A recent thread about Ozempic has caused me to reconsider my stance on these modern weight-loss drugs. I am scheduled to see an endocrinologist in July, and I am preparing myself for making a decision.
My question applies to any or all these medications: once you start taking them and have lost some weight, do you have to continue taking them for the rest of your life or else the weight will just come back? I am interested in both anecdotal as well as clinical information.
It will if you resume your previous eating habits. But taking a forced break from those habits by essentially using an appetite suppressant can make breaking those habits easier.
Studies show that most people regain about 2/3 of the weight lost.
The difficulty with GLP-1 drugs is that they work through a number of different actions and they are not well understood. Not only do I eat less and feel fuller, I also burn more calories through an increased metabolism.
I’ve been on a low dose (.5mg) for two years now. I lost 14 pounds over the first 4-6 months and my weight has continued to creep down another 5 lbs or so. I’m under 175 for the first time in 30 odd years from a high of 225 or 230. The Ozempic is just one reason for the weight loss. Treating a screwed up pituitary accounted for some as did lifestyle changes. Working at home and not eating fast food has been a big part of the last 5 years.
For someone who stops taking a weight-loss drug, regardless of which one, it presents you with a problem. If the drug successfully took away your appetite and cravings, and you lost all the weight you needed/wanted to lose, but you did nothing to improve your diet or lifestyle, your appetite and cravings will return and you will likely gain most, if not all, of the weight you just lost back over time.
However. if instead of getting the drug through your PCP you went through a healthy weight-lose program and improved your eating habits and lifestyle, there’s a good chance you can keep the weight off, at least while you continue working with the weight-loss program. So it really depends on what you do after you stop taking the drug. If you simply go back to your old eating habits and lifestyle, you will likely gain the weight back.
One option would be to continue to take a low-dose of the drug for the rest of your life, but for many that would be prohibitively expensive. However, if money is no object, and you can tolerate the side effects of the drug, that can be an option. Note that they haven’t done long-term studies on these drugs om humans so it’s unclear what would happen if you took them for 40 years.
This is why some people chose bariatric surgery instead of the weight-lose drugs. Surgery is a more permanent solution for weight loss, but as my ex-wife can attest, you can just start eating lots and lots of small calorie-dense meals, and eventually gain the weight back. That’s what happened before she changed her diet and lifestyle which allowed her to successfully manage her weight. YMMV.
I am very familiar with these parameters. And I guess it could be said that I already knew the answer to my question. So let’s switch it up a little, and ask this one instead: for those who have started with one of these drugs and lost weight, have any of you kept going on them for maintenance? For how long?
With all weight loss drugs, you have to take them for life. Same as medications for hypertension. Weight loss drugs work because they temporarily cause biochemical changes that make it easier to lose weight and keep it off. If you quit taking the drugs, the biochemistry goes back to normal and you gain the weight back.
Having said that, there are multiple receptors affected by modern injectable peptide weight loss/anti-diabetic drugs. Things like the GLP-1 agonists, amylin agonists, calcitonin agonists, GIP agonists, Glucagon receptor agonists, etc.
Of these, the GLP-1 agonist (semaglutide) seems to have a wide range of health benefits aside from just weight loss. It seems like every week they find some new health benefit of taking a GLP-1 agonist.
Some people see their autoimmune diseases, depression, fatty liver, kidney function, etc improve on GLP-1 medications.
When I started taking metformin (not one of the weight loss drugs, but has a definite, if limited weight loss effect) I lost 20 lb over the next couple years, making no attempt at dieting. Then I dieted and lost 40 lb more. And stayed that way for a dozen years. Now I stopped taking metformin nearly a year ago and have gained maybe 5 lb. Not happy about that, but my A1C was too low.
I didn’t know Metformin could give someone hypoglycemia. Did something else change over that time? Were you eating less carbs than you used to?
Since weight loss and management is primarily an endocrine issue, your endocrinologist is the best person to talk to.
I was able to lose substantial weight and subsequently keep it off by keeping insulin low through lifestyle changes that included moderate exercise, time restricted eating, and cutting out snacking. When I transitioned from weight loss to maintenance it was the only way I could avoid putting back on the weight, and I have been able to maintain my ideal weight for two years now.
To lose the weight I didn’t use weight-loss drugs or surgery. I relied on a strict ketogenic diet and intermittent fasting and never cheated once. My appetite quickly diminished and I lost my cravings for sweets. Eating only one meal a day was easy and greatly simplified my life at the same time.
It was difficult giving up sweets, although I do allow myself to occasionally eat a piece of birthday cake. I also have a piece of 90% dark chocolate every day, and that’s good enough for me. Cutting sugar and processed carbs out of my diet changed my life for the good.
I assume your endocrinologist will give you sound advice on what would make the most sense for you long term. Good luck on your journey. Remember that losing the weight isn’t the biggest problem, becoming healthier and keeping the weight off for the rest of your life is the real challenge.
Apparently, metformin cannot cause hypoglycemia, but is no good if you have it. In June 2023, the Q1C was 4.6. He halved the dose. In June 2024, it was 5.4 and he concluded that I no longer had diabetes and dropped it entirely. Last Dec. it had risen to 6.2 and he was satisfied.
Yes, I had lost a fair bit of weight, but that was a dozen years ago. None since.
Speaking only for myself, the reason I gain weight easily and struggle to lose weight is not because I have bad habits. I am hungry, even when I am not at a calorie deficit, and when I am at even a moderate calorie deficit, I am desperately hungry. My body seems extremely unwilling to burn fat, and will do almost anything to get me to eat more. This hunger substantially interferes with my life: it makes me cranky and takes an enormous about of attention and willpower to resist.
I’ve been on tirzepatide (Zepbound) for six months, and the greatest difference is that when I don’t eat, I get moderately hungry, and eating resolves that hunger. I am beginning to suspect that this is what other people with normal metabolisms experience all the time. There is some clinical research that suggests that tirzepatide, specifically, encourages lipolysis (burning fat). This is subjective, but for me it feels less like I am eating less and so losing weight, and more like I’m accessing my energy stores and therefore don’t need to eat as much. The loss of appetite is the outcome of being able to burn fat properly as much as it is the cause.
So I expect to be on this for life, because I think the problem is physical, not behavioral. I mean, I can control my weight behaviorally, but it is at a tremendous cost in terms of discomfort and emotional expenditure. I realize that a lot of people flat out don’t believe this and assume my physiological responses are the same as theirs and I am just making excuses. But after nearly 50 years of this, and literally hundreds of pounds lost “the old fashioned way” and regained whenever I shifted my focus to, you know, contributing to society or being a good parent and wife, this is the conclusion I’ve reached.
I do think tirzepatide is a much better drug than the others, in terms of addressing metabolic issues.
I’m not sure that is the case. It’s a complex issue and the changes the glutides enable in eating patterns can persist for many.
Most will regain…but even “some” is still a large number of people and the regain is fairly often not the entire loss.
I will very likely take it for the rest of my life tho at times the digestive issues get annoying.
I don’t see that as a negative. It is a maintenance drug for me like Raprazenole.
Some people keep the weight off, some gain weight but not as much as they lost. Some gain more weight than they lost.
Overall, the long term record for people keeping weight off long term with lifestyle changes alone is very poor.
Yep - and I’d certainly never risk bariatric surgery.
The added health benefits of glutides alone sez that;s the way to go …as millions have learned.
Hell aspirin has nasty side effects for some.
The biggest issue was finding supply once Ozempic ran out - doc put me on Liraglutide.
I’ve stayed on the lowest possible dose and find it remarkable.
I could never skip a meal or even go past a meal…now I sometimes have to remember to eat.
I’m down 57 lb . clothes fit better, no low blood sugar issues,
Speaking of which - did not take my shot today …be back in 5 min 
I’m back. 
One interesting data point - I had been on Bydureon, then Trulicity, then Mounjaro since 2018. I’ve lost about 70 lbs in that time.
When I was on Trulicity I started feeling hungry again and my A1C went up a bit so I was up to 1.25mg shots. Then my insurance stopped covering Trulicity so we switched to Mounjaro 1.25mg shots.
Then there was that drug shortage in 2024 and I could not get any shots for a while. I was off the drug for 6 weeks. I didn’t gain any weight in this time, and felt fine. My hunger didn’t return. When the drug was available again, I didn’t want to start in at a high dose and feel sick, so I started back on Mounjaro .5mg, a significantly smaller dose.
I’ve actually been able to stay on the smaller dose and do just fine. Hunger hasn’t come back. A1C is fine and in fact I had my lowest ever (5.5) at the end of 2024.
I thought it was pretty interesting that I could be off it for a long time and not immediately get ravenous. Yes, the drug stayed in my system for a while. But my body had changed and my habits had changed.
I still assume I’ll have to be on it for life…but maybe not.
This is me. I didn’t realize how much I worried about food until I started Zepbound and I suddenly didn’t worry about food at all.
Exactly …used to drive my partner batty. I need to have lunch NOW …not an hour later.
Now waiting an hour or skipping lunch entirely is fine.
Also had lots of low blood sugar headaches and if I waited too long that would turn into full blown migraine.
All of that gone now
I will still get cravings for this or that but will eat very little of what ever craving of the day is in play to be satiated.
I do think people not on the glutides have a hard time getting their head around the change in relation to food.
Partner denies she gets hangry when she is hungry but it is obvious.
So she fights and fasts and then piles into a quart of ice cream. 
Happy to be done with that in return for the occasional runs and some indigestion.
I started compounded semaglutide 6 weeks ago through Weight Watchers. I have lost about 4 pounds and an inch each from my waist and hips. I finally eat like a person with a normal appetite eats. The injection has cut down food noise by 95%. My hunger is regulated. My portions are average because I get fuller faster and I can actually recognize when I am full. I am making really good food choices. Certain foods that I used to eat daily like popcorn no longer taste good. Years ago, I took Chantix for quitting smoking and it was like a switch turned off in my head. That’s what the injection is like. Will my brain ever regulate itself? I don’t know. And I’m fine if I have to take a low-dose every 10 to 14 days for maintenance. It’s not a quick fix and I don’t understand how celebrities have lost so much weight so quickly. But I am not them. If it takes me a year to lose 50 pounds so be it.
There seems to be a good bit of experience with weight loss drugs here. I would appreciate thoughts on the approach I’ve taken.
After years of worsening back problems I’m working on trying to lose weight in the attempt to avoid serious surgery. My PCP has offered me Wegovy. At first I was reluctant (thinking about the “miracle” weight-loss drug years ago that turned out to cause heart valve problems), so I changed eating habits first to see what I could accomplish.
I’m blessed with a wife who is an excellent cook and I love her cooking. I guess it’s a blessing and a curse but I didn’t want to do something like Weight Watchers. So I resolved simply to eat less and mostly cut out sweets - no more late-night ice cream or chocolate chip cookies (that’s one true change). Oh, and basically no fast food except the occasional Chic Filet salad or a grilled chicken sandwich when we’re on the road. I also drink a lot of water and cut alcohol to a few glasses of wine on the weekend.
In other words, for the most part I still eat things I like but less of it. Over the past nine or so months I’ve gone from roughly 250 to 220 (at 6’0”). I’d really like to get to 200 but that may be a bridge too far.
My thinking when I started this was to see first what I could accomplish without Wegovy and then consider taking it if/when my program either (1) didn’t work, or (2) worked only until I plateaued after losing the “easy weight” (the few pounds anybody can lose pretty easily without too much pain).
So my question is this: Will Wegovy or equivalent work after losing what I suspect is the easier weight to lose? My suspicion is that it would work, but not as dramatically.
It would also be great to hear about any experiences with compounding and whether that offers any cost advantage.
Thanks.
Thanks to everyone who has responded. This discussion for me appears now to be rather moot, at least for the time being. It occurred to me to check what is covered by my supplemental Medicare insurance, and none of these drugs is covered in my current plan (which has always seemed to me to be rather expensive). I certainly can’t afford the uninsured cost (in the neighborhood of $1K per month) so I guess if I want to use any of these drugs I have to go shopping for new insurance.
Suggestions from anyone on Medicare? My current provider is Humana.