Weight cycling can be harmful to a person’s physical and mental health. And those who lose and gain weight repeatedly have a higher risk of mortality than people who maintain a stable weight, various studies have found, including in the Journal of Clinical Endocrinology & Metabolism.
Doctors tell patients not to go off the drugs without talking to a physician. Dr. Sowa says tapering, rather than going cold turkey, can help curb rapid regain, as can supplementing with other weight-management medications, such as Qsymia.
Long-Term Questions
Christine Gal, a radiologist in Honolulu, quit Wegovy in the summer of 2022. She said the drug left her repulsed by most food and vomiting near-daily. Gastrointestinal symptoms such as nausea, constipation and diarrhea are common side effects, doctors say, but are relatively mild for the majority of patients.
“I told my husband at one point, ‘I would rather starve than feel this way,’” Dr. Gal, 52, recalled. “I wanted to enjoy my food again.”
After gaining roughly 5 pounds back and struggling to manage cravings, she went back on. She hopes to taper off the drug eventually, citing a lack of research on long-term Wegovy use for weight management. She knows the odds are stacked against her when it comes to maintaining weight, but hopes to beat them anyway.
More research is needed to fully evaluate how long-term semaglutide use affects weight loss, doctors say. The Diabetes, Obesity, and Metabolism study found that although participants regained most of the lost weight after stopping the drug, other benefits persisted, such as lower levels of certain types of cholesterol.
It is unclear how long those benefits could last, said Natasha Bhuyan, a family medicine doctor at One Medical in Phoenix, who wasn’t involved in the study.
Some patients, like Mrs. Woods, say they will do whatever it takes to stay on the drug long-term. She said she enjoys the absence of back and joint pain she dealt with at higher weights, but the bigger benefit is the time she gets back in her day from not having to think about eating.
“Just to be able to just wake up, get ready, go to work and not worry about being obsessed with the concept of food,” she says. “It is freedom.”
Write to Alex Janin at alex.janin@wsj.com
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