Stopping GLP-1s? It's so hard!

Compound

Compound

Well-known member
I'm seeing a disturbing trend: patients who *refuse* to discontinue their GLP-1s.

https://www.statnews.com

An endocrinologist describes the issue:

Some patients are begging to stay on the drugs longer than medically advisable, creating an ethical grey area.

He categorizes patients:

* Most lose 10-20% and maintain it on treatment.
* 5% don't respond or can't tolerate it.
* 5% are "super responders" losing upwards of 25%.

He struggles with patients who want *more* loss, or who have lost *too much*, and resist stopping or lowering the dose, even with unhealthy eating behaviors, muscle loss, or strained relationships.

He uses metrics like cholesterol, blood pressure, and reported diet/exercise to guide decisions, avoiding numeric weight loss goals from the start. It's a tough situation.
 
Man, I wish I had that 'super responder' problem! I'm down about 33% and still technically overweight according to BMI. I'm 5'6" and around 215 pounds. I'm trying to get to 190, but I've been stuck for months. I'm doubling up on sema and reta hoping to break through.
 
I see this article as a doctor trying to navigate uncharted territory without much solid research to guide post-weight loss treatment. He's probably influenced by older weight loss paradigms where a small, maintainable loss was considered a win.

Now, much better outcomes are achievable. But that said, using these meds without professional guidance carries risks, and people end up hospitalized from dosing errors. Still, I think he draws the line between patient choice and medical paternalism too far on the paternalism side.

Long-term, the health benefits for the severely obese, diabetics, and those with heart issues are clear. Higher doses often correlate with better outcomes, so stopping or reducing doses might be counterproductive. And of course, stopping will likely cause weight regain.

Ultimately, the person themselves is the best judge of their quality of life, with exceptions for severe eating disorders. Many doctors are biased against the severely obese and lack a full understanding of their experiences. He might be erring on the side of excessive caution.

Before GLP-1s, significant long-term weight loss was rare and required obsessive lifestyle changes. Yet, he considers social eating interference a red flag. Maintaining major weight loss requires control, which can clash with social eating norms.

His approach might drive people to unregulated markets for cheaper meds. The demand for weight loss solutions is huge, and black markets were inevitable. While regulated options should become more affordable over time, this paternalistic attitude pushes people toward riskier alternatives and neglect of related health issues.
 
I get both sides. I dropped 30% on Mounjaro in a year and I'm in maintenance now.

I should be lowering my dose to avoid losing more, but I'm eating more calories to compensate. It's hard to actually lower it; it's a mental block.
 
I don't see the article as paternalistic at all. I see it as a doctor adhering to the Hippocratic Oath. He is wrestling with how to support these meds while acknowledging the risks of body dysmorphia and disordered eating.

People are experiencing transformations they never thought possible, and it's easy to overuse a good thing.
 
Congrats to ShedSquad for maintaining a 30% loss! I'm aiming for that. Maybe I should stay on the same dose through the holidays like someone on Reddit suggested. I'm worried about overdoing it during Thanksgiving and Christmas. Then I could think about tapering down in January.
 
It's vital to transition patients off GLP-1s carefully, particularly those with a history of disordered eating. We need to monitor body composition, not just weight, and address any psychological issues that may arise. Muscle loss is a real concern.
 
I hear you HeartCake, but what if the muscle loss isn't excessive? I feel much better at a lower weight, even if I'm not as strong as I used to be. I can always build muscle back.
 
Good point, Jules89. It's about balancing risks and benefits. Quality of life certainly matters. But some patients develop unrealistic expectations and chase a number on the scale at the expense of their overall health. It's a tough conversation to have.
 
I saw someone on Reddit say they lost 130 pounds mostly thanks to Mounjaro!! That's amazing. I'm T2D and insulin resistant, so I understand how hard it is to lose weight. I hope I can get close to that!
 
Been on 50 units sema for about 20 months. Hit my goal weight after a year and kept the full dose for 8 more months with no more loss. I'm 70, 5'10", started at 260, now at 195 and holding. Still overweight by the charts so I'm surprised it's stayed so flat for months. Maintenance dose same as my loss dose, I guess. What do others think?
 
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