In 2023, I wrote for STAT about GLP-1 shortages leading to treatment delays, interruptions, and difficult decisions about who “deserved” to get these precious medications. I struggled in particular with the ethical dilemma of robbing Peter to pay Paul: prescribing GLP-1s that are specifically approved for type 2 diabetes to people without diabetes for weight loss.
Today, my most troubling clinical dilemma is ironically due to excess GLP-1s: I’m trying to slow down runaway trains, and even spot them before they leave the station. By this I mean people who seek to reach an unhealthy and likely unsustainable body weight.
Everyone eventually reaches a weight loss plateau at the maximum tolerated dose of GLP-1 treatment. And I have had very few people tell me that the plateau weight is their Goldilocks weight. It’s not uncommon for people to become so fixated on seeing a certain number on the scale that they lose sight of having made tremendous improvements in their overall health. Almost everyone wants more weight loss, and I am learning in real time how to best support patients who have reached a weight loss plateau at a weight that is higher than they hoped at the start of treatment. I feel like I’m asking someone who trained for a marathon to feel satisfied after completing 10 kilometers.
The whole point of the drug is it increases how fast and long you feel full, the moment you stop taking it that’s going to come back again. It doesn’t somehow permanently alter you. If it did, you wouldn’t have to take it every week.
I don’t see how people are confused about this. If you were overeating before, you’re likely going to go back to exactly the same pattern.
Yeah, it’s not a miracle drug, but it does allow you to diet on easy mode. What you’re supposed to do while on the drug is switching to healthier food and healthier eating habits. The drug should make that easier as it should remove the cravings that you’d normally get from switching to less calorie dense meals, and if you’re eventually used to healthier meals then it should be easier to keep that up once you’re off the drug.
But you do have to actively build those healthier eating habits while on the drug to get that lasting effect. It offers an easier way to switch to a healthier lifestyle, but if you don’t actually make that switch then the effect will indeed just wear off immediately once you stop taking the drug.