EVERYONE talks about starting weight loss jabs – but what about stopping them?
If you’re worried about the food noise roaring back with a vengeance, you’re not alone. Here, we reveal the secrets to maintaining your goal weight – on and off drugs like Mounjaro and Wegovy.
You’ve hit your goal weight – well done! Now what? Experts reveal all[/caption]
“Reaching your goal weight, whatever that weight may be, is a remarkable achievement worth celebrating, but the journey doesn’t stop there,” Dr Sophie Dix, head of medical affairs at MedExpress, tells Sun Health.
“Obesity is a chronic health condition and maintaining your goal weight requires ongoing effort.”
So what do you need to know if the scales are inching in your favour?
Hitting your target weight doesn’t necessarily mean it’s time to bin doses you haven’t used, or even refrain from ordering another pen.
“[Patients] can stay on their current dose, reduce it, take a break from treatment, or stop altogether,” explains Dr Dix.
“Each of these approaches can support long-term weight maintenance, depending on what’s right for the individual.”
If you want to stay on the medication, you’ll still require a prescription and in most cases, this will be decided by your provider with, or without, your input.
Some jabbers see themselves “on GLP-1s for life“, while others are eyeing up the ‘microdosing‘ trend. But the common theme is the fear of ‘food noise’ returning and piling all the weight lost back on, not to mention a worry all the associated health benefits being lost.
Studies have shown that, on average, people regain 14 per cent of the lost body weight when they stop Mounjaro completely.
Most are keen to live a life without them, however, whether due to cost or because they have gained enough information on how to maintain a healthy weight.
After all, the jabs are not a “quick fix” and should be used in conjunction with learning healthy diet and exercise habits that you can carry on afterwards.
Here, we reveal everything you need to know about the next steps…
GENTLY DOES IT
SOME people start tapering off the drugs once they have hit their goal weight, rather than stopping them abruptly – the risk of which is a sudden surge of appetite and being tempted into old habits again.
“Tapering is a gentle way to step down the dose over time so the body can adjust as appetite returns,” explains Roj Helin Parlakyildiz, clinical pharmacist at Voy.
Tapering may look like reducing the dose by 2.5mg each month.
At Morrisons Clinic, they say: “After an initial 12 months, it is an option to then reduce the dose each month as you taper off the medication.
“How long you taper down will depend on the maximum dose you reached and how successful you feel your treatment is.
“Combined with the diet and lifestyle changes you’ve been making, this will increase your chances of sustained weight loss, even after you stop using the injections.”
Finally got the weight off? Now it’s time to decide if GLP-1 medication will remain in your life[/caption]
THE ‘MAINTENANCE PHASE’
IT is understandable why so many jabbers go for what’s known as the ‘maintenance phase’.
Whether this is available to you or not will depend on your provider.
Ms Parlakyildiz says at Voy they define a maintenance dose as “the lowest effective dose that keeps hunger and weight stable”.
She adds: “Some patients may need this for several months or longer, especially if they’ve lost a significant amount of weight and want additional support maintaining it.”
Typically, Ms Parlakyildiz says, this is “a lower dose that helps prevent weight re-gain and supports appetite regulation during the transition to long-term lifestyle-based management”.
If your prescriber is happy for you to continue taking the drugs, prepare for prices to roughly stay the same.
Dr Dix says: “During the maintenance phase, treatment costs generally remain the same as during the weight loss phase.
“However, if a patient chooses to move to a lower maintenance dose, the cost may decrease accordingly.
“In general, lower doses are more affordable while higher doses typically come at a higher cost.”
Some patients will choose to continue taking a maintenance dose[/caption]
Interestingly, Dr Dix says at MedExpress: “Patients can choose their maintenance dose.
“We provide health information to help patients make an informed decision.
“Prescriptions are always reviewed by a qualified health professional to ensure that the dose is suitable for each patient.”
At Voy, the maintenance dose is clinician-advised, but the patient has a say.
If it’s been over six months since your last treatment, you’ll need to restart treatment from the beginning.
Dr Sophie Dix
An individualised approach is key here – regardless of your provider and its rules, it’s claimed that a person’s circumstances will be taken into consideration.
MedExpress, for example, can prescribe treatment with no fixed end date, “as long as the treatment continues to benefit the patient, they’re not experiencing serious side effects and their BMI remains above 23.5”.
At Pharmacy2U, however, they say: “You’ll likely be removed from treatment once you hit your goal weight.”
If patients drop below a healthy weight, then they must cease medication.
ASDA Online Doctor say: “Mounjaro is meant for long-term treatment, but this does not mean you have to take it for the rest of your life, that will depend on your circumstances.”
THE TRUTH ABOUT MICRODOSING…
A LOT of the Mounjaro and Wegovy gang are going rogue and doing maintenance their own way, with microdosing.
You may have seen on social media that instead of using the full weekly dose of their pen, they are only administering a small amount, saving the rest for upcoming weeks.
For example, they might use a dose smaller than the starting dose of Mounjaro (which is 2.5mg per week), such as 1mg. They would, therefore, get 10 doses out of a 2.5mg pen designed to last one month.
The weight loss pens have a certain number of doses available – altering this, such as for microdosing, is not recommended[/caption]
The obvious reason is to spread the cost and minimise side effects, while getting enough appetite suppression to reap benefits.
But microdosing is not recommended by healthcare professionals because the pens are not designed to be used this way and have a 30 day expiry date from opening.
Mounjaro, for example, should be kept in the fridge, and after first use, “patients may store their pen at room temperature up to 30 °C and dispose of it after 30 days”, says the manufacturer Eli Lilly.
This is line with medicine guidelines more broadly, but it is not clear what the risks are of dosing up post-30 days.
There have been studies on small doses of semaglutide (Wegovy) which do show that weight loss is achievable, but not of tirzepatide (Mounjaro). The bottom line is, there is no robust evidence of the safety and efficacy of microdosing in the long-term.
Therefore, you do not know what you are bargaining for, or if it’s even worth it.
This means that microdosing, if prescribed privately, would be deemed “off-label” – although not illegal, a medical professional has the option to prescribe it to a patient, using their own clinical judgement, outside the official guidelines or licensing.
CAN I USE JABS FOREVER, THEN?
IN theory, experts believe you could use weight loss jabs forever, though scientific studies don’t stretch beyond a few years.
If you are being prescribed the medicine by the NHS you will only receive it for a max of two years.
Pharmacy2U says: “The highest maintenance dose of Mounjaro (15mg for 72 weeks) has no clinically known adverse long-term effects.”
That doesn’t mean they don’t exist. Rather, that these drugs haven’t been around for that long and long-term studies are limited.
Continuing the meds, even after fitting in your skinny jeans, may actually have health benefits beyond keeping you slim.
Weight loss provider Numan flags that trials on semaglutide (the active ingredient in Wegovy) show it “reduced the risk of adverse cardiovascular events, including a heart attack or stroke”.
STOPPING AND STARTING
WHAT about if you decide to stop (say, over Christmas or a holiday), can you jump straight back into jabbing?
Dr Dix says: “If resuming treatment after a break of less than eight weeks, patients typically have two options: they can return to their previous dose – if it was effective and side effects were manageable – or move up to the next dose, to further support weight loss following the recommended schedule.
“If it’s been over six months since your last treatment, you’ll need to restart treatment from the beginning.
The known side effects of weight loss jabs
LIKE any medication, weight loss jabs can have side effects.
From vomiting to indigestion and pancreatitis, here’s what to look out for.
Nausea: This is the most commonly reported side effect, especially when first starting the medication. It often decreases over time as your body adjusts.
Vomiting: Can occur, often in conjunction with nausea.
Diarrhoea: Some people experience gastrointestinal upset.
Constipation: Some individuals may also experience constipation.
Stomach pain or discomfort: Some people may experience abdominal pain or discomfort.
Reduced appetite: This is often a desired effect for people using Ozempic for weight loss.
Indigestion: Can cause a feeling of bloating or discomfort after eating.
Pancreatitis: In rare cases, Ozempic may increase the risk of inflammation of the pancreas, known as pancreatitis, which can cause severe stomach pain, nausea, and vomiting.
Kidney problems: There have been reports of kidney issues, including kidney failure, though this is uncommon.
Thyroid tumors: There’s a potential increased risk of thyroid cancer, although this risk is based on animal studies. It is not confirmed in humans, but people with a history of thyroid cancer should avoid Ozempic.
Vision problems: Rapid changes in blood sugar levels may affect vision, and some people have reported blurry vision when taking Ozempic.
Hypoglycemia (low blood sugar): Especially if used with other medications like sulfonylureas or insulin.
“If you’re resuming treatment after a break of between eight weeks and six months, patients will need to drop down doses dependent on the length of time since their last injection.
“This is to help patients tolerate the medication and avoid side effects.”
Weight gain can occur when you stop taking Mounjaro, so it’s necessary to continue eating healthily and regularly exercising
Dr Sophie Dix
At Voy, all restarters are reviewed by clinicians to confirm the safest entry point.
“It depends on the person, side effects, prior dose, and the length of the break,” says Ms Parlakyildiz.
Well Pharmacy adds: “Whether cost, side effects or your expectations have affected your use of the medication, you can talk to your healthcare provider about starting again with the right mindset.”
The time it takes for the drug to be eliminated from your body is “approximately 25 days”, says Dr Dix.
“This is why patients often continue to feel its effects for several weeks after stopping treatment,” says Dr Dix.
At least half of the medicine is expelled after about five days, however, which is why the dosing schedule is once a week.
This means that missing the odd dose isn’t the end of the world (you’ll still likely have some appetite suppression).
Ms Parlakyildiz says it’s important to be aware of drug elimination when making “decisions about restarting treatment, pregnancy planning, and surgery”.
For example, the Medicines & Healthcare Regulatory Agency says to “avoid getting pregnant while using GLP-1 medicines”. For this reason, you should make sure you are taking contraception while on it.
LIFE AFTER JABS
ALL outlets should offer consistent, medical support while you’re taking the medication, but follow-up care once you stop can be patchier.
“At MedExpress, we provide nutritional and lifestyle advice throughout a patient’s weight loss journey,” says Dr Dix.
“While we don’t currently have any specific lifestyle support for patients coming off medication, we’re looking into providing this in the near future.”
Voy does offer support, says Ms Parlakyildiz, adding: “Patients can speak to a clinician within minutes via the in-app chat or hotline.
“Our health coaches also provide tailored nutrition and behaviour support.
“If appetite rebounds or weight starts to regain, we review quickly and may recommend a short maintenance phase or brief re-titration to steady progress.”
SIMPLE TRICKS TO SUSTAIN YOUR SUCCESS
WHETHER you stop, maintain or taper, all of the GLP-1 providers are clear that you can’t just start eating crisps and biscuits again and skip the gym.
Dr Dix says: “Weight gain can occur when you stop taking Mounjaro, so it’s necessary to continue eating healthily and regularly exercising to prevent this from happening.”
Morrisons Clinic says: “When you stop Wegovy, to maintain your weight your longer-term, you need to adopt lifestyle changes and regular exercise.”
Well Pharmacy adds: “Wegovy is a great tool to support weight management. But it is just that.
“A medical tool that should be used with an ongoing commitment to a healthier lifestyle.”
How to avoid regaining weight when the ‘food noise’ creeps back in
By Vanessa Chalmers, Assistant Head of Health
IF you’ve been using Mounjaro or Wegovy, you’ll likely be feeling ecstatic to finally see stubborn fat melt away.
But despite feeling the best you’ve felt in years, and the flow of compliments, you’re quietly battling profound fears about weight regain.
The ‘food noise’ can creep back in, and appetite is no longer suppressed by GLP-1, the hormone stimulated by GLP-1 medications.
“Many people return close to their original weight within two years,” registered nutritionist and author Alison Bladh (alisonbladh.com) tells Sun Health.
“When the drug is discontinued, the body’s natural hunger hormones may rebound, leading to a noticeable increase in appetite.”
Here’s how to prepare for the next step in your new life…
MINDSET
- Believe in yourself. You’ve regained control, so don’t forget that weight gain often comes from self-loathing.
- Ditch diet language. You’re not on a diet anymore, so don’t say things like, ‘I’ve fallen off the wagon’ or ‘I’ve been bad’.
- Plan for triggers. People eat due to stress, low mood and reward. Learn your own triggers and come up with a plan.
- Don’t fear food. Stick to regular, balanced meals which will keep blood sugar levels stable and cravings in check.
- Don’t self-sabotage. When you’ve got a birthday, celebration or bank holiday, old habits have an opportunity to stick around afterwards, but only you allow this to happen.
- Keep a diary. Tracking what you eat can help you stay healthy.
DIET AND NUTRITION
- Focus on protein and fibre at every meal. Try a three-egg omelette, Greek yoghurt, or a smoked salmon bagel for breakfast, for example.
- Eat the good fat. The Mediterranean diet emphasises healthy fats like olive oil and avocados and can be “especially effective” for health and weight loss.
- Support your gut with the natural GLP-1 that is fibre, as well as whole grains and fermented foods like kefir and kimchi.
- Keep high-calorie foods out of sight. The urge to eat for pleasure rather than physical need “can become more pronounced” once you come off the jabs.
- Be prepared. You make poorer choices when you’re hungry so get ahead by planning.
- Get grab-and-go snacks. If your hunger is incessant you need to eat between meals, look for ‘minis’ or single-portioned foods.
To read about each tip in more detail, read the full article here.
