“It’s like a switch is flipped and you instantly start feeling hungry.”
Tanya Hall has tried several times to stop taking weight loss medications. But every time she stops the injections, the uncontrollable craving for food returns. Big and strong.
Weight loss injections, or GLP-1, have done for many what diets never could. This constant buzzing, which encouraged them to eat even when they were full, was turned off.
Medication has given those who never thought they could lose weight a new body shape, a new perspective, and in many cases, a completely different life.
But you can’t keep taking them forever, can you? Or can you? Well, that’s one of the questions that still needs to be answered, and no one knows the answer for sure.
Known by brand names such as Ozempic, Wegovy and Mounjaro, these drugs are new and the potential side effects of their long-term use are just beginning to emerge.
The injectable pens mimic a hormone released after eating, called GLP-1, which helps control appetite and prolongs the feeling of fullness. Mounjaro (tizerpatide) also acts on another hormone, GIP.
In Brazil, a pen containing 4 doses of 2.5 mg of Mounjaro, the lowest dose, is on sale in pharmacies for around R$1,400. In other words, continuing treatment for a long time is not cheap. So what happens when you try to quit?
Two British women, with very different stories, but with the same goal – to lose weight and get fit – told the BBC about their experience.
“It was like something opened up in my mind and said, ‘Eat everything, go ahead, you deserve it because you haven’t eaten anything in a long time’.”
Tanya, a sales manager at a large fitness company, started taking Wegovy (semaglutide, the same active ingredient in Ozempic) to prove her point. She was overweight, felt like an “imposter” and felt her opinion was not valued in her industry because of her size.
Would she be taken more seriously if she were thinner?
Ultimately, she says her suspicions turned out to be correct. After she started using the injections, people came up to her and congratulated her on her weight loss. She felt like she was being treated with more respect.
However, during the first months of treatment, Tanya had trouble sleeping, felt sick all the time, had headaches and even started losing her hair. The symptoms may not be directly caused by the medication, but they are among the possible side effects of rapid weight loss.
“My hair was falling out in clumps,” she remembers. But in terms of weight, she was getting the expected results. “I had lost about 50 pounds.”
Now, over 18 months later, what started as an experiment of sorts has turned into a complete life change. She lost 80 pounds and tried to stop taking Wegovy several times.
But with each attempt, after a few days, she says she eats so much she’s “completely horrified.”
Should she continue her treatment and live with all the side effects that come with it, or venture into the unknown?
Wegovy’s manufacturer, Novo Nordisk, says treatment decisions should be made in collaboration with a healthcare professional and “side effects should be considered as part of this process.”
Stopping weight-loss medications can be like “jumping off a cliff,” notes GP Hussain Al-Zubaidi.
“Often I see patients who stop treatment when they have reached the maximum dose because they have reached their goal and they simply stop.”
According to Dr Al-Zubaidi, the effect can be similar to that of an “avalanche or tsunami”. The desire to eat returns the next day.
He said the data available to date suggests that within one to three years after stopping treatment, people regain a “significant proportion of the weight lost.”
“Somewhere between 60% and 80% of the weight lost comes back.”
Ellen Ogley is determined not to let that happen. She decided to start taking weight loss medication because she had reached a “pivotal moment” in her life. She was so overweight that she had to sign a waiver saying she might not survive life-saving surgery.
Starting at Mounjaro was her “last chance to get it right,” she says. “I ate compulsively for emotional reasons,” he says.
“If I was happy, I ate compulsively. If I was sad, I ate compulsively. It didn’t matter, I didn’t have a filter.”
But when she started using the injections, “all that went away.”
Life without “food noise” gave Ellen the space to rethink her relationship with food. She began researching nutrition and creating a healthy diet that would help nourish her body.
She took the drug for 16 weeks before starting to gradually reduce the dose, gradually over six weeks. She lost 22 kg.
As she lost weight, she found she was able to exercise more, and when she felt “down”, instead of “going to the cupboard and binging”, she would go for a run.
But when Ellen stopped taking Mounjaro, she started seeing her weight increase, which she said “made me a little confused.”
This is why adequate support is crucial, says Dr Al-Zubaidi. The UK medicines regulator, NICE, has recommended that patients receive at least a year of ongoing advice and personalized action plans after stopping treatment, helping them to make practical changes in their lives so they can maintain their weight and, above all, stay healthy.
But for those who pay for their medication privately, like Tanya and Ellen, this type of support is not always guaranteed.
Over the past few months, Tanya’s weight has remained the same and she feels like the medications are having little effect. But she won’t stop taking it, she said.
She’s finally reached a weight she’s comfortable with, and every time she tries to stop, the fear of quickly gaining the weight back becomes too great and she finds a reason to go back on her medication.
“For the first 38 years of my life, I was overweight. Today, I’m 80 pounds lighter,” says Tanya.
“So there’s a part of me that feels like there’s an addiction that’s keeping me alive because it makes me feel the way I feel, makes me feel in control.”
She stops for a second. Maybe it’s the opposite, he thinks, maybe it’s the drugs controlling him.
“It all comes down to an exit strategy,” says Dr Al-Zubaidi. “The question is: What are the experiences of these people after they stop using the vaccine?”
He fears that without additional support for people transitioning, society’s unhealthy relationship with food means little will change.
“The environment people live in should promote health, not weight gain.”
“Obesity is not GLP-1 deficiency,” he says.
In a way, many people engage in a sort of weight loss Russian roulette when it comes to stopping the use of weight loss medications.
Factors such as lifestyle, support, mindset and timing influence how the post-GLP-1 future unfolds.
Tanya continues to take her medication and is fully aware of the pros and cons of this decision.
Ellen believes that this chapter is now closed. She has already lost more than 51 kg.
“I want people to know that life after Mounjaro can also be sustainable,” she says.
Eli Lilly, the company that makes Mounjaro, says “patient safety is Lilly’s top priority” and that it “actively engages” in monitoring, evaluating and disseminating information to regulators and prescribers.
This report was originally published here.
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