Episode 243: Why people stop taking GLP-1s

[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.

[00:00:28] Hello, and welcome back to the Back on Track Achieving Healthy Weight Loss podcast. I'm your host, Dr. Alicia Shelly. Now today we're talking about something that happens more often than people realize, having to stop your GLP-1 medication. And then trying to restart it later. So maybe your insurance stopped covering it. Maybe the pharmacy ran out and can't get it back in stock or get your dose back in stock.

[00:00:53] Or maybe you went on vacation for a month or for a few weeks. Or yeah, got sick or had surgery or simply needed a break because of the side effects. And then now suddenly you're wondering, can I just restart where I left off? Why am I so hungry again? And why am I getting side effects now? And did the medication stop working? These are all very valid questions. And if this sounds familiar, then this episode is for you.

[00:01:22] Because restarting GLP-1 medications like Wegovy, Zepbound, Sixenda, Ozempic Mounjaro, is not always as simple as picking back up where you stopped. So today I'm going to walk you through what happens when you stop GLP-1s. Why does restarting can feel a little different than it was when you first started? And how to restart safely and the common mistakes people make and how to mentally get back on track without shame. So let's dive in.

[00:01:52] Now first, let's normalize this. A lot of people stop medications temporarily. And honestly, most of the time it's not because they failed. It may be insurance changes. Like it's the first of the year and you have to pay this deductible. So it's $400. You have to stop the medication temporarily and you can't afford the higher prices. Also, another reason could be prior authorizations get denied. It is common for people to change insurances, change jobs.

[00:02:21] And so this job no longer covers for GLP-1. And then the third reason is pharmacies run out of stock. I remember, I think it was in 2024 when there was not enough Zepfam, not enough Ozumbic, not enough Monjaro, and they were all pharmacies run out of stock. And so that made it really difficult for people to continue the medication. And then the next reason is the cost.

[00:02:45] The cost could become too expensive, especially if you have to hit your deductible before your insurance will cover the medication or if you're paying out of pocket. Sometimes you may just not have it. Also, sometimes the side effects can become overwhelming, that constant nausea or a little bit of vomiting or constipation. So you just want a break. The third thing, life just gets busy. You know, you are moving around so much stuff to do and you just forget to take the medication.

[00:03:12] And sometimes it can be more than one week in a row. And I always tell patients that a break does not erase your progress. Just because you stop the medication does not mean you're starting from zero. But your body does respond differently after the time off of the medication. So let's talk about what happens biologically when you stop a GLP-1.

[00:03:34] Number one, the GLP-1 medications do help reduce appetite, slow stomach emptying, improving fullness and decreases food noise and improves insulin resistance. So when you stop the medication, your body may begin returning towards that baseline because that baseline is always there. The medication is just suppressing it a little bit. And that means your hunger will increase, your cravings may return, and your portions may start to get bigger.

[00:04:00] You're able to complete, actually eat your full plate. And then sometimes the emotional eating may become harder to control. You may be under a good amount of stress and it's hard to, you know, not get that sweet treat or that savory chips because of the fact that you're in an emotional state and it's hard to control. And, you know, when people start to experience this, many patients panic when this happens. But remember, this is about biology, not a lack of willpower.

[00:04:28] Your body is responding to the loss of the medication support. That does not mean you are weak. It means obesity is a chronic disease that often requires long-term treatment. And one of the biggest questions that I get is, can you just restart at your old dose? Can I just start back at the high dose I was at? And the answer is usually no. And the reason being that if you've been off the medication for a long time, your body loses some of its tolerance to that.

[00:04:58] And so if you restart it at a high dose, you can experience nausea, vomiting, diarrhea, stomach pain, sulfa burps, and constipation. And it can hit you hard. Now, I've seen people where they've accidentally went up on that dose for one reason. They may have had some extra doses in the refrigerator. So they decided to take that. And they ended up in the emergency room.

[00:05:23] So even if you tolerated that high dose before, it's important that you start at a lower dose. Because the Wegovy, the Zepbound, the Mounjaro, the Ozempic, these medications are designed to be increased slowly over time and not started at a high dose. So remember, your stomach remembers where you stopped. But sometimes restarting too aggressively causes patients to quit altogether because they feel miserable.

[00:05:52] Now, how long is too long to be off the medication? This varies depending on the medication and, of course, the person. But in generally, if you miss one dose, you may not require restarting lower. You can start at that same dose. But if you're missing two to three weeks or almost four weeks, then you may require starting going down to a lower dose before going up. And if you miss over one to two months, then you usually have to step all the way back down.

[00:06:19] And this is why it's so important to communicate with your health care provider before you restart, because restarting plans are so individualized. And, of course, we don't want you to be sick. Some factors you need to include is how long you were off that dose, what your previous dose was, and any side effects history. Have you had noticed some nausea throughout, you know, before? And now that you are trying to restart the medication, you know, there's an increased risk of having more nausea.

[00:06:47] Also, what your current rate is and other medical conditions and how your body has tolerated the medication before. These factors are so important in deciding how you restart. And it's important that you see your own doctor and health care provider so that they can kind of walk you through. So let's talk about the common restart mistakes that I see. Mistake number one, restarting at the highest dose immediately.

[00:07:12] This is probably the most common issue because sometimes people still have just, you know, random doses in the refrigerator. And so they're just trying to clean it out. And by restarting at the highest dose, they get so sick. I remember I had a family member who did that. She had some doses in her refrigerator. She took it and then she got super duper sick.

[00:07:33] So it's important that you make sure that if that's all you have, that you talk to your doctor on what dose you need to start off. And then mistake number two, comparing yourself to your first journey. I sometimes have patients that say, why isn't the weight coming off as fast as it was this time? Like I felt like the medication just worked better when I started initially and now it doesn't work better.

[00:07:58] And I think it's important that you remember that your body is different now and your body adapts to what you're doing. It remembers the medication that you were on. And so sometimes you have to go up on that dose or taper up on the dose so that you can still have that same feeling of fullness and feeling that the medication is working. Also, hormones change, stress change, sleep changes, menopause changes, and even muscle mass changes affect how fast the weight comes off.

[00:08:27] And your second journey may look different than your first journey, but that's okay. That is okay. And it's important to not compare yourself to that first journey. So mistake number three, stopping lifestyle habits while trying to restart. Sometimes patients will say, well, I'm off the medication. So what's the point in doing any lifestyle habits? And that is not a great place to be.

[00:08:52] Because at that time when you stop the medication, it is very important that you prioritize your protein, making sure you hydrate two to three liters per day, move your body, sleep well, and manage stress. Because these habits help stabilize things during the transition and help you not regain the same amount of weight that you just lost. So now let's talk about expectations.

[00:09:18] When you restart, some patients notice that their appetite suppressant comes back quickly, the fullness improves, food noise decreases again. But other people notice slower responses initially, mild side effects, needing time to rebuild tolerance. And know that that's normal. I often tell patients don't judge the medication by week one because your body needs time to adjust. So I have a few tips here to help with restarting earlier.

[00:09:45] Tip number one, eat smaller portions initially because your stomach may become sensitive again. Number two, prioritize your protein because protein can help preserve muscle and improve fullness. Number three, hydrate aggressively. Many side effects worsens with dehydration. So it's important to make sure you're drinking enough fluids. Also avoid greasy or heavy foods early on because these foods often worsen nausea.

[00:10:13] And then listen to your body because sometimes slower dose increases lead to better long-term success. This is a huge lesson in obesity medicine. The faster is not always better. I mean, do you still remember the tortoise and the hare? The hare and the hare and the hare and the hare are the rabbit. The hare was so fast that he took a nap and the tortoise passed him and won the race.

[00:10:39] So with that being said, I do want to just share a little bit about the emotional side of restarting. Because sometimes when people see that their weight has come back, they start to feel embarrassed about restarting. They feel like they failed or that they've gained the weight back and should have done better. But hear me clearly, needing to restart treatment is not failure. We don't shame people for restarting blood pressure medications. We don't shame people for restarting insulin.

[00:11:06] Obesity is a chronic relapsing multifactorial disease. And sometimes chronic diseases just require restarting the treatment. What matters most is not perfection. It's getting back up and continuing the journey. So today's main takeaway is this. If you stopped your GLP-1 medication, don't panic. Don't shame yourself. And don't automatically restart at the same high dose without guidance.

[00:11:32] Restarting safely and slowly can help you stay successful long-term. And remember, progress is not a race because of a pause. Thank you so much for joining me today on today's episode of Back on Track Achieving Healthy Weight Loss podcast. If this episode helped you, please share it with someone who may be restarting their medication journey.

[00:11:53] And don't forget to subscribe, leave a review, and follow along for more conversations about obesity medicine, mindset, nutrition, and sustainable health. And until next time, stay strong, stay committed, and stay consistent. And remember, we are stronger together.