Gradual weaning off anti-obesity jabs could help avoid weight gain – study

Gradually bringing patients off anti-obesity jabs over a longer period could be effective in helping them to avoid regaining weight, a study has found.

A lower dose of the drug combined with lifestyle changes could also be effective for weight loss, according to researchers.

They claim tailoring dosages to each individual patient would be cheaper and could help tackle shortages of semaglutide, as well as minimising side-effects such as diarrhoea, nausea, vomiting and dizziness.

The research, which is being presented at the European Congress on Obesity in Venice, included 2,246 people from Denmark who were enrolled in a weight management programme through the Embla app.

The programme gives advice on diet and exercise, as well as access to clinicians and a course of semaglutide.

Semaglutide, sold under the brand names Ozempic, Wegovy and Rybelsus, works by targeting an area of the brain that regulates appetite.

Also known as GLP-1 agonists, the drug helps increase the production of insulin and was originally developed for managing type 2 diabetes.

The recommended initial dose of Ozempic and Wegovy is 0.25mg once a week for four weeks. This is gradually increased every month to a maximum of 2mg weekly for Ozempic and 2.4mg for Wegovy.

For the study, patients were initially prescribed the lowest dose, but this was only increased if they stopped making progress.

If side-effects and hunger were manageable, and patients maintained a weekly weight loss of 0.5% of their body weight, they remained on the same dose.

After 76 weeks, 185 patients were still taking part in the study, with an average weight loss of 14.9kg.

The average maximum dose of semaglutide reached in the study was 0.77mg.

Lead researcher Dr Henrik Gudbergsen, who is chief medical officer at Embla, said: “Our results show that weight loss is achievable regardless of initial BMI and the amount of semaglutide used.

“Using lower doses of semaglutide is cheaper for patients, results in fewer side-effects and helps ensure that stocks of the drug, which are still limited, go further.”

The National Institute for Health and Care Excellence (Nice) approved the use of Wegovy for weight loss on the NHS in England last year.

However, Ozempic and Rybelsus are only recommended on the NHS to help patients with diabetes manage their condition.

Some 353 patients taking part in the Embla study started using semaglutide less after reaching their target weight, gradually reducing their dose to zero over an average of nine weeks.

During this period, there was average weight loss of 2.1%.

According to Dr Gudbergsen, semaglutide is “typically stopped abruptly”, and if a patient is weaned off the drug, this happens over the course of a “couple of weeks”.

Nice recommends patients in England should stop using the drug after a maximum of two years.

Some 240 patients in the group stopped semaglutide completely. Of this group, data was available for 85 patients, who reported maintaining a stable weight after 26 weeks.

Of the 240 patients, some 46 restarted semaglutide after stopping. Average weight gain between stopping and restarting the drug was 1.3%.

Dr Gudbergsen added: “The combination of support in making lifestyle changes and tapering seems to allow patients to avoid regaining weight after coming off semaglutide.

“A patient’s appetite returns when they stop taking the drug and if they stop taking it suddenly, they may find it hard to resist their cravings.

“However, if they stop slowly, and have expanded their awareness and understanding of healthy lifestyle behaviours and eating habits, their hunger and satiety will be more manageable, making it easier for them to maintain a healthy weight.

“Meanwhile, the lower maximum dose creates a bigger need for patients to engage whole-heartedly in supportive lifestyle changes throughout the programme, which should help with losing weight and with keeping it off.”

Katharine Jenner, director of the Obesity Health Alliance, said: “This will be good news to those at highest risk who need medicine to control their weight due to many complex factors.

“Obesity is a chronic, relapsing condition with many causes that don’t just suddenly disappear when the medication stops.

“We cannot just treat people and then send them back into the conditions that made them sick.

“In addition to providing effective and equitable treatment, it is essential that we tackle the root cause of obesity, such as the flood of unhealthy food and drink that is constantly marketed and promoted to us.

“We must make it easier, cheaper and more appealing to buy healthier food and drinks, and to help people, especially children, reach and maintain a healthy weight for life.”

In August, Nice recommended a number of virtual platforms to be used by the NHS to help treat obesity.

The four programs – Liva, Oviva, Roczen and Second Nature – can be downloaded as an app or on a computer, allowing specialists to provide care online.