The advent of GLP-1 treatment solutions for obesity and weight management have provided alternatives to surgical intervention. However, these medications are not meant to be taken long-term, therefore putting best practices in place to make the most of the time while taking the medication to sustain long-term weight loss is important.
Tirzepatide and semaglutide medications can produce significant weight reductions, sometimes up to 20% of baseline weight. However, emerging evidence suggests that individuals who discontinue use often experience a weight regain within a year of stopping. Evidence from the STEP-1 trial demonstrated that individuals who discontinued semaglutide regained approximately 2/3 of the weight lost within one year as well as partial reversal in cardiometabolic benefits such as reduction in blood pressure and improvement in glycaemic control.(1) In the same trial participants experienced weight reduction of nearly 15% over 68 weeks compared to approximately 2% in the placebo group. Similarly, Tirzepatide produced weight reductions exceeding 20% of baseline body weight.(2) Both demonstrate effective treatments for chronic cases of overweight.
When treatment is discontinued appetite regulation and metabolic balance slowly returns to normal as medication is no longer in control, returning the person to the same place before starting GLP-1 treatment. Support during the time of taking and when reducing medication is a critical phase in which sustainable behavioural and metabolic changes can be implemented.
Body weight is regulated by physiological systems that are designed to maintain energy balance. When weight is lost the body activates compensatory responses intended to restore previous energy stores. This is a response that evolved as a protective mechanism during time of food scarcity, not known in my lifetime, but certainly in my parents and grandparents’ lifetimes. Following weight loss, levels of the hunger hormone ghrelin, often increases and the corresponding hormone leptin that suppresses hunger and promotes satiety often declines.(3) Neural pathways associated with food as a reward may also become more sensitive, increasing the appeal of carbohydrate and calorie dense foods. GLP-1 agonists suppress many of these responses which slowly return on cessation of medication causing the return of weight unless lifestyle and dietary changes have been put in place.
A structured framework for transitioning to fully support the reduction of weight means you are giving yourself every chance to sustain weight loss without the medication. This can be done through lifestyle habits that support movement, healthy eating and good sleep. Habits might include:
1. Nutrition planning to include structured meal timing and appetite regulation. Seek expert advice on a dietary plan to ensure adequate intake of vitamins, minerals, proteins and fats while providing interest and variation.
2. Regulation of mealtimes to maintain stable blood glucose levels and provide an easy structure to follow within your lifestyle and work-life commitments.
3. Pre-meal metabolic support. Soluble fibre can be helpful in promoting feelings of fullness and contributing to weight loss when taken before meals.
4. Exercise regime that preserves lean body mass and metabolic stability is essential. Overall exercise promotes the feel-good hormone, serotonin and positive mental health while increasing mitochondrial function and cellular health. The best approach is a variety of different exercise and movement options that address bone density, body mass, stamina and flexibility for example dancing, walking, gardening, swimming and resistance training combined with yoga, tai chi or qigong.
5. Stress management
Stress management is crucial to minimising “reward” eating due to elevated cortisol levels. Stress may also affect sleep creating a vicious circle that leads to poor eating decisions due to a drive for quick energy fixes.
6. Engagement - Behavioural coaching
Empowerment and engagement to take responsibility for your weight is critical to long term success. Knowing that an increase in appetite may occur re-frames this away from personal failure. Practitioner support plays a key role in building engagement through goal setting, regular review and reinforcement of lifestyle changes. It may also be helpful to have someone in your circle who is your support and who encourages you to keep up with lifestyle and healthy habits so that you don’t feel you are on your own.
With over a year of experience and knowledge of these medications practitioners and clients can use this information positively to implement strategies that can work for each person through empowerment, encouragement and guidance to result in sustainability of weight loss, mental wellbeing and overall success.
References:
(1) Müller TD, Finan B, Bloom SR, et al. Glucagon-like peptide-1 (GLP-1). Mol Metab. 209;30:72-130.
(2) Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387:205-216.
(3) Bhatt DL, et al. Real-world use and discontinuation patterns of GLP-1 receptor agonists. 2024.
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