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Those on a new weight-loss therapy may gain back much of their weight — and lose the associated cardio-metabolic benefits — when they discontinue treatment, according to a new study published in the journal JAMA. This new class of drugs — which includes the celebrity-endorsed drug Mounjaro — has become a rage owing to their ability to substantially bring down body weight.
The recent study of Eli Lilly’s Tirzepatide said, “Withdrawing Tirzepatide led to substantial regain of lost weight, whereas continued treatment maintained and augmented initial weight reduction.”
What did the study find?
After taking the treatment for 36 weeks, those who stopped the once-a-week injection gained back 14 per cent of their body weight at 88 weeks after losing 20.9 per cent. And, those who continued the treatment lost another 5.5 per cent weight. The total weight reduction in those who continued Tirzepatide was 25.3 per cent and those who stopped at 36 weeks was 9.9 per cent.
“An overall weight-loss of 25 per cent is tremendous, almost equivalent to bariatric surgery. We know that most of the weight loss with these medicines happens in the beginning but it is good to see much of it is maintained. The only difference with bariatric surgery is that the weight gain usually does not happen or happens very slowly afterwards. We need more data to see how both compare,” said Dr Anoop Misra, Chairman of Fortis C-Doc Hospital for Diabetes and Allied Sciences, New Delhi.
While this meant that the weight of the participants at 88 weeks was still lower than what they began with, “much of their initial improvement in cardio-metabolic risk factors had been reversed,” as per the study.
What does it mean for users?
Several anti-obesity medicines, including Semaglutide from the same class, have shown that weight is regained once the therapy is stopped. This, the researchers said, means that obesity is a chronic condition “similar to Type 2 diabetes and hypertension, requiring long-term therapy in most patients.”
While long-term data on these medicines still does not exist, Dr Misra said that a decision needs to be taken on whether the therapy should be continued after the ideal BMI is reached. “On reaching the ideal BMI, if the person is motivated to continue with lifestyle changes, the medicine may be stopped. Unless they have any cardiac issues, in which case, the medicine may be continued as they have cardiovascular benefits,” he said.
What leads to discontinuation of therapy?
Gastro-intestinal side effects such as nausea, vomitting, diarrhoea — and more severe ones such as stomach paralysis — are known to result in participants discontinuing the therapy, especially during the initial period. There was seven per cent discontinuation of Tirzepatide during the first 36 weeks, mainly due to gastrointestinal side-effects.
When it comes to body composition, some trials showed that these drugs led to loss of lean body mass. This, the experts said, could be a problem for older individuals for whom preserving lean body mass is important to prevent frailty. The experts also said that it might lead to weight cycling — when people who lose weight stop taking the medicine, regain primarily fat, and subsequently have more difficulty in losing weight.
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