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With the rise in popularity of weight loss injections like Mounjaro and Wegovy, many individuals have experienced amazing results – as demonstrated by numerous patients who have been through our weight loss service.
However, once the desired weight is achieved, or if treatment needs to be paused or discontinued, it’s essential to understand the safest way to come off these medications. This blog will outline the recommended approaches for maintenance and discontinuing GLP-1 injections while maintaining weight loss and minimising the risk of regaining weight.
NICE Guidelines on Weight Loss Injections
The National Institute for Health and Care Excellence (NICE) recommends that Wegovy be used for a maximum of two years. In contrast, there is no specific time limit for the use of Mounjaro. NICE does however advise healthcare professionals to assess treatment efficacy. If a patient on Mounjaro has not lost at least 5% of their initial weight after six months, doctors should consider stopping the treatment.
Why a Gradual Approach is Essential
When stopping weight loss injections such as Mounjaro or Wegovy, our team at DrOnline generally recommend a gradual reduction of dosage rather than abrupt discontinuation. There are several reasons for this:
- Preventing Rapid Weight Regain: Abruptly stopping the medication can lead to rapid weight regain. These drugs work by mimicking hormones that suppress appetite, and sudden cessation can cause a rebound effect, making hunger and cravings more intense.
- Allowing Your Body to Adjust: Gradual tapering helps your body transition from relying on these medications for appetite control to naturally managing hunger through lifestyle changes like diet and exercise.
- Supporting Long-Term Weight Maintenance: A step-by-step reduction in dosage helps solidify healthy habits, such as balanced nutrition, improved sleep, and physical activity. These habits play a crucial role in maintaining weight loss after discontinuing the medication.
The Role of GLP-1 and GIP Hormones
Mounjaro works by mimicking two hormones: GLP-1 (Glucagon-Like Peptide-1) and GIP (Glucose-Dependent Insulinotropic Polypeptide). These hormones communicate with the brain’s appetite control centre, the hypothalamus, to create a feeling of fullness after eating. Healthy habits such as regular exercise, balanced nutrition, and proper sleep can naturally increase GLP-1 and GIP levels, reducing hunger and helping to maintain weight loss lifelong.
Our SCOPE obesity trained GPs are equipped to give you all the tools required to achieve the above,
If you are either considering starting weight loss treatment or if you’ve already commenced your weight loss journey with a GLP-1, but are heading towards your target weight, the team at DrOnline are happy to guide you through.
Recent Research on Weaning Off Medications
Research has shown that many patients tend to regain weight after discontinuing Mounjaro or Wegovy. This has led to discussions about whether some individuals might need to stay on these medications long-term. However, more recent studies suggest that patients who taper off the medications gradually over several months are more likely to maintain their weight loss.
At DrOnline we can offer both tapering and long-term maintenance for GLP-1 treatment. We strive to adopt a patient centred approach, working together with our patients to adopt the most effective and safe way to maintain weight loss for everyone. We also focus on intensive lifestyle interventions, like the ones below to help maintain weight loss during maintenance/cessation of treatment.
Increasing physical activity: Engaging in regular (especially high intensity) exercise to promote weight maintenance.
Improving diet quality: Eating whole, nutrient-dense foods.
Sleep hygiene: Ensuring consistent and restful sleep.
Developing a Weaning Plan
As mentioned above, a customised tapering plan is crucial to safely come off weight loss injections. Our GPs will create a schedule that works for your body, considering your response to the medication and individual needs.
Here’s a typical tapering plan:
- Gradual Dose Reduction: Weaning your pen by a dose increment as tolerated by your level of appetite suppression alongside carefully monitoring your weight. This gradual approach allows your body to adjust without experiencing significant hunger or weight fluctuations.
- Monitoring and Adjustment: Your doctor will monitor your progress during this tapering period, adjusting as needed based on your body’s response. Some people may require a slower tapering schedule to minimize side effects and weight regain.
- Lifestyle Support: During the tapering process, it’s crucial to reinforce healthy habits such as balanced eating, consistent exercise, and proper sleep. These habits can help boost natural hormone levels and maintain your weight after discontinuing the medication
Your journey through our service
Targets/expected weight loss
At 6 months we would expect our patients to have lost at least 5% total body weight, or we would be carefully reviewing their treatment and diet, and considering cessation of treatment considering lack of effect.
The SURMOUNT-1 Study showed the following weight loss results over 72 weeks in the doses shown
- 5 mg: Lost 16.0% of baseline weight,
- 10 mg: Lost 21.4% of baseline weight,
- 15 mg: Lost 22.5% of baseline weight
- 85% of participants taking the 5 mg dose, 89% taking the 10 mg dose, and 91% taking the 15 mg dose achieved a weight reduction of at least 5%
- 30% of participants taking the 5 mg dose, 50% taking the 10 mg dose, and 57% taking the 15 mg dose achieved a weight reduction of at least 20%
We would expect similar results to the ones above for patients enrolled in our service. We believe our combination GP video calls alongside treatment can significantly maximise weight loss in comparison to treatment alone
Conclusion: Long-Term Weight Management
While weight loss injections like Mounjaro and Wegovy have proven to be effective tools, coming off them requires a carefully planned approach. A gradual reduction in dosage, paired with the development of sustainable healthy habits, can help maintain the weight loss achieved and prevent sudden weight regain.
This is where our doctor led support really stands out in the market, enabling a safe and in-depth clinical oversight to the end of your weight loss journey.
Written by Dr Christian Winiger
Medical Director
DrOnline UK
https://www.bmj.com/content/385/bmj.q1239.full