Health Care Provider Can Help Create a Plan, ThedaCare Expert Advises

The success of GLP-1 drugs like Ozempic, Wegovy and Mounjaro is clear as relates to their impact on safe weight loss. For many people, weaning themselves off these breakthrough drugs is less clear, a ThedaCare obesity medicine expert said.

GLP-1s were designed to help manage blood sugar and glucose levels in people with type 2 diabetes. Later, they were also discovered to slow digestion and suppress appetite. This may help people eat less which helps treat obesity.

“Cost often drives people to ask about stopping GLP-1s, not necessarily because their disease is cured,” said Dr. Benjamin Duffy, an obesity medicine specialist and director of the ThedaCare Weight Wellness Solutions program. “In such instances, it is important to work with a health care provider to create a tapering plan to help minimize side effects and manage the return of a person’s appetite.”

Dr. Benjamin Duffy

ThedaCare Weight Wellness Solutions offers the support of a whole team, including an obesity medicine specialist. This physician may help determine if a GLP-1 is a good option for a person, how long they should use it and what support and treatments or medications they may need after stopping the drug.

Potential for Regain

“In Wisconsin, the average amount of time a person takes GLP-1s is seven months,” Dr. Duffy said. “After that, they often discontinue the drug or switch to a lower, maintenance dose.”

Early studies suggest that some patients may hold their weight loss for a time after stopping the medication but many likely will experience weight gain. That’s because obesity is not a temporary problem. It’s a chronic, lifelong disease, Dr. Duffy said.

“Like blood pressure or cholesterol disorders, most patients likely will need some form of ongoing treatment,” he added. “That might mean staying on GLP-1s long-term or transitioning to another medication strategy. Trying to stop these medications too soon or for the wrong reasons isn’t ideal.”

In a monitored setting, people on GLP-1s may lose 1 to 2 pounds per week, Dr. Duffy said. If weight loss is too rapid at the start, it may cause unpleasant side effects including but not limited to hair loss, saggy skin and loss of muscle mass.

If a person abruptly stops GLP-1s, they may regain between 50% and 80% of the weight they lost. This is because the medication suppresses the appetite and metabolism. A sudden halt causes a spike in appetite while metabolism lags behind – a perfect storm that may cause rebound weight gain, Dr. Duffy explained.

That’s why Dr. Duffy and his team encourage a measured approach.

“We help people taper off their treatment dose over about two months so that as their appetite slowly increases so does their metabolism,” he said. “We can use oral medications to help suppress appetite during this phase, too, and it’s proven to be very successful.”

Tapering GLP-1 Use

Allie Hatley, a health coach with the ThedaCare Weight Wellness Solutions team, ramps up her support for patients as they begin to wean off GLP-1s.

“We want these changes to feel realistic and sustainable, not overwhelming,” she said. “A person should feel supported and not alone.”

Starting with weekly or bi-weekly meetings, people may work with a health coach to learn about:

• Victories beyond the scale, including recognizing the health benefits that come from weight loss and how feeling better can help people live more fulfilling lives.
• Embracing an active lifestyle, both exercise and beyond. All kinds of movement have merit. These can include completing home chores, running errands and having energy to pursue hobbies.
• How to handle out-of-the-ordinary situations or other high-risk circumstances, like going on vacation, dining out or holiday celebrations.
• Challenging negative thought patterns that people have been conditioned to believe.

Bottom Line

“GLP-1s can be life-changing but they are not a cure,” Dr. Duffy said. “Obesity is a lifelong disease and most patients will need ongoing treatment. That could be continuing a GLP-1, transitioning to another medication or leaning on a full care team. The key is staying connected to expert support and recognizing that health is a journey, not a finish line.”

There’s no universal experience for people who come off a GLP-1. Setbacks and weight regain are common.

“There can be flare-ups, like injuries that prevent exercise or new prescriptions that cause weight gain,” he said. “Our team is here if we need to intervene.”

Hatley said setbacks should not cause guilt or shame.

 “Let’s shift into curiosity mode and treat it as a slip-up, not a defeat,” she said. “I always say, if you have a flat tire, you fix the tire. You don’t slash the other three. Let’s make that fix and keep going.”

 Dr. Duffy encouraged people needing help with their weight loss journey to start with their primary care physician or contact the Bariatrics team at ThedaCare for weight loss solutions.

About ThedaCare

For more than 115 years, ThedaCare® has been improving the health and well-being of the communities it serves in northeast and central Wisconsin. The organization delivers care to more than 650,000 residents in 17 counties, and employs approximately 7,000 providers and team members at 180 points of care, including nine hospitals. As an organization committed to being a leader in Population Health, team members are dedicated to empowering people to live their unique, best lives. ThedaCare is a not-for-profit health system with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs, as well as primary care. ThedaCare also partners with communities to understand needs, find solutions together, and encourage health awareness and action. ThedaCare is part of Froedtert ThedaCare Health, Wisconsin’s most comprehensive health care system.