How much weight will I gain after I stop using diet pills?

The newly approved weight loss drug Zepbound hits the market this month. New research confirms that people seeking the drug may have to continue taking it for the foreseeable future or even for the rest of their lives if they want to maintain their weight.

A study published Monday tracked 670 people who took tilsiparatide, the compound in Zepbound, and the diabetes drug Mounjaro for 36 weeks. Eli Lilly and Company, which makes both drugs, funded the study. Tezepatide regulates insulin levels and slows gastric emptying. It also acts on areas of the brain that control hunger and appetite. As a result, people can lose significant weight: On average, study participants lost about 20 percent of their body weight during this period.

After that, half of the participants continued taking high-dose tezeparatide for a year, while the other half received placebo injections. Participants in the study also received lifestyle counseling to ensure they were eating fewer calories and exercising regularly.

People who continued taking tezepatide for a year lost an average of 5.5% more weight. However, those who switched to the placebo gained an average of 14% more weight. People who took the placebo also tended to have higher cholesterol, blood sugar and blood pressure than those who took tezepatide, said study lead author Dr. Louis Aron, director of the Center for Comprehensive Weight Management at Weill Cornell Medical College.

None of this will surprise the doctors who prescribe these drugs.

“We don’t give someone a blood pressure medication and then say, great, your blood pressure is better, you should stop taking it,” said Dr. Michelle Hauser, director of obesity medicine at the Center for Lifestyle and Weight Management at Stanford University. Somehow people have this magical idea about obesity, like you take this drug and it causes weight loss and then it stays that way.

Studies have shown similar results in patients taking semaglutide, a compound in the diabetes drug Ozempic and the weight-loss drug Wegovy.

People in the placebo group did not regain all the weight they lost during the first 36 weeks of the study. It’s unclear whether their weight loss was due to the long-lasting effects of tezepatide or whether lifestyle counseling played a role, Dr. Aron said.

Still, weight gain is often a reality for many patients who want to stop taking these drugs, said Dr. Melanie Jay, director of NYU Langone’s Comprehensive Obesity Program. Side effects can be serious, especially when people first start taking the drug: 53 people dropped out of the trial because of side effects such as nausea, diarrhea and constipation.

Cost is also a factor, and insurance coverage can vary, with Zepbound’s list price exceeding $1,000 per month, although some patients end up paying less at the pharmacy counter. Patients often have trouble finding the drugs in the first place, with shortages of certain doses of Wegovy and Ozempic, and Mounjaro also faced supply challenges last year.

Some patients just don’t want to receive injections indefinitely.

Dr. Jay says no one wants to be on medication forever. For anything.

Tezepatide and similar drugs are considered long-term medications, but there is no reliable data on what happens to people who take them for decades. Ozempic, Wegovy, Mounjaro and Zepbound all belong to a single class of drugs and have been on the market for less than 20 years. Dr. Hauser said that in the grand scheme of the drug, this period of time is very short.

For now, doctors say they are trying to balance the side effects and possible risks of these drugs with the health problems of untreated obesity.

However, they acknowledge that the only way to maintain the effectiveness of diet pills may be to continue taking them.

If the patient wants to stop taking the medication, we can give it a try. “But what we’ve also said so far is that it seems like most people will gain weight back,” Dr. Jay said. That’s not your fault. That’s because obesity is a disease, and this drug is helping to fix it.

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