Weight Gain After Weight Loss Treatment

Opinion Piece:  Joshua Fink, MD

We have all heard about the weight gain after GLP-1 therapy. The bigger question is “how much” weight gain and what happens to all of the beneficial changes in cardiovascular risk factors? When you hear “Semaglutide”, think of the brands Ozempic*or Wegovy*.
The first point is this: GLP-1 medical treatment for people who are overweight or obese is NOT just about the weight. It’s also about improving the cardiovascular negative effects of being overweight. This is why being overweight or obese is a medical condition, not a cosmetic one, and like other conditions, should be considered a chronic disease.

An important trial called “The Step 1 Extension Trial” gives us some valuable insight. Essentially, what happens after you stop taking a GLP-1 medication, such as Semaglutide?

First, they looked at 1,961 adults from 5 different countries who did not have diabetes. They were all on Semaglutide 2.4 mg a week and took it for 68 weeks and had “lifestyle” interventions. They also had a placebo arm in the study. After 68 weeks, they stopped everything…including the lifestyle changes. They followed them for a year afterwards.

How Much Weight did They Lose?
That’s a reasonable first question. For the sake of keeping things simple, I am not going to report the “.” Number and I am going to round it off. Anything .5 or less will be the lower number and anything .6 or more will be the higher number. So, for example, “2.8” will be rounded to “3”….you get it :]
They lost 17% of their starting weight at week 68 [rounded off, that’s close to 16 months] vs 2% with placebo.

What Happened at One Year?
They regained back about 11% of their 17% loss…so, they were still down about 6% from baseline. Keep in mind, that’s off medication and no lifestyle intervention…or perhaps “supervised” lifestyle intervention.
In terms of blood pressure, it slowly started moving back “upwards” to were they started.
They also looked at “CRP” which is a maker of inflammation. This also started going back up, but at the time the study ended, it still was blow the starting point.

The A1C, a measure of long-term control of diabetes, also started going back up…but remember, these were all non-diabetics in the study, so not clear what that means in this setting.

Does this mean you are “destined” to regain weight after stopping GLP-1?

No…not necessarily. Lifestyle plays an important role. No one can question the role of diet and exercise. A research company called “Epic Research” published a study of over 20, 000 people on Semaglutide and found that 2/3 of users were able to maintain weight loss “even a year after discontinuing the medication”.https://www.epicresearch.org/articles/many-patients-maintain-weight-loss-a-year-after-stopping-semaglutide-and-liraglutide

As a lifelong fitness advocate myself, I have come to question “how much” exercise contributes to weight loss. I know that sounds crazy, and I bet you are going to be quick to disagree. That’s fine…..but more and more data is pointing to something disturbing and possibly out of most our control. First understand there is “Basal” or “Resting” Metabolic Rate and there is an Energy Expenditure that comes with exercise. The Basal Metabolic Rate accounts for close to 60-70% of the calories we burn. For some unknown reason, our BMR’s are going down.

There are commonly held thoughts as to “why” this might be happening, such as aging [2% decrease per decade], with some of that contribution being less lean muscle, changes in hormone levels such as Leptin. So, it this a bad thing?
Well, maybe not. There is some evidence that a decrease in BMR, which may in part be responsible for some of the weight gain as we age, may have benefits in terms of decreasing the risk of cancer, according to some research published in Frontier Genetics in 2021 and looking at the UK’s BioBank data.
So, if losing weight with a GLP-1 type of medication can modify our “weight-gain-as-we age” while at the same time, allowing Nature do “do what it naturally does as we age ” in terms of decreasing a BMR-cancer possible association, is that such a bad thing?

Just our thoughts…..if you are interested in signing-up for ur Medical Weight Loss meeting in Nashville this June, where we focus on the GLP-1 meds, here is the link : https://medicalaestheticmentors.com/event-register/

Disclaimer:

This blog post represents own personal opinions and is for entertainment purposes only. This blog post should not be used as a substitute for personal medical advice. This site does not provide medical advice. Do not infer or reach any conclusions about your own medical condition by reading this post. Any decision that you make about your own medical health should be made strictly between you and your healthcare provider. No doctor-patient relationship is established nor is it inferred by reading this post. Any comments you make about this blog post may be seen publicly and any identifying features such as your name or other identifiable features are strictly controlled by you and are not the responsibility of Joshua Fink, MD, his staff, owner, employees, employee, affiliates, representatives, website hosts or creators.

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