Episode 249: Do I Have to Stay on My Medication Forever? What the ATTAIN Maintain Trial Reveals

[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, everyone, and welcome back to the Back on Track Achieving Healthy Weight Loss podcast. I'm your host, Dr. Alicia Shelly. Today's episode begins with one of the most common questions I hear in my office. Usually, it's asked on the first visit, Doc, do I need to take this forever? Or they will ask a similar question after they've lost 30, 40, or even 80 pounds.

[00:00:51] They're smiling, they're feeling better, their knees don't hurt anymore, they're sleeping better. And then they look at me and ask, Dr. Shelly, how much longer do I need to take this medication? Dr. Shelly, how much longer do I need to take this medication? And sometimes they'll even follow up with, you know, just right now. And if you've ever wondered that yourself, then today's episode is for you. Because today we're talking about one of the biggest questions in obesity medicine.

[00:01:20] Do I have to stay on my medication forever? And we're going to discuss an exciting new study called the ATTAIN-MAINTAIN, which is beginning to reshape how we think about long-term obesity treatment. But first, let's talk about something we don't celebrate enough, which is maintenance. We celebrate losing weight. We celebrate our before and our after pictures.

[00:01:50] We celebrate fitting into smaller clothes. But almost nobody talks about what happens after you lose the weight. Because here's the truth. Losing weight is hard. Keeping it off is often even harder. And that's not because you lack willpower.

[00:02:14] It's because your body is incredibly good at protecting itself and protecting and defending its body fat. Your body doesn't know you're trying to be healthier. It actually thinks that you're starving. So when you lose weight, your body starts to make adjustments. Your metabolism starts to slow down. You burn fewer calories.

[00:02:43] Your metabolism decreases. And your hunger hormone increases. Your fullness hormones decrease. So you feel more hungry. And your brain starts encouraging you to eat more. It's almost as if your body is saying, listen, let's get back to where we were. That's biology. But it's not failure.

[00:03:09] And understanding that biology completely changes how we think about obesity treatment. And let's think about other chronic diseases too. If someone has high blood pressure and their blood pressure improves, we don't say, great. Let's throw away your medication and just stop. Or if someone has asthma that's controlled, we don't tell them to get rid of their inhaler. Why?

[00:03:37] Because we recognize those conditions are chronic. And obesity is no different. For many people, obesity is a chronic, a multifactorial relapsing disease that requires long-term management. We learned an important lesson from an earlier study. Some of you may have remembered me talking about the SIRMOUT4 trial.

[00:04:04] Researchers treated patients with terzepatide, also known as Zepbound, and they lost a significant amount of weight. And then what happened is one group was continued on the medication. The other group was stopped. And so what happened when that occurred? The group that stopped the medication regained much of the weight they had lost over the following year. Not because they became lazy. Not because they just stopped caring.

[00:04:33] Their biology simply reasserted itself. And that study taught us something important. Stopping treatment completely often allows the body's natural drive to regain weight and to return to where it was originally. But then researchers asked a different question. Enter the ATTAIN-MAINTAIN trial.

[00:04:57] Instead of asking what happens if we stop the medication, researchers asked, what if we switched to a different medication that's easier to take? Now that's a completely different question. Let's put our science hats on for just a few minutes. So let's talk a little bit about what the ATTAIN-MAINTAIN trial is.

[00:05:24] It was a Phase 3B randomized, double-blinded, placebo-controlled trial. Which means that the trial compared one group who was taking the medication to another group who was taking either a placebo or sugar pill. The participants did not know which group they were in and they were randomly placed in either group. The researchers and the participants didn't know which group they were in.

[00:05:49] And so the researchers enrolled 376 adults who had obesity or overweight with weight-related complications. These patients had already completed weight loss study and another study. Either they were using tezepatide, which is Zeppound, or Semaglutide, which is Wegovy, and had already achieved meaningful weight loss.

[00:06:11] And importantly, these participants did not have diabetes because the researchers wanted to focus specifically on weight maintenance. So instead of continuing their injections, participants were randomly assigned to either receive a once-a-day oral GLP-1 medication called Orforglyperon or Fundayo versus receiving a placebo or sugar pill.

[00:06:37] Both groups continued lifestyle counseling, including healthy nutrition and physical activity. And researchers then followed them for an additional 52 weeks or another year. So what were they actually measuring? And here's what I love about this study. The researchers weren't asking, can people lose even more weight on these medications? Instead, they asked, can people keep the weight that they've already lost?

[00:07:06] That is the question millions of people really, really care about. So here's what they found. The results were very encouraging. Among the people who had previously lost weight with Trezeptide or Zeppound, they were switched to, and they were switched to the oral Orforglyperon. They maintained approximately 75% of the weight loss they had already achieved.

[00:07:33] The placebo group, on the other hand, only maintained about 49%. So they basically gained 50% of their weight back. And among people who came from the semaglutide or Wegovi and started taking Orforglyperon, they maintained approximately 79% of their previous weight in comparison to only 38% in the placebo group.

[00:07:54] And another finding stood out to me that nearly half the patients switching from Trezeptide and more than half of those switching from semaglutide were able to maintain at least 80% of the weight they had already lost. This is exciting because this tells us that maintenance therapy may not have to look exactly like the treatment that helped you lose weight in the first place. Why is this such a big deal, you may be asking?

[00:08:22] Because for years, our choices have been pretty limited. Either you stay on the injections or you stop treatment and you hope for the best. But now we may have another option. Imagine a patient saying, Dr. Shelley, I've done great with my injections, but I travel every single week for work.

[00:08:49] Or I just don't want to keep taking an injection for the rest of my life. Or they may be saying, My insurance covers the pill, but not the injections anymore. My insurance changes. So studies like Attain Maintain suggest that transitioning to an oral medication may become an effective maintenance strategy for some patients. That doesn't mean it's the right answer for everyone. Everyone's different.

[00:09:17] But it is another tool in your toolbox. And does this mean nobody regained weight? No. And that's important to understand. Some people still regained weight. The goal wasn't perfection. The goal was preventing the significant rebound of weight gain that happens when we stop treatment completely. And that's more of a realistic goal.

[00:09:46] So do you have to stay on medications forever? Here's my answer. Maybe. It just depends on you. Or maybe not. I think it just depends on you. But almost everyone needs a maintenance plan. And for some people, that may mean staying on the same medication. For others, it may mean lowering the doses. And for others, it may even be switching to another medication entirely or stopping.

[00:10:16] Some people may eventually be able to maintain their weight with just lifestyle changes alone. But the key is that the plan should be individualized to you. And there isn't one answer for everyone. But maintenance isn't just about medications. Medication is only one piece of the puzzle. Long-term success also means prioritizing protein to preserve muscle, strength training at least two to three times a week,

[00:10:46] getting adequate enough rest and sleep, managing your stress, staying physically active, and continuing regular follow-ups with your healthcare team. Maintenance is active. Isn't something that just happens. It's something that you work at, just like you lost weight. And so my biggest takeaway is that one of the reasons that I love the Attain, Maintain trial is that it changes the conversation. Instead of asking,

[00:11:16] when can I stop the medication? The question we should be asked is, maybe we should ask, what is the best long-term plan to help me stay healthy? Because the goal was never just to lose weight. The goal is to reduce your risk of healthcare problems, such as diabetes, improve your heart health, your joints, sleep better, move better, feel better, most importantly, and then enjoy a healthier, longer life.

[00:11:46] Because if medications can help you achieve that, then it's doing exactly what it was designed to do. So, as far as my final thoughts, if you're taking a GLP-1 medication and wondering whether you'll be on this forever, don't make that decision based on fear or something you read online. Have that conversation with your healthcare provider. The good news is that obesity medications is evolving rapidly. Studies like the Attain,

[00:12:16] Maintain trial are giving us more options, more flexibility, and more personalized ways to help patients succeed, not just for six months, but for years to come. Thank you so very much for joining me on another episode of the Back on Track Achieving Healthy Weight Loss Podcast. If this episode helps you, please share it with someone, leave a review, share it with somebody who's wondering what comes next after the weight comes off.

[00:12:45] And until next time, stay strong, stay committed, and stay consistent. And remember, we are stronger together.