You have got where you wanted to be, what next?
We have talked in the last blog about the joy of achieving the things you wanted to achieve with your weight loss and health gain. It’s a fantastic feeling and one that we will celebrate with you. With traditional weight loss organisations, that is often where things ended. You got your certificate/badge/well done and off you went. But we have talked about weight regain being the normal state of affairs for those with obesity, due to the changes in body hormones, and the often-asked question is, what happens when you stop the medications? Can you only take them for a certain amount of time? Is it ok to take them for a long time? And if so, at what dose?
The trials of the GLP-1 based medications are now looking at longer term use for weight loss, but the original guidance (which still stands in NICE guidance) for semaglutide which said it was to be used for 2 years confused many. Tirzepatide has no such time limit placed upon it, and both medications have been used safely long term for type 2 diabetes.
If you search for weight-loss medication forums and blogs, you will see that there are a whole range of approaches taken to answer these questions. The evidence for regain from trials suggests that it does happen, but perhaps more slowly than thought. This can be further slowed by titrating back down the doses and ensuring that resistance exercise is undertaken during weight loss, to reduce the loss of skeletal muscle and perhaps even increase the amount. This is known to be helpful in reducing weight gain from any weight loss technique and the meds are no exception. It is good news that exercise, whilst not helpful for weight loss, is helpful to prevent weight gain. As the NICE guideline update 2024 states, it is not in small amounts however, with 60-90 minutes recommended daily to avoid regaining weight.
What do we do when we have titrated back down the doses, or when someone has got to where they want to be health and weight wise, but is still on the maximum dose?
There are many frustrated posts of people reaching a “normal” BMI and then being refused any more of the meds from their provider because they shouldn’t need them anymore. This unfortunately shows a lack of understanding of the medications and how they work.
We know that people with obesity will need life-long treatment for their chronic condition. The Lancet commission of experts on obesity in 2025 confirmed the need for people with obesity to need different interventions at different points in their life. This could include behavioural changes, metabolic bariatric surgery and medications. There will almost never be a “one-off” intervention for someone with obesity to “cure” the problem anymore than someone with asthma or high blood pressure will have one thing that fixes the problem for them. As so often is the case with obesity, this goes against the prevailing narrative that X, Y or Z will fix someone’s weight, and they won’t every have to worry about. There is no one answer, not even surgery. Weight regain with that is less, but it is still a factor that needs to be considered.
Medications therefore are very likely to play a part in lifelong weight maintenance and we need to have a better approach to this than the current “make it up as you go along” approach which people using the meds have had to have until now. What options are people currently trying?
Reducing the doses gradually and then stopping. Starting again at low dose when weight regained
Carrying on at the highest dose as their weight has plateaued and they aren’t losing any more
Going down the dose titration until they stop losing and staying at this dose
Going down to the lowest dose and staying there
Stopping suddenly and seeing what happens
Any or all combinations of the above!
What other things should people be looking at apart from the meds?
If someone has had a very high starting weight, they may lose up to 20% of their bodyweight with the medications if it all goes to plan. This may still leave them at quite a high weight with some more that they wish to lose, for either health or life reasons. With expert guidance, they may well consider that this would be time to explore the option of metabolic bariatric surgery. They could then use meds again afterwards as required. Expert care through this process would be important to ensure safety and nutritional guidelines are being met. We can offer that at Genwell, even if someone chooses to go abroad for surgery (we cannot recommend surgical providers).
We have discussed the importance of resistance exercise to prevent weight gain, but we haven’t yet talked in the blogs about the importance of eating well. Unfortunately, it is often said that on the meds people will “learn healthy new habits” and if they do this, perhaps they won’t’ regain. As discussed in the previous blogs, these medications work on the gut-brain hormones to reduce hunger and help people feel more full. Some people also find that their tastes change, and they naturally choose fewer sweet foods and reduce their alcohol intake. When the meds are stopped, it is entirely possible that these changes will reverse and along with the lack of hunger and therefore it is back to fighting your own biology to control appetite. This isn’t a failure of learning new “good” habits, it is physiology.
But nutrition is important and what we put in our bodies, if we are lucky enough to have choice, does matter. With the reduced appetite with the meds, it is incredibly important to ensure that someone gets a good balance of protein, vegetables, fibre and carbs and the correct micronutrients. Continuing the intake of good foods with nutritional value once the meds have stopped is equally important but may no longer be a way of controlling weight regain due to increased appetite and less satiety (fullness). It is important to prevent bone loss and anaemia, especially in those who are having periods. Genwell experts will be on hand to help you with all of this and can look at your diet to ensure good micronutrient intake and provide supplements if required – usually in the form of a multivitamin and/or iron.
Healthy behaviours – a holistic view
Food and activity are often thought of as the most important factors when we are looking at both weight loss and weight regain. However, we know that our lives are not just these two elements, and it is important to look at:
stress levels
psychological wellbeing
connection to others
sleep quality
These things are important for our entire lives, not just in periods of weight loss and at Genwell we will be looking at all of these elements of your life to see what we may be able to advise and help with, or simply discuss.
Your Genwell doctor will get to know you and be able to provide continuity so that we can be there for you in the long term. Holistic health is about the whole of you, looks at what makes you unique and aims to optimise your health alongside your weight loss. We know that this may be a long-term commitment, and we will be there for you.
