Cardiovascular diseases like high blood pressure, heart attacks, and congestive heart failure remain the #1 cause of death in the world. Rising rates of obesity remain a major contributor to this sad statistic. A new class of medications, peptides like semaglutide, sold as Ozempic and Wegovy, were developed as diabetic medications but produce major weight loss in most patients and are being prescribed in non-diabetics. Indeed, the craze is on and the expensive mediations are in short supply. Are the weight loss and associated benefits sustained if the medication is stopped? New data published recently answers this important question.
To explore changes in body weight and cardiometabolic risk factors after treatment withdrawal in a randomized weight loss study using semaglutide or placebo.
The STEP 1 study randomized 1961 adults who were overweight or obese without diabetes to 68 weeks of once-weekly subcutaneous semaglutide 2.4 mg (including 16 weeks of dose escalation) or placebo, as an adjunct to lifestyle intervention.
At week 68, treatments (including lifestyle intervention) were discontinued.
A subset of participants were followed for a year after stopping the injections. This subset comprised all eligible participants from any site in Canada, Germany and the UK, and sites in the United States and Japan with the highest main phase recruitment.
The study included 327 participants who were followed after stopping the injections. From week 0 to week 68, mean weight loss was 17.3% with semaglutide. Following treatment withdrawal, semaglutide and placebo participants regained 11.6 % of f lost weight, respectively, by week 120, resulting in a final net losses of 5.6% of body weight from week 0 to week 120 in the trial. About 75% of the weight was regained.
Cardiometabolic improvements seen from week 0 to week 68 with semaglutide reverted towards baseline at week 120 for most variables after stopping the medicine like blood pressure and blood sugar control.
One year after withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss, with similar changes in cardiometabolic variables.
These findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health.
There are some potentially serious side effects that can occur with these medications, including pancreatitis, kidney failure, and medullary thyroid cancer. There is also the possibility of risk to a developing fetus in a pregnant patient. Many patients experience nausea and even vomiting.
Overall, the diabetic patient staying on these medications long term for diabetic therapy may do well and sustain weight. Others who use it as a short term crutch must focus on replacing prior lifestyles with a better diet, exercise program, sleep hygiene, and overall commitment to wellness.
