Dr. Hwang said that physicians often try other therapies to help control blood sugar in patients with diabetes, like metformin or insulin. But starting and stopping drugs can be disorienting for patients and doctors as they cobble together a plan, she said.
Cravings come back
Semaglutide mimics a hormone called glucagon-like peptide-1, which we produce in our intestines and which signals to our bodies that we are full. The medicine affects the brain by blunting hunger signals and making people feel indifferent to, or even actively repulsed by, food. “They’re not ruminating about it all the time,” Dr. Kraftson said. “They just have this low-drama relationship with food.” For some, that’s “very liberating,” Dr. Kraftson said, but when a patient stops taking the drug, those cognitive effects can dissolve quickly. Some patients, he said, become more hungry after forgetting to take just one dose of the medication. “People will say they feel cravings come back,” Dr. Hwang said. After weeks or months without Ozempic or Wegovy, many will gain weight.
A trial published in the spring and funded by Novo Nordisk, the company that manufactures Ozempic and Wegovy, examined people who had taken semaglutide once a week for 68 weeks and then stopped using it. After a year, participants gained back two thirds of the weight they had lost.
Doctors say that, anecdotally, they’ve seen this kind of rebound in patients, too. Dr. Kraftson said, “I’ve seen people and they’ve lost maybe 50 pounds, and then they’re off of it for a month and then I see them back in clinic and they’ve gained 20 pounds.”
Side effects subside
In some cases, when people stop taking the medication, they realize that they had been experiencing side effects while on semaglutide, Dr. Kraftson said, like mild headaches or upset stomachs. For those with side effects, ending the medication can be a relief. Lee Levin, 67, who started Ozempic to help manage Type 2 diabetes, had such intense nausea that she once went to the emergency room. When she stopped the medication, she said, that near-constant queasiness went away “almost immediately.”
Those who return to a full dose rather than ramping up their intake gradually may experience more severe side effects at first, Dr. Kraftson said, including vomiting and diarrhea. Dr. Kraftson also warned that patients might not follow all the guidelines from when they first started taking the medications, like chewing slowly and avoiding heavy foods so that they don’t feel so full that they become sick. For those who slowly work up to their original dose, it may take even longer to lose weight, adding another hurdle to an exhausting cycle of medication.
“It’s been a whirlwind for our patients, and not in a good way,” Dr. Hwang said.
