Discontinuing Medications Means Regaining Appetite
Anne Peters, MD, a professor of medicine at USC’s Keck School of Medicine in Los Angeles and director of the USC Clinical Diabetes Programs, underscored that the possibility of regaining weight with discontinuation of GLP-1 receptor agonists is indeed “a big concern because your appetite comes back in spades when you take away the effect of these hormones,” she told this news organization. “For that reason, I don’t ever tell people to stop cold turkey.”
Regarding the question of how long patients should remain on the medications, Peters said the scenario might be compared to the need for patients with type 1 diabetes to be on insulin, which is a gut hormone.
“These medications are also gut hormones, and some patients may need to also be on them for life to maintain the benefits,” she said.
“If a patient for some reason wishes to come off of the medication, for instance in order to be on less medicine, I have them titrate down and usually there will be a dose where they actually need only a small dose.
“I even have some patients who just take semaglutide once a month who are able to manage to maintain their weight loss,” Dr. Peters noted.
“But the whole goal in people who are overweight or obese is to establish a new set point and maintain whatever that new target weight is.”
Dr. Peters agreed that the loss of insurance coverage for the medications can throw a big wrench into that maintenance, presenting adverse effects of its own by causing a lack of treatment continuity.
“When you lose weight, you lose lean body mass and fat mass, but when you regain, it’s primary fat mass, so if you go on and off these drugs, it can contribute to a loss of lean mass. Therefore, these drugs should not be taken if someone is going to go on and off them repeatedly.”
The study received funding from the National Cancer Institute. Dr. Peters has consulted for Eli Lilly in the past.
A version of this article appeared on Medscape.com.