Boston Wellness News Part 2: A surprising number of people stop taking popular weight loss drugs (3/3)
Mutsuko Ohnishi, MD, Internal medicine physician in Boston, USA
Continuing from the previous article, today’s topic is also about the much-talked-about weight-loss drugs. In the U.S., Novo Nordisk’s obesity treatment drug Semaglutide (brand name: Wegovy), the type 2 diabetes treatment drug with weight-loss effects Semaglutide (brand name: Ozempic, with a lower dose of Semaglutide than Wegovy), and Eli Lilly’s type 2 diabetes treatment drug with weight-loss effects Tirzepatide (brand name: Mounjaro) are popular.
By the way, with these treatments, “how many people can lose how much weight, and in what time frame?” Also, “how significant is the difference in effectiveness between Semaglutide and Tirzepatide?” In November 2023, a non-peer-reviewed study addressing these questions was reported (1).
● Tirzepatide vs. Semaglutide: Which is more effective for weight loss?
The analytics company Truveta, owned and operated by 30 healthcare systems in the U.S., collected data from a large cohort to compare the two drugs. Notably, this research was not supported by pharmaceutical companies.
The study began with over 40,000 overweight or obese patients who started using either Semaglutide or Tirzepatide between May 2022 and September 2023. Of these, 52% had type 2 diabetes, while the remaining 48% had no record of diabetes in their medical history. According to CNN, researchers speculated that these patients were likely prescribed off-label for weight-loss purposes at the discretion of their physicians (2).
After one year of treatment, Tirzepatide was found to be more effective for weight loss than Semaglutide:
• ≥5% weight loss: 82% in the Tirzepatide group, 65% in the Semaglutide group
• ≥10% weight loss: 62% in the Tirzepatide group, 38% in the Semaglutide group
• ≥15% weight loss: 42% in the Tirzepatide group, 19% in the Semaglutide group
Both drugs reported similar gastrointestinal side effects during the trial. However, this study only targeted doses approved for type 2 diabetes treatment, potentially limiting conclusions. The U.S. Food and Drug Administration (FDA) has approved higher doses of Tirzepatide (brand name: Zepbound) and Semaglutide (brand name: Wegovy) for weight loss.
Incidentally, the longer the treatment period, the greater the weight loss, but 55% of study participants (55.7% for Tirzepatide and 54.4% for Semaglutide) discontinued treatment during the study period. Researchers stated, “Patients who achieve desirable weight loss are more likely to continue treatment. On the other hand, those who do not see weight changes are more likely to discontinue or switch treatments. Drug shortages during the trial period may have made access difficult.”
● Surprisingly high treatment discontinuation rates
Not only in the aforementioned report, but Reuters also noted that analysis of insurance company data revealed that fewer than one-third of patients who started weight-loss drugs for weight management continued treatment after one year (3).
One possible reason for discontinuation is the misconception that the drug is not effective. Many expect weight-loss drugs to have long-term effects. However, it is not realistic to expect these drugs to cause perpetual weight loss, leading to extreme thinness and eventual disappearance… Such scenarios are impossible. Regardless of the method—dietary therapy, fitness, or obesity surgery—weight loss eventually plateaus. Similarly, Semaglutide and Tirzepatide cause rapid weight loss after treatment initiation, but then reach a plateau.
According to a 2022 report by Dr. W. Timothy Garvey from the University of Alabama at Birmingham published in Nature Medicine, patients taking Semaglutide reached a weight-loss plateau approximately 60 weeks after starting treatment (4).
The reasons for plateauing are unclear, but possibilities include:
• The body’s natural mechanism to preserve weight in response to perceived starvation
• A slowed metabolism following rapid weight loss
• The body conserving energy by burning fewer calories
• Increased tolerance to the drug, requiring higher doses to continue weight loss
However, discontinuing treatment often results in regaining the lost weight. Additionally, diabetes and hypertension controlled by the drug may worsen. A 2022 study by Dr. John P. H. Wilding from the University of Liverpool reported that after 68 weeks of Semaglutide treatment, average weight loss was 17.3%. However, one year after stopping treatment, two-thirds of the weight loss was regained on average. Blood pressure and blood glucose levels also began to return to pre-treatment levels (5).
● Weight cycling increases the risk of new diseases
Weight cycling refers to repeated cycles of weight loss and regain. When caused by dieting, it is called “yo-yo dieting.” This can have serious impacts on physical and mental health. Repeated dieting or weight cycling is associated with an increased risk of eating disorders, other mental illnesses, obesity, type 2 diabetes, hypertension, cancer, fractures, and higher mortality rates (6) (7).
● Weight-loss drugs are not magic; effort and dedication are necessary
NBC News (8) pointed out that Ozempic, a blockbuster type 2 diabetes treatment drug also prescribed off-label for weight loss, is used for several years by very few patients. They interviewed seven individuals who had been on Ozempic for 1.5 to 2.5 years.
All agreed: “Ozempic is not a shortcut to health.” They noted that while it helps with weight loss, blood sugar control, or both (reasons vary by person), sustaining changes requires effort.
Barbie Jackson-Williams, 54, from Iowa, started Ozempic treatment in early 2021 for weight loss and type 2 diabetes management. She said, “Thanks to this drug, I’ve been able to make changes that I previously found difficult, like swapping my favorite pasta for low-fat proteins or cutting out sweet iced coffee from my diet. But using the drug just to lose weight is wrong. You have to make an effort, and people don’t realize that.”
Edward Mathias, 45, an IT professional from Connecticut, stated, “This is not a miracle cure. It’s not the fountain of youth. It requires effort and dedication. If you want to lose weight and think you can eat anything while taking this drug, you’re in for trouble. I still have to watch my intake of sugary and carbohydrate-rich foods because of diabetes. During Ozempic treatment, my weight dropped from about 140kg to 104kg.”
Most interviewees said, “Ozempic is not a cure-all, but it has provided a boost for lifestyle changes that were previously unattainable, such as enabling me to exercise in ways I couldn’t before.”
Jackson-Williams remarked, “Losing weight has made me feel more energetic and less sedentary. I want to be active. I want to do something. I can’t just sit and watch TV like before.”
Dr. Eduardo Grunvald, an obesity internist at the University of California, San Diego, commented, “These medications should be used in conjunction with lifestyle improvements. You need to pay attention to your diet and exercise while undergoing treatment; that’s the purpose of these drugs.”
While weight-loss drugs are popular, stopping treatment on your own may lead to regaining weight and worsening diabetes or hypertension. Falling into weight cycling could defeat the purpose altogether. Just as many patients with chronic conditions like hypertension or diabetes take medication for life, obesity treatment may also require lifelong continuation. However, for some patients, lifestyle improvements may allow discontinuation of medication. In such cases, monitoring changes in blood pressure, blood glucose levels, and other factors under medical supervision will be essential.
January 9, 2024, Published by MRIC by the Medical Governance Research Institute
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