Oh-Oh-Oh-NOzempic Part II

[Razors Edge ★]

 

What Happens When You Stop Taking Ozempic?

 

 

Hundreds of thousands of people take Wegovy or Ozempic to lose weight or manage diabetes. For some, going off the drugs is leading to unexpected outcomes.

The drugs’ main ingredient is semaglutide. It was originally prescribed for long-term diabetes management and attracted widespread attention because it can spur significant weight loss. Sales of Wegovy, the brand of semaglutide approved for weight loss in 2021, reached nearly $900 million in 2022, according to Novo Nordisk, the pharmaceutical company that manufactures both brands.

Supply-chain snags and high demand have resulted in shortages of Wegovy. And the costs, as much as $1,349 a month out of pocket for the injection pens, as well as unpleasant side effects, have prompted some patients to discontinue their use. When these patients stop, doctors say the pounds and cravings return.

People who stopped taking semaglutide gained back, on average, two-thirds of the weight they lost within a year, according to a study published in August 2022 in the journal Diabetes, Obesity, and Metabolism. Novo Nordisk funded the trial.

“Some people don’t have an awareness that this might have to be a medication that will be lifelong,” said Alexandra Sowa, an obesity medicine physician in New York. Dr. Sowa said more than half of her new patients are asking about semaglutide.

Weight Cycling

Frustratingly, even those who maintain a healthy diet and exercise regimen after Wegovy or Ozempic can expect to gain some weight back, said Gregory Dodell, an endocrinologist in New York City. He said he rarely prescribes Wegovy except for patients with polycystic ovary syndrome, or PCOS, a condition associated with an increased risk of Type 2 diabetes.

Semaglutide spurs weight loss by stimulating the release of insulin and lowering blood sugar. It also delays stomach emptying, which causes people to feel full quickly and stay sated for longer stretches. When a patient comes off the drug, their normal appetite returns. 

“Most likely, you’re going to end up eating what you were before and maybe more because the body has been in something like a starvation mode and it’s trying to catch up,” said Dr. Dodell. “It’s not a matter of willpower and self-control.”

Some patients say they weren’t initially aware that they might need to take weight-loss drugs long-term. 

Jenny Woods, a bartender in Nashville, Tenn., received a free five-month trial for Wegovy last July. When the trial ended, Mrs. Woods, who has PCOS, had lost roughly 17% of her starting weight. 

Her insurance didn’t cover the medication, so she stopped taking it. Over the next two months, her PCOS-driven sugar cravings returned, as did about half the weight she had lost. She has since restarted the medication, working extra shifts to cover her $750 monthly out-of-pocket cost.

“I don’t think other people are aware that this is a forever thing,” she said. “This isn’t something you’re going to take for 10 to 15 vanity pounds because it’s going to come right back.” 

Of roughly 110 million Americans with obesity, 40 million have access to Wegovy through commercial coverage or Medicaid, according to Novo Nordisk, which said it is working to expand coverage.

Physicians prescribe long-term semaglutide use for diabetics and recommend the same for obese patients to avoid weight cycling, or repeated weight loss and gain. (Ozempic isn’t approved to treat obesity in non-diabetics, but some doctors prescribe it off-label.)

Weight cycling can be harmful to a person’s physical and mental health. And those who lose and gain weight repeatedly have a higher risk of mortality than people who maintain a stable weight, various studies have found, including in the Journal of Clinical Endocrinology & Metabolism.

Doctors tell patients not to go off the drugs without talking to a physician. Dr. Sowa says tapering, rather than going cold turkey, can help curb rapid regain, as can supplementing with other weight-management medications, such as Qsymia.

Long-Term Questions

Christine Gal, a radiologist in Honolulu, quit Wegovy in the summer of 2022. She said the drug left her repulsed by most food and vomiting near-daily. Gastrointestinal symptoms such as nausea, constipation and diarrhea are common side effects, doctors say, but are relatively mild for the majority of patients. 

“I told my husband at one point, ‘I would rather starve than feel this way,’” Dr. Gal, 52, recalled. “I wanted to enjoy my food again.” 

After gaining roughly 5 pounds back and struggling to manage cravings, she went back on. She hopes to taper off the drug eventually, citing a lack of research on long-term Wegovy use for weight management. She knows the odds are stacked against her when it comes to maintaining weight, but hopes to beat them anyway. 

More research is needed to fully evaluate how long-term semaglutide use affects weight loss, doctors say. The Diabetes, Obesity, and Metabolism study found that although participants regained most of the lost weight after stopping the drug, other benefits persisted, such as lower levels of certain types of cholesterol.

It is unclear how long those benefits could last, said Natasha Bhuyan, a family medicine doctor at One Medical in Phoenix, who wasn’t involved in the study. 

Some patients, like Mrs. Woods, say they will do whatever it takes to stay on the drug long-term. She said she enjoys the absence of back and joint pain she dealt with at higher weights, but the bigger benefit is the time she gets back in her day from not having to think about eating. 

“Just to be able to just wake up, get ready, go to work and not worry about being obsessed with the concept of food,” she says. “It is freedom.”

 

[Razors Edge ★]

Why is Ozempic all over my news lately? 

[Longjohn ★]

1 hour ago, Razors Edge said:

Weight cycling can be harmful to a person’s physical and mental health.

Does that mean I should leave out the cast iron sink on my next eight day cycling  trip?

[MickinMD ★]

Though I've only dropped 18 pounds in a year - though water weight is 5-10 more than it should be due to med changes - I know that keep weight off it a matter of making permanent diet changes.  I've done small steps in the right direction and don't expect to put weight back on unless I fall into bad habits.

[Wilbur ★]

On 2/27/2023 at 10:05 PM, Razors Edge said:

Why is Ozempic all over my news lately? 

Because people take it and lose weight.  Typically 12-18 pounds.  Then their body adjusts and they stop losing and the docs up their dose.  Then their bodies adjust and they gain weight.  It does have a positive blood sugar reduction though, which is what it is intended for.  Long story short, it is the new magic pill for weight loss. 

[Dirtyhip]

The lengths people will go to lose weight is nutty.  In this scenario they opt for injection meds, instead of eating better and exercising.  Sub Q injections are tough.  I did them for years.  Glad that is over.

[jsharr ★]

9 minutes ago, Dirtyhip said:

The lengths people will go to lose weight is nutty.  In this scenario they opt for injection meds, instead of eating better and exercising.  Sub Q injections are tough.  I did them for years.  Glad that is over.

Ozempic is not bad. The needle is tiny.  Cannot even feel it go in (insert that's what she said joke here)  It comes in a multi use pen, some have variable dosage.  You screw a needle onto the pen, turn the dial to your dose, hold against your abdomen or thigh and hold down a button until the pen quits clicking.    My numbers are starting to look really good.  I was in the mid 200s when I stared and in the 140s now.  Around a 100 point drop and my weight is going down as well.  Down to 232 this AM.   I will be in the 220s by the end of the month for sure and hope to have my A1C down around 100.   My blood pressure is showing similar good trends with the weight loss.  Upper number in the low 120s or high 110s and bottom number in the low 80s to upper 70s

We are all flawed.  I deal with stress by eating.  Sad but true.  I am learning to do better about my choices, but 40 or 50 years of bad habits are really hard to break.   Ozempic has turned off my cravings and if I do give in and snack, I am miserable, so it is a win win.   It helps that I am back in the gym on a regular basis.  Might have to start working out in the morning, as my evenings lately have been very busy with Scouts.  

[Dirtyhip]

2 minutes ago, jsharr said:

Ozempic is not bad. The needle is tiny.  Cannot even feel it go in (insert that's what she said joke here)  It comes in a multi use pen, some have variable dosage.  You screw a needle onto the pen, turn the dial to your dose, hold against your abdomen or thigh and hold down a button until the pen quits clicking.    My numbers are starting to look really good.  I was in the mid 200s when I stared and in the 140s now.  Around a 100 point drop and my weight is going down as well.  Down to 232 this AM.   I will be in the 220s by the end of the month for sure and hope to have my A1C down around 100.   My blood pressure is showing similar good trends with the weight loss.  Upper number in the low 120s or high 110s and bottom number in the low 80s to upper 70s

We are all flawed.  I deal with stress by eating.  Sad but true.  I am learning to do better about my choices, but 40 or 50 years of bad habits are really hard to break.   Ozempic has turned off my cravings and if I do give in and snack, I am miserable, so it is a win win.   It helps that I am back in the gym on a regular basis.  Might have to start working out in the morning, as my evenings lately have been very busy with Scouts.  

Possibly my sub q experience was rougher.  I remember the ISRs and it was painful when the med went in. 

[maddmaxx ★]

You were warned.

[BuffJim]

I doubled my dose from 25 to 50 after 4 weeks at 25. Not sure the Unit of Measure. 
 

Felt ok at 9 for worldwide call, but then after that felt like garbage. 2 Naps, one single size serving of chips for lunch. A lot of water. 
Nausea, chills and generally weak and tired. Common side effects, but Grrrr 👿. 

[shootingstar]

Best of luck. Hope folks here don't have to take it for life.

[Longjohn ★]

On 2/27/2023 at 5:00 PM, Fret Buzz said:

Weight cycling can be harmful to a person’s physical and mental health.

Maybe we should all buy carbon fiber bikes and stay in motels instead of packing gear on our bikes for camping?

[BuffJim]

Last Dr appt last month, I was 212. Today I am 201. In danger of going below 200 for the first time in about 40 years. Blood pressure was also best in decades. 

[Ralphie ★]

My cardiologist has drank the kool aid and wants me to seek it oot, which causes me concern. I have been dribbling weight off very slowly by eating less which I much prefer.  It is snot nice to try to fool Mother Nature. 

[Razors Edge ★]

3 minutes ago, Ralphie said:

My cardiologist has drank the kool aid and wants me to seek it oot, which causes me concern. I have been dribbling weight off very slowly by eating less which I much prefer.  It is snot nice to try to fool Mother Nature. 

Mounjaro is getting a ton of hype this week:

People who are overweight are flocking to the drug Ozempic to slim down. Looming is an even more powerful weight-loss treatment.

The drug Mounjaro helped a typical person with obesity who weighed 230 pounds lose up to 50 pounds during a test period of nearly 17 months. 

No anti-obesity drug has ever safely made such a difference. In the coming months, it is widely expected to get the go-ahead from U.S. health regulators to be prescribed for losing weight and keeping it off, and some patients are already using it unapproved for that purpose.

The advance of Mounjaro, which is already on the market to treat Type 2 diabetes, has excited doctors and patients who have been waiting decades for effective treatments, while helping turn its maker, Eli Lilly & Co., into the most valuable standalone pharmaceutical company in the U.S. with a market value of more than $300 billion.

 

[Further]

Did you ever see a fat meth head ?

 

[Razors Edge ★]

1 hour ago, Further said:

Did you ever see a fat meth head ?

Probably. It's not until they get really skinny that they are easy to identify, but like most folks, I imagine they began the journey overweight. 

[Further]

It’s an option that we know works.

There are some side effects…

[Razors Edge ★]

3 minutes ago, Further said:

It’s an option that we know works.

There are some side effects…

More or less than the prescribed drugs?  I mean, meth is bad, but relative to some other options, where's it stack up?