Incorporating weight-loss drugs into your life

In My Humble Opinion
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Is there a recommended maintenance dose? When one is actively trying to lose weight, I got the impression that the doctors would keep raising the dose if the patient wasn’t losing weight (or not “fast enough”). Then, when one has lost all the weight they are likely to lose, my doctor suggested that lifelong maintenance on a lower dose (unspecified level) would be necessary to avoid regaining the weight.

There would be different considerations for anyone taking these medications primarily for control of diabetes and blood sugar. I’m under no delusions about that for me, It’s my cardiologist who has been the strongest driver for this, for me to lose weight to help my heart stay healthy.

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IANA doctor and you should listen to yours, obviously, but as for the Wegovy oral pill for the treatment of obesity (only, not for other uses or other GLP-1 medications), the official marketing materials say the maintenance dose is 25mg/day: Wegovy® Pill Guide and Dosing Information | Wegovy® (semaglutide)

But, as usual, it also says to listen to your doctor and let them adjust the dosage according to your individual response.

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Funny, I was wondering if maybe I experienced some kind of anti-placebo-effect: I didn’t expect the 2.5 mg dose to be effective, therefore it wasn’t. :slight_smile:

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On this part, though, I don’t think it’s a necessarily binary “take the drugs forever or you regain all the weight” sort of situation. It would depend on a lot on individual responses and lifestyle changes you make during that time (if any).

All else being equal, people do quickly regain weight after stopping the drugs: People regained weight, worsened heart health after stopping weight loss drugs: review | CBC News

I’m hoping for this to be more of a “kickstart” — losing enough weight to be able to take more on activities and do things I currently can’t (like a pushup or pullup), coupled with behavioral therapy and consultation with a dietician. My doc said this three-prong approach (exercise + better nutrition + better emotional/mental regulation) is really necessary (and often suggested by insurance companies, apparently) in order to sustain a healthy weight, with or without the help of drugs. The goal for me is for the drug to make the first few months/years a bit easier, but after that, keeping up the weight loss is up to me. I can’t afford to stay on the maintenance dose ($300/mo at Costco, more elsewhere) unless it becomes generic soon.

I mean, it makes sense, right? If you use the drugs to help you jumpstart a healthier lifestyle and you can keep it up afterward, then you shouldn’t regain all the weight.

If all you do is take the drugs and change nothing else, well, once you stop, you’ll go right back to your previous, unhealthy habits (and the unhealthy “food environment”, as the professor in the CBC article called it):

Once people stop taking weight-loss medications, the hunger-curbing effects of the drug are removed but their “food environment,” such as ultra-processed foods, remains, and weight tends to return, said Dana Small, a professor at McGill University who holds a Canada Excellence Research Chair in metabolism and the brain.

“I still think that the GLP-1 drugs, as well as the new drugs in the pipeline are incredibly helpful and should be continued to be prescribed,” Small said. “However, we need to couple this with weight-loss maintenance strategies and concerted efforts to change the food environment.”

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I’m frankly not that optimistic about my ability to change. But I guess I could surprise myself.

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Can you get help with that? I struggle with food self-discipline too, and that’s part of the reason my doc suggested talking to the other professionals too instead of relying solely on the drug.

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Article today in the NYT: Gift link

Highlights:

Most Patients Keep Weight Off With Fewer GLP-1 Shots, Study Finds

In a recent review, a small group of patients received the injections less frequently but still maintained weight loss and health benefits.

Dr. Biermann also conceived a study to test the strategy. Now the results of that research are in: After 36 weeks of follow-up, most of the patients who spaced out their GLP-1 injections kept the weight off and also maintained health benefits like reduced blood pressure and better blood sugar control.

Seventeen took the standard drug dose every other week, while six took it every 10 to 14 days. Seven others spaced shots out more than two weeks apart, with the longest interval six weeks.

While on less frequent dosing, most participants continued to lose modest amounts of weight or maintained their weight; only five gained a modest amount of weight. After 36 weeks, the patients’ average B.M.I. dropped to 24.6, which is considered normal weight.

The extra weight lost during this period was from fat, and not muscle, the study also found. And patients maintained their improvements on measures including prediabetes, triglycerides, high density lipoprotein (so-called good cholesterol) and blood pressure.

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news …

India could soon get a lot thinner - at least in theory.

On Friday the patent on semaglutide - the molecule behind Danish drugmaker Novo Nordisk’s blockbuster weight-loss drugs Wegovy and Ozempic - expires in the country.

This will allow domestic pharmaceutical companies to release cheaper copies or generics, triggering a rush of competition that could slash prices by more than half and rapidly expand access for people in India, and eventually in other countries too.

…

Analysts expect around 50 branded semaglutide generics to enter the market within months - a familiar pattern in India’s fiercely competitive pharmaceutical industry.

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Is it legal to import drugs from India? They’re very expensive in the US, even with the Costco discount.

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Doesn’t the injectable Ozempic need to be refrigerated? That would complicate importation.

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Oh, I didn’t think about that. I naively thought the oral form would be on the same patent, but probably not.

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My (semi-educated) guess is: the “high-maintainance” version that requires refrigeration is a stage that the medicine will pass through before it will exist in a “low-maintainance = shelf stable” format.

IIRC Novo-Nordisk already have an oral version (donno if it is on the same patent or not) … but def. oral meds have more acceptance than injectables - so there are not just logistics reasons, but also marketing reasons for a preferred product.

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I was finally able to meet with my endocrinologist yesterday, and we decided to move me back to the lowest dose, 2.5 mg, for the time being and see how it goes, since I had such bad reactions to the 5 mg dose. I started today. If we decide to try the higher dose again, she suggested it might be something like every other week for a while, higher dose vs. lower dose, to give my body more time to adjust.

I was off the drug completely for 4 weeks; it took maybe 2 or 3 weeks to cycle out of my system, and I started feeling those familiar hunger pangs. It’s true that my stomach appears to have shrunk, but in these last 2 weeks I had put on a couple of pounds.

It’s true that eating is one of the few physical things I do for pleasure, in addition to necessity. The benefit of this drug for me is that it takes away a significant part of that pleasure, making it much easier for me to not eat when I don’t need to. I don’t know what habits I can build up while under the influence of the drug that would carry over to a maintenance regimen, once I have reached my goal weight, but I am encouraged by the multiplication of options that are appearing over time.

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Yeah, oral Wegovy is already on the US market (and slightly cheaper than the injectable version). It’s a daily pill instead of a weekly shot. (I’m currently on it and it’s working extraordinarily well)

Have you talked to your doctor about this part in particular?

My primary care doctor (the woman who prescribed my GLP1) also referred to me a dietician (nutritionist with certification) and a behavioral therapist. She would’ve referred to me a personal trainer, too, had I not already had an exercise routine. Apparently that is the standard trio for weight loss under some insurance providers.

There’s a lot of things that could be worth trying, but I don’t know what you’ve already done.

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I’ll keep my fingers crossed for you and the 2.5 mg dose!

This past Friday morning I saw the nurse practitioner at my bariatric center: my labs are mostly alright, but she agrees that I’m not eating — or drinking — enough. Psychologically I love that the Mounjaro has silenced the food noise and almost entirely taken away my appetite, but I know that having just 2 protein shakes and 1 small meal a day isn’t sustainable (and my nutrition needs are complicated by being a bariatric patient). So when I see my primary care doc in two weeks, I’ll reluctantly ask her to switch me from 7.5 mg back to 5 mg. I’ll see how things are going in three months, when I’ll get more comprehensive labs done and go back to the bariatric center.

I’d considered quitting the injections entirely because of the GI side effects, but the NP recommended some OTC things to start taking and so far they’re working. :crossed_fingers: If I’m still experiencing relief when I see my PCP, I’ll be happy to just lower the dosage.

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You can also get it in 5 mg vials, get your own supply of syringes if yours don’t come with them, and measure out an amount between 2.5 and 5.

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Wish I could take them, so does my doctor (I have bad insulin resistance) but I get Allodynia when I take them, even at the lowest dose..

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And that’s what I do now that I’m finding my way to the right maintenance level. But the downside is that the 5 mg vials cost more than the 2.5 mg vials. The vials have no preservatives, so they’re meant for single puncture only, you can’t bank what’s left and get a fifth or sixth shot out of a box of four.

The new Kwikpens do have preservatives because they’re meant to be multi use. And you can apparently dial in between doses into them, but you still have to re-order about once a month to stay on the discount program.

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They seem to keep for 2 weeks opened and refrigerated without any evident degrading. My daughter did it that way for quite awhile. Her doctor didn’t have an issue with it, fwiw (probably not a lot).

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Yeah, I know a lot of people do that but it’s personally one step too far risk-wise. Everytime you puncture the vial, you’re introducing non-sterile air into a solution with no preservative properties. I might do it in a pinch if kept refrigerated, but warm? No.

I had to clue my endocrinologist into the fact that the vials were single-use only. She assumed they were multi-use like most/all of the vials in her clinic.