Millions of Americans who have dropped pounds and boosted their health using popular obesity drugs like Wegovy are facing a new dilemma: What happens if they stop taking them?
Many worry that they’ll regain weight and revert to old habits. In studies, people who paused the drugs put back on most of the weight they lost.
But others are gambling on a do-it-yourself strategy to ease off the drugs and stay slim by stretching out doses, taking the medication intermittently or stopping and starting again only if needed.
More than 3 million prescriptions for the new medications are dispensed each month in the U.S., according to 2023 data from the health technology company IQVIA. They include semaglutide, the drug in Ozempic and Wegovy, and tirzepatide, the drug in Mounjaro and Zepbound.
But many people don’t stick with it. One study published in the journal Obesity found that just 40% of patients who filled a prescription for Wegovy in 2021 or 2022 were still taking it a year later.
Here's what you need to know about taking a break from these new medications:
How are the drugs designed to be taken?
Doctors who treat obesity stress that the disease is a chronic condition that must be managed indefinitely, like heart disease or high blood pressure. The new injection drugs work by mimicking hormones in the gut and the brain to regulate appetite and feelings of fullness. They were designed — and tested — to be used continuously, experts said.
“I don’t think they should be used in intermittent fashion. It’s not approved for that. They don’t work like that,” said Dr. Andres Acosta, an obesity researcher at the Mayo Clinic.
Why do people want to stop the drugs?
Some people who achieved their health and weight goals with the drugs are looking for an offramp, said Dr. Amy Rothberg, who directs a weight-management and diabetes treatment program at the University of Michigan.
“Many of them want to step down or de-escalate their dose,” she said. “And they’re also wanting to ultimately discontinue the medication.”
Some patients don’t like side effects such as nausea and constipation. Others want to stop for holidays or special occasions — or just because they don’t want to take the weekly shots indefinitely, said Dr. Katherine Saunders, an obesity expert at Weill Cornell Medicine and co-founder of the obesity treatment company Intellihealth.
“To me, it’s a help, it’s an aid,” said Donna Cooper of Front Royal, Virginia, who lost nearly 40 pounds (18 kilograms) in nine months using Wegovy along with diet and exercise. “At some point you have to come off of them. I don’t want to be on them forever.”
Other people have been forced to ration or halt doses because the drugs are costly — $1,000 to $1,300 per month — and insurance coverage varies or because demand has far outstripped supply, Rothberg noted.
What happens if they stop?
The drugs work by changing the way the body processes and stores energy. When people stop taking it, many gain back the weight they lost, plus more. And many report a return of symptoms of obesity such as so-called food noise or intrusive thoughts of food, raging hunger and decreased feelings of fullness when they eat.
Some people who stop the drugs and start again have severe stomach side effects. Others find the drugs don't work as well as before. There's no data on the long-term effects of intermittent use, Saunders said.
“I don’t think it’s a strategy that will work for most individuals, but it could be an option for select patients,” she said.
