Will I need to be on weight loss medicine for life?

When new patients come for a weight loss consultation with me, one of the most common questions I get, is some version of, “how long do I really need to be on this medication”. This type of question is often driven from many myths and misunderstandings that exist surrounding obesity and medial weight loss therapy. So, what are the facts?

Obesity is considered a chronic medical disease. The World Health Organization (WHO) has included obesity in the International Classification of Diseases (ICD) since 1948 and officially recognized obesity as a chronic disease in 1997. The American Association of Clinical Endocrinology (AACE) and the American Medical Association have both recognized obesity as a chronic disease for over 10 years. In short, obesity and weight issues are complex and heterogeneous, meaning there is variety, and no one form. Many factors play in genetics, lifestyle, other medical conditions, medications, stress, hormones and more. When caring for a person struggling with being overweight or having obesity, we should approach care like how we would for any other condition. This doesn’t mean we disregard lifestyle modification, nutrition and exercise are critical to successful and healthy weight loss, but the reality is, for most people, it will not be enough. We give medications to treat many conditions; this should be no different.

I have heard people say, “What’s the point of taking a weight loss medication? You’ll just regain the weight if you stop it”. I’d remind people that I have never heard somebody say, “don’t take medication for your high blood pressure, it will just go back up if you stop it”. I understand the hesitation about being on a medication lifelong, but we need to reframe how we think about this. If something exists that is safe and effective and will allow you to feel good and be healthy, why would we be against that? The reality is, taking a weight loss medication for a few months is the equivalent of a crash diet, it is very unlikely to provide lasting results. Unfortunately, certain people are predisposed to gaining weight and are likely to always struggle, despite best efforts. My priority is your health, and for many people, the GLP1 agonists, like Ozempic or Zepbound are key to improving health. It’s also worth noting that for many people, taking a GLP1 agonist allows them to stop other medications, or minimize medications or surgeries they may need in the future.

The other concern patients have regarding long-term use of a GLP1 agonist is the fear that these medications aren’t safe, or not enough is known about them. As a matter of this, I would point out that the first GLP1 agonists, exenatide, was approved by the FDA in 2005. It underwent about 10 years of research prior to approval as well. So, at this point, we have 30 years’ worth of data on GLP1 agonists. Millions of people take these medications, and we have had many large retrospective studies reviewing patients on these medications showing their safety. Not only are they considered safe, but they can reduce your risk of heart attack, stroke, kidney disease, liver disease, and possibly cancer. We are discovering new benefits to the GLP1 agonists all the time.

The last concern is logistical, patients are worried that once they lose weight, their insurance will no longer want to cover the medication. This is not true. The approvals are always based off your pretreatment weight. Once you are on the therapy, most insurance will require that we demonstrate a response to the drug, which often is a minimum loss of 5% of the starting body weight. In my experience, if the insurance doesn’t change their coverage policy, it is extremely rare for a patient to not get approval to stay on the drug.

So, when it comes to medical weight loss therapy, remember, we are playing the long game. I want you to lose weight for good and stay healthy. It is completely okay if you need a little help to get there.