Abstract:
Worldwide, nearly 40% of adults are overweight and 13% can be categorized as obese. Health consequences of excess weight are well-established and include elevated risk of cardiovascular diseases, heart failure, type 2 diabetes, dyslipidemia and an overall increase in mortality. Treatment of obesity is challenging and calorie restriction often leads to rebound weight gain which may devolve into a fluctuating pattern of loss and gain. Treatments such as bariatric surgery are invasive and carry their own risks. GLP1 medications have revolutionized weight loss and can reduce body weight in obese patients with and without diabetes by between 15% and 25% on average after about 1 year. Their mode of action is to mimic the endogenous GLP1, an intestinal hormone that regulates glucose metabolism and satiety. However, GLP1 drugs carry known risks and, since their use for weight loss is recent, may carry unforeseen risks as well. These drugs carry a boxed warning for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Gastrointestinal adverse events (nausea, vomiting, diarrhea) are fairly common while pancreatitis and intestinal obstruction are more rare. There may be loss of muscle mass and premature facial aging. A tremendous disadvantage of using these medications is the high rate of weight regain when they are discontinued. The management of weight loss induced with GLP1 therapy is a critical topic, especially for the many young persons who are currently using these drugs and for whom it is inadvisable to continue indefinitely. The longer they are treated, the more adverse effects may be revealed. It is highly desirable to achieve a balance between success with pharmacologic treatment and then weaning to avoid future negative effects and this is particularly important for those who plan pregnancy. GLP1 drugs are also being applied for weight loss prior to elective surgery where obesity poses an obstacle and this group would also see health benefits if weight control can be maintained after the drug is stopped. While long-term data on effects of GLP1 drugs are scarce, lifelong use of these drugs by a generation of individuals for weight control would be an unwarranted experiment of monumental proportions with an unknown outcome. We present literature-based suggestions for building a roadmap to successful weight maintenance after completing a defined course of GLP1 therapy.
Audience take away notes:
- The risks and benefits of GLP1 treatment for obesity and the need to plan for discontinuation of treatment without weight regain to avoid lifelong dependence.
- Health professionals are using GLP1 medication at an increasing rate to bring about weight loss in persons who will face health consequences from the drug that will worsen with longevity of treatment. There is a pressing need for individualized planning to stop the drug and avoid rebound weight gain.
- The contents of this talk will be useful to physician-educators who are responsible for overseeing weight loss programs.
- The suggestions for managing discontinuation of GLP1 drug treatment with weight maintenance are practical, clinically relevant and can be implemented in the office setting.
- The guidance here can assist in designing individualized plans for patients.
