Weight regain four times faster after GLP-1s than diet and exercise programmes

Weight regain after stopping GLP-1 medications is four times faster than after diet and exercise programmes, research suggests.

An analysis of pooled trial data by a team at Oxford University found an average rate of weight regain is 0.4kg/month after stopping treatment with drugs like semaglutide and tirzepatide.

Individuals were projected to return to their pre-treatment weight by 1.7 years and have reversed improvements in cardiometabolic risk markers within 1.4 years of stopping the drugs.

Monthly weight regain after weight loss drugs was 0.3kg faster than after behavioural weight management programmes regardless of initial weight loss, the team reported in the BMJ. 

It is estimated that around half of people with obesity discontinue GLP-1 drugs within 12 months, they noted.

The latest analysis was based on 37 studies of more than 9,000 participants. It is not the first time researchers have flagged the issue of a reversal in weight gain and health benefits once the jabs are stopped.

In December researchers reported a re-analysis of the Surmount-4 clinical trial of tirzepatide which showed that regaining weight after stopping the medication was associated with a reversal in cardiovascular benefits.

It suggests that ‘despite their success in achieving initial weight loss, these drugs alone may not be sufficient for long term weight control,’ they concluded.

‘This evidence cautions against short term use of weight management medications, emphasises the need for further research into cost effective strategies for long term weight control, and reinforces the importance of primary prevention.’

A recent analysis suggested that one in ten British adults were either taking weight loss drugs or had plans to do so in the near future.

Professor Tricia Tan, professor of metabolic medicine, diabetes and Endocrinology, Imperial College London pointed out that although the paper found weight regain after weight loss medication was faster than after behavioural weight management programmes, those programmes do not in the first instance seem to cause enough weight loss to materially improve cardiovascular disease.

‘To ensure that we get maximum value for money for the NHS, the Department of Health should ensure that these treatments are rolled out cohesively and in a long-term plan, ensuring that that there is equity of access across the UK. 

‘The current situation, where access is restricted to people who can only afford treatment privately, is clearly inequitable.’

She added that obesity management, as a whole, must be managed as a national long-term strategy integrating GLP-1 drugs, associated lifestyle therapies and the option of weight loss surgery.

Professor John Wilding, professor of medicine in the Department of Cardiovascular and Metabolic Medicine at the University of Liverpool said the results were not surprising and highlighted that obesity was a chronic condition.

He noted that study populations of those taking weight loss drugs and following other programmes were not necessarily comparable but lifestyle support should always be used alongside medication.

‘We should consider these as long-term treatments, not as a quick fix.’