Episode 207: What Happens When You Stop Ozempic? The Truth About GLP-1 Meds & Weight Regain

[00:00:00] Welcome back to the Back on Track Achieving Healthy Weight Loss, where I help you get on track and stay on track with your weight loss journey. I'm your host, Dr. Alicia Shelly. So let's get started.

[00:00:27] Hello, and welcome to the Back on Track Achieving Healthy Weight Loss podcast. I'm your host, Dr. Alicia Shelly. I'm a board certified internal medicine obesity medicine physician. And today I wanted to talk about a question I hear all the time, which is what happens when I stop taking a GLP-1 medication?

[00:00:51] Now, whether you are considering taking it or currently taking it or just curious about it, this episode is for you. So let's first discuss what is a GLP-1 injection?

[00:01:04] Now GLP-1 stands for glucagon-like peptide-1 receptor agonist. What that means is that this is a medication that actually attaches and causes more hormones or more glucagon-like peptide or GLP hormone in the body.

[00:01:23] So it increases those levels. Usually when this class of medications came out in like 2007, the first was Bayetta. Bayetta was a daily injection that was used to help treat type 2 diabetes. But recently, in the last several years, they've been able to, instead of daily injections, do weekly injections. And so they were treating type 2 diabetes and they noticed that people were losing weight.

[00:01:50] They noticed all these other really good outcomes from these medications. And so they started to do more research to see how it would work for individuals who are trying to lose weight. And what they found is that these medications help people lose weight in a couple of ways. Number one, they slow down how quickly your stomach empties. So you may find that when you eat, you may not be eating as much and you start to feel full.

[00:02:18] Also, you'll find that not only are you feeling full after eating, you may find that you're not as hungry throughout the day because your stomach is still digesting, but it's just slowing it. Also, it reduces your appetite. So certain things that you're craving for, you're not going to be craving for it as much. You may notice I've had some people where the cravings are like sweets, chips, and even like alcohol.

[00:02:42] Like I had one guy who was like, man, this really helped me to reduce how much alcohol I drink because I'm just not craving it. And it also can help increase the insulin production when your blood sugar goes high to bring down your levels so that overall, your blood sugar levels are pretty low and actually maintained. And so that is very helpful, especially if you have type 2 diabetes and you're trying to reduce your diabetes.

[00:03:08] Also, too, because that insulin is better regulated in your body, people who have insulin resistance, where you see that the insulin levels are on the higher end, it can help regulate that. So for conditions like PCOS, conditions like prediabetes, it can be very helpful. Now, some of the brand name medications that are in this class that you've heard of is the Ozempic and Manjaro, which is just for type 2 diabetes.

[00:03:37] But then you have Wagovi or Zepfound, which are just for obesity. Also, now Wagovi has an indication for people who have a history of a heart attack, stroke, or peripheral arterial disease. It's been shown to benefit them. Also, for Zepfound, it's FDA approved for people who have moderate to severe obstructive sleep apnea. So those are kind of those additional indications that we see.

[00:04:03] But the one thing I do want to mention is that although these receptors, these medications are helpful for people, they're not magic pills. They're not magic pills. I know some people think like, oh, if I do this, I'm taking the easy way out. No, you are not. You're not taking the easy way out. Because honestly, even as you're trying to lose weight, they can help assist. But you still have to do the lifestyle or conventions to really see that weight loss.

[00:04:34] But these medications are powerful tools that can help support weight loss by targeting the biological pathways, especially that make it harder for those people to lose weight and keep it off. But know that you're not cheating. You're not taking the easy way out because you still need to eat healthy and make sure that you're exercising and staying physically active as you're taking these medications. And the one thing I will say is that these medications may not be for everyone. Well, let me talk about this in a second.

[00:05:04] It's just what are those side effects that you see with these medications? And so for some people, the most common side effects are going to be GI. So they're going to be your nausea, your vomiting, your diarrhea, your constipation, abdominal pain. For those people who have a history of gastroparesis, which is basically slowing of the gut. And for some people is where the gut just does not work, does not digest well. These medications are not for you because they will make that condition even worse.

[00:05:34] They'll slow it down too much. So definitely it's not recommended for them. Also, too, because these medications are working in the pancreas as well as the brain and as well as the gut, sometimes if you have a history of acute pancreatitis, depending on why you have a pancreatitis, sometimes these medications may not be as helpful as well. So it's important to see your doctor and discuss whether, you know, this medication would be okay for you.

[00:06:03] The one thing I will also say is that when they did the studies, they didn't study these medications in people who had a history of pancreatitis. So we don't know how it will affect. The other thing is, is that when they were doing the studies for these medications, they noticed in rats that they sometimes would develop a thyroid CISO tumor.

[00:06:24] And so therefore, if you have a family history or a personal history of medullary thyroid cancer or multiple endocrine neoplasia type 2, then it is contraindicated to take these medications. Because we haven't seen thyroid cancer develop in humans. We just want to be on the safe side. So if you already have a predisposition to it, it's better for you to not be on these medications that may increase that risk.

[00:06:55] Also, the other thing is, too, is that that's the black box warning. So that's on there. But if you're pregnant, you should not be on this. If you're breastfeeding, you should not be on this. Because we just don't know how these medications will affect. The other thing is why people end up stop taking these medications and not just the side effects, but sometimes it's the cost. These medications can be very expensive.

[00:07:23] It can be sometimes hard for your insurance to cover it. When it comes to obesity medications, your employer has to opt in to cover these medications. And if you have like federal, like Medicare or Medicaid or even just federal insurance, sometimes it depends on that state whether they will cover it or not.

[00:07:47] I know in Georgia, Medicaid does not cover obesity medication as well as Medicare does not cover anti-obesity medication. In order to get it covered, you have to kind of find the different loopholes, the other indications to get the insurance to cover. Also, sometimes you just need a break. I've had patients where they're just so tired of taking medications and they just want to stop. Interestingly enough, we don't necessarily have data on this, like a study to look at this.

[00:08:14] But the one thing that we've been noticing is that sometimes when you do stop the medication, when you get back on it, it's not as strong as when you first started it. And so sometimes it does take a little bit longer to, as you're titrating up, to really feel that same experience when you're like, okay, you know, I really feel like it's curbing my appetite. So just know that if you do decide to take a break, that this can occur.

[00:08:39] So once again, what happens when you stop taking this medication? So physically, your appetite will return. Usually these medications stay in your system for about two months. So you may find that it's kind of gradual. But then what some of my patients have noticed was that after that two months, even maybe a little bit earlier, that hunger comes back with a vengeance. Because once again, your hunger is not being suppressed.

[00:09:07] And then also too, people, your cravings may come back. So you may notice that you're drinking, you're eating sweet things a lot more than usual. If you have type 2 diabetes, your blood sugars may rise again. And for some people, they may regain their weight that they lost. So they did a study looking at ZepBound.

[00:09:30] And they noted the people who got off of that medication or kind of cut it off cold turkey, they gained around 14% of their body weight back. So there is that risk of regaining some of that weight. Now, what happens psychologically when you stop taking it? So stopping it can kind of trigger sometimes the fear, guilt, or shame, especially as the weight starts to come back. Sometimes you may feel like all your progress is undone.

[00:09:58] Although it's not true because you have gained tools, you've gained knowledge, you've gained awareness. You've gained so much, so not all of it's gone. But when the weight comes back, it just kind of messes with your mind. And then if we look at the science, one study found that people regained two-thirds of their weight they lost one year after stopping semaglutide. So, you know, definitely these medications are so powerful and they help. But sometimes it is common to gain that weight.

[00:10:26] And it's not necessarily the reason why they gain the weight. It's not because that they failed or that they couldn't control their hunger. But it's really because basically science is happening. So understand this. When you start to lose weight, your body works against you. And it starts to undergo metabolic adaptation where basically your hunger hormone starts to increase, your metabolism starts to decrease.

[00:10:53] This is why, especially when you're on a weight loss journey or you're changing your appetite, you're changing your exercise, you see that you start to plateau. Where you lose weight and then you kind of hit a level where you can't break through anymore. And it's because your body is working against you. So our body is hundreds of years old, thousands of years old. And so its goal is to survive, basically. So it wants to survive. And in order to survive, we have to have as much weight as possible.

[00:11:22] So as you start to lose weight, the body works against you in order to maintain the weight that it has. Now, the one good thing with GOP-1 is that it's curbing that appetite. So you don't feel that hunger hormone increase. But when you stop it, basically you can start to feel that hunger hormone again. So you feel like, oh, I'm so hungry. And you feel that fullness decreases as well. And I just want to be very clear that weight regain is not a personal sign of failure.

[00:11:51] But you have to remember that obesity is a chronic relapsing condition. And we can't really change how the body responds. Like we can't really retune the body so that it won't increase your hunger hormone. But what we can do is understand what's going on and make sure that mentally we're in a good place, especially if we do decide to stop the medication. Because many people may have to stop it. Could be the side effects that are causing the issue. It could be just expensive.

[00:12:21] I can't get it. But when it does happen, know that that weight regain is not a sign of personal failure. Now, let's say if you know your insurance is no longer covering this and you have to stop it. Maybe you wanted to get pregnant and you need to stop it. The one thing, how do you prepare yourself? So if life requires you to stop it, the first thing I would talk to your doctor. See how you can taper off on the medication so it's not stopping cold turkey.

[00:12:48] Sometimes if you know insurance is not covering it, you can kind of just space it out a little bit. Take it maybe every one or two weeks just so that you can still get some of that benefit. Also, it's going to be important to reinforce your lifestyle habits. Eating balanced, protein-rich meals. Keeping a consistent exercise routine is going to be imperative. And so the goal is to increase your activity around 150 minutes per week.

[00:13:14] Exercise plus two days of strength training is going to be important. Also, it's going to be important to prioritize your sleep and stress management during this time. So that's not causing you to gain weight. And then you may want to consider working with a health coach or therapist to kind of help with the different emotions that come as you change your lifestyle or if you stop doing that. And then also maybe join a support group to stay accountable. Now, I like to think of it like this. The GOP one helped you climb the mountain.

[00:13:44] But if you step off the medication, you may need a different set of tools to either stay on top or to keep climbing. And so definitely, can you reinforce those lifestyle habits to kind of help you maintain where you are? Now, for those who GOP one is just not working, they have a lot of side effects. They don't feel like it's helping them anymore. If they're not for you, I just want to let you know you're not out of options.

[00:14:10] There are other medications that support weight loss, oral tablets that you should talk to your doctor about. There are actually programs out there that are nutrition focused programs where they are giving you that accountability, giving you that combination of things that you need. Also, cognitive behavioral therapy that can help. Tools like meal planning apps, food journal, mindfulness techniques that can help. The key is to have a more comprehensive plan if you need to stop or switch to something else.

[00:14:40] So to recap, GOP one medications are effective, but they're not permanent solutions. We can't really change the biology on why we tend to gain weight. And I didn't really talk about this, but there's multiple reasons why we gain weight. Sometimes 40 to 75 percent of the time is due to genetics. It could be due to certain medications were put on certain conditions like hypothyroidism, PCOS that develop when we start to lose weight.

[00:15:08] Sometimes it can be aging. As women, if we do nothing, we don't change anything. We eat the same. We move the same. We can still gain one to two pounds per year. And that's just the natural aging process. Also, the other thing I would say is that even the anxiety, depression can drive obesity as well as just social determinants of health. Like, do we have access to go outside our home to exercise?

[00:15:35] Do we have access to proper fruits and vegetables that make a difference? So there's many reasons why people gain weight. And GOP ones are medications that are effective that can help with controlling it. But if for some reason you have to get off of this or you have to stop it, it is not the end of the world. And there's other things that we can do. Know that you are just not alone and you're not failing because long-term success requires a plan, support, and compassion for yourself.

[00:16:05] I always tell people your weight loss journey is a marathon, not a sprint. And every tool you use along the way is valid. So if this episode resonated with you, I'd love for you to share it with somebody who needs to hear it. If you stop the GOP one and want to share your experience, tag me on social media at DrShelliamd. And don't forget to subscribe so you never miss a new episode. And please leave a review.

[00:16:30] Until next time, thank you again for joining me on the Back on Track Achieving Healthy Weight Loss podcast. Remember to stay strong, stay committed, and stay consistent. And know that you are worthy, capable, and never alone in your journey. Until next time, see you later.