Ask the Doctor: ‘Will coming off Ozempic treatment for obesity undo my weight loss?’

“I have been on Ozempic for treatment of obesity for the past year. This has done wonders for me, not only physically, but also mentally and for my self-esteem and confidence. I am down over 4 stone and almost in a healthy weight bracket once again. I am considering coming off ozempic and attempting to live my new healthier lifestyle without the assistance of ozempic. Is this a good idea or will this just undo all of my good work? I really want to try to do this by myself now but I am also terrified of reverting.”

Answer from Professor Robert Kelly, Consultant Cardiologist and Lifestyle Medicine Physician, Beacon Hospital

Ozempic is a GLP agonist (mimicking the body’s own glucagon like peptide 1). This is naturally produced in the bowel after eating. Taking Ozempic stimulates insulin secretion, slows food emptying from the stomach, so people feel full for longer. Drugs last longer than naturally occurring GLP1 and have a prolonged effect over days. These medications also affect appetite pathways in the brain that reduce food cravings.

GLP1 drugs have been around for almost 20 years and appear relatively safe, albeit with side effects and careful patient selection. In 2021 Semaglutide (Ozempic, Wegovy) was approved in the USA specifically for weight management in obesity and overweight adults. These and similar drugs deliver 6-20% weight reduction in patients.

In Ireland the drug is only approved for use in diabetics who are overweight or obese. Eligible patients are covered by a drug payment scheme for this. It can reverse diabetes and reduce weight albeit not in every patient. Data from obese patients without diabetes has shown significant reductions in weight, improved cardiovascular health, improved kidney health, less sleep apnoea, reduced food related cancer risk and reduced mortality in selected obese adults with chronic diseases. At present, the drug is not licensed in Ireland for this use and so it is considered off-label for use in obese adults. Patients who are taking it are told that, but we make them aware of the international efficacy data of benefit to inform them. Reducing weight by 5% results in health benefits.

The drugs cause nausea, vomiting and diarrhoea but in most people after adjusting doses over weeks the symptoms diminish. Certain foods make the symptoms worse, especially fat and spicy foods. Patients who lose weight will lose skin elasticity (saggy skin) and others may lose muscle mass permanently so use of drugs needs close medical supervision. Childbearing women need to be aware that the drugs can reduce the effectiveness of the oral contraceptive pill.

At 12-18 weeks the weight reduction of the medication plateaus. In weight-lowering non- diabetic patients’ higher doses of Ozempic or alternative agents such as Wegovy and Tirazepitide can drive even more weight reduction. (The latter drugs are not yet available in the Republic of Ireland).

These drugs are not for use in people at risk/with history of thyroid cancer, pancreatitis and type one diabetes.

The medication is administered as a weekly injection and costs between Euro 140 -250 per month. The duration is lifelong, but tablet versions are likely to be available in a few years. The question about stopping the treatment after a few weeks is popularised by social media, media and new clinics offering “short term pain with massive gain.”

Many want to use the treatment for holidays to look well going and coming back and to fit in with friends, or to fit into a dress or look well. While the medication does achieve that, it is not licensed for that use, the supplies are licensed primarily for diabetes patients and are limited by demand. The companies are doing their best to make more available.

A major concern is that ‘fake’ GLP1 injections have appeared online, some of which have led to patient death in Europe.

Weight loss returns when you stop taking GLP1 agents and that has been shown in every clinical trial. It is not known whether on-off use causes any long-term health problems or greater permanent weight issues.

These drugs do not work on their own nor do they have any effect unless you change your diet (no ultra processed food, more unprocessed fresh natural foods, fresh fruit, vegetables, whole grains – effectively a Mediterranean like diet) plus high protein intake, exercise and resistance-based training to minimise muscle loss. It is important to get good quality sleep and manage stress as they affect weight loss too. If patients fail to follow these lifestyle measures the medication will not be effective.

I am a Cardiologist and a Lifestyle Medicine Physician. I also coach health behaviour change. My approach is to help patients adopt healthy eating. I like the Mediterranean diet! Then add regular daily walking and gym work 1 hour per week. Drink lots of water. Address sleep and stress issues and if weight is not shifting, then I will discuss GLP1 treatment options.

GLP1 drugs are game changers for reversing diabetes and for reducing weight in overweight and obese patients. Their potential health benefits are enormous.

They are not short-term aesthetic products. Unfortunately, there are no magic bullets for permanent weight loss without changing lifestyle habits.

Have a question for the professionals you’d like answered? Get in touch with sarah.gill@image.ie with the subject headline ‘Ask The Doctor’.