How much weight gain can be expected by stopping Zepbound?

The latest research finds that individuals who discontinue the use of Zepbound (tirzepatide) might regain most of the weight they initially lost on the medication.

Recent studies released in JAMA suggest that there might be concerns over who should use Zepbound and whether some patients might need to use the drug indefinitely to see positive effects.

Eli Lilly and Company, the makers of Zepbound, sponsored the research.

Louis Aronne, MD, an endocrinologist from the Weill Cornell Medicine and a contributing author to the study, noted that major outputs from the study indicate the need for long-term treatment given that obesity is a chronic ailment.

According to the study, doctors ought to view obesity as a condition that needs ongoing monitoring and maintenance throughout an individual’s life, replicating the treatment pattern for any other chronic metabolic ailment, as explained by Aronne.

The current research appears to indicate that discontinuing Zepbound might lead to some people gaining weight. However, Zepbound, part of the glucagon-like peptide-1 (GLP-1) agonists medication class, might be a life-altering choice for some obese individuals unable to lose weight through behavioral alterations, stated W. Scott Butsch, MD, MSc, the Bariatric and Metabolic Institute of Cleveland Clinic's Director of Obesity Medicine.

Butsch argued that for the correct patient, these medications could immensely transform their lives.

Apart from enhancing an individual’s quality of life, these medications could also better some health markers like their cholesterol and blood pressure measurements, said Butsch.

Discussion on who is best suited for Zepbound, how it could benefit obese individuals, and what both doctors and patients should deliberate on before deciding to use the medication are presented.

Zepbound, another common name for tirzepatide, was authorized as a weight loss drug by the Food and Drug Administration (FDA) recently.

In a 2022 phase 3 clinical trial, the drug revealed promising potential, demonstrating that it could aid people in losing 20% of their body fat over a span of 72 weeks.

The researchers wished to scrutinize how patients fared after they stopped using Zepbound, explained Aronne.

The research concentrated on whether the condition recurred and if it did, over what duration, stated Aronne.

Aronne’s team went through data from 670 trial participants, a majority being white females, who took Zepbound for 36 weeks, and on average, lost 20.9% body weight. The participants, with an average age of 48, hailed from Argentina, Brazil, Taiwan, and the United States.

Upon reaching the 36-week mark, a few participants were given a placebo, while the rest continued usage of Zepbound for another year.

Those on Zepbound noticed an extra 5.5% body weight reduction, whereas those who started taking the placebo regained 14% of their weight.

Aronnes was of the belief that if the placebo group were to continue with the placebo after the year, they would probably regain more weight.

Not everyone who was administered the placebo regained a substantial amount of weight, which is noteworthy, Aronne said. Aronne stated that future research needs to understand why some participants were able to maintain significant weight loss and what could have triggered weight gain in others.

The field of obesity medicine is progressing quickly, but expert's still need to understand how new medications like tirzepatide can benefit patients the most.

According to the study’s results, patients might be inclined to try Zepbound again after discontinuation if they observe weight gain.

Next steps in research need to clarify this, suggested Aronne.

In order to qualify for Zepbound, an individual needs to have a BMI of 30 or higher, or a BMI of 27 or higher with a comorbid condition like sleep apnea, high cholesterol, hypertension, or another health problem.

There are other new medications that have been approved for weight loss, but whether Zepbound is prescribed often depends on if a person’s insurance will cover it.

Prior to starting Zepbound, Aronne highlighted that one must acknowledge the possible side effects of the weekly injections.

He explained that there could certainly be side effects including gastrointestinal issues, irritation at the injection site, and potential risks such as thyroid cancer.

But, overall, experts haven’t found Zepbound—and the other obesity medications that have come out in recent years—to be unsafe.

“Medicines in these categories have been around for 18 years, since 2005, and as time has gone on, I think we’re seeing they may be safer than we thought,” Aronne said.

Zepbound and other GLP-1 agonists haven’t been available long enough to know whether there are serious complications associated with multi-decade use. But experts say they’ve seen many success stories.

“I’ve had patients who’ve been on these drugs 15 years and have done perfectly fine,” Butsch said.

What remains to be seen, Aronne explained, is whether there are side effects to starting, stopping, and then starting the medications again.

In the meantime, if you are thinking of taking a GLP-1 agonist, it’s in your best interest to see an obesity specialist, as not all physicians know the best practices of obesity medicine, Butsch explained.

“Right now, you’re getting a lot of medical providers who may not have any training in obesity and not know how to manage patients with obesity,” he said.

This is important considering the nuance involved in prescribing GLP-1 agonists and helping people who are taking them.

“I’ve had people on [one of these medications] and I’ve weaned them off, and they’ve maintained their weight,” Butsch said. “When you’re in the care of an obesity provider like myself, who is fellowship trained in this disease, we manage patients a lot differently” than other physicians.

It’s important to talk with a healthcare provider about how long you may need to take the medication, as well as which option they think will be best for you and why that is, Butsch explained.

You should also speak with your doctor about any side effects you experience after starting the medication.