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Coming off Wegovy: how to keep the weight off

Exploring the complexities of sustaining weight loss post-Wegovy treatment. Uncover the impacts of modern lifestyle on obesity, genetic influences, and the role of Wegovy in weight management.

Nicholas Syhler
Nicholas Syhler
Founder, Co-CEO, Doctor, MBA
Coming off Wegovy: how to keep the weight off

The latest science tells us that it seems possible to taper off Wegovy and sustain your weight loss but it depends on how you have used the medication.

How modern life causes obesity

To start off, it's important to understand the role of our modern lifestyle in obesity. Simply put, the rise in obesity rates is largely due to how modern society shapes our behaviours, leading us to consume more calories than we burn.

These influences include:

- The aggressive promotion of ultra-processed foods that are designed to be irresistible, leading to overconsumption

- The convenience of modern transportation and sedentary work environments that make us less physically active.

- The emotional strain from constant online presence, leading some people to seek comfort foods.

Our genetics and hormones make losing weight hard

In addition, the way modern society has evolved over decades is playing tricks with our genetic makeup that has been shaped through thousands of years. 

Our bodies are genetically programmed to store body fat as a defence against periods of famine. But today, famine never happens (at least not in the Western world), which means that this effective ancient survival mechanism now works against us by making it challenging to lose weight once you’ve gained it.

In other words, it is easier to stay ‘normal weight’ than lose weight once you have gained it. 

Our feeling of fullness is controlled by hormones in the body, primarily the hunger-reducing hormone leptin. When we have gained too much weight for too long, it appears that the normal functioning of leptin is disrupted which makes it difficult to lose that weight again. This is where novel weight loss medications like Wegovy come into play.

How Wegovy works to combat obesity

Novel drugs like Wegovy have been developed to circumvent the pathways of leptin and help you feel full faster through alternative pathways. This way, they can help you achieve and sustain weight loss by countering the body's ancient response to weight gain.

Yet, the same reason they’re effective also makes them ineffective as a stand-alone treatment for obesity. They make you eat less when you’re on them, but once you stop, nothing about your body or behaviour has fundamentally changed, leading to weight regain. Instead, they are meant to support behaviour change as they do not address the root causes of obesity.

Behavioural intervention to support lifestyle change is the foundation of any treatment of obesity. It’s how we address the root causes of why an individual is living with obesity and teach them to guard against the negative impact of modern life, ultimately leading to successful weight loss maintenance. 

Why semaglutide is not a cure

Wegovy contains the active ingredient semaglutide which mimics the effect of the gut hormone GLP-1 found naturally in the body. In high concentrations, GLP-1 mimics, also called agonists, reduce your appetite by both affecting your brain and slowing the emptying of your stomach. In this way, semaglutide changes your behaviour causing you to eat less.

Yet, semaglutide is not a cure and the appetite-reducing effect stops when you stop taking the drug. 

Study: What happened when people stopped taking semaglutide (Wegovy)

In a Novo Nordisk-initiated study running for a full 120 weeks, participants were on semaglutide and received nutritional advice for the weight at 68 weeks and lost 17.3% of their initial body weight. After 68 weeks, both semaglutide and the nutritional support were discontinued and participants regained 11.6% of their body weight for a total weight loss of 5.6% after the full 120 weeks. 

It might seem pretty good to achieve a 5.6% weight loss but the problem is that when you take semaglutide you lose both muscle and fat but only regain fat when you stop.

Likely, what you regained was fat, and what you did not regain was muscle, making you less healthy from a body fat percentage point of view than before you started semaglutide treatment.

The power of (the right) nutritional support

Now you’re probably thinking, what if the nutritional advice had continued? Could participants then with the help of nutritionists have maintained their weight loss? 

Here the picture starts to get muddy. 

One study also initiated by Novo Nordisk showed a similar weight regained when Semaglutide treatment was stopped after 20 weeks but nutritional support continued. 

However, A recent study from Virta Health Corp, a healthcare provider in the US, showed that carbohydrate-restricted nutrition therapy (CRNT) helped participants maintain their weight loss for a full year after stopping semaglutide. 

The results from Virta Health Corp match what we see here at Embla.

Members have tapered off semaglutide and maintained their weight loss for more than a year. We look forward to soon publishing our research to further enlighten what is now a muddy picture.

Embla’s holistic approach to sustained weight loss

The conflicting results lead us to the next question, what are the differences in the nutritional programs? Can we determine what is working? It is not possible to determine the detailed nature and difference of the two programs based on the data that is publicly available. However, all nutritional support and other behavioural intervention programs cannot just be classified under the same umbrella of ‘nutritional support’. 

Our experience at Embla tells us that a holistic program works the best. 

We believe the reason is that obesity is a complex condition with multiple and individual root causes. Some have lifestyle habits in the family where ultra-processed meals, like many fast foods, are the norm. Others have trouble with emotional eating and use food to cope with emotions, which may be caused by an emotional trauma in the past. Often, one cause is bundled with another, such as emotional eating being coupled with a lack of physical activity. 

Here, it's important to address the psychological reasons for emotional eating while building habits that increase your level of physical activity. Hence, a holistic approach is best because it can address the likely multiple root causes of why you are living with obesity.

The key to avoiding weight regain post-Wegovy

The question of whether you can maintain your weight loss after stopping Wegovy should now be clearer. The answer is yes, if you've addressed the underlying causes of your obesity. However, if you've relied solely on the medication without tackling these root issues, maintaining weight loss becomes challenging.

At Embla, our experience suggests that gradually tapering off Wegovy is key. By slowly tapering off, it’s easier to maintain healthier eating habits and behaviours. Whereas tapering off too quickly might make the return to your original body state too overwhelming. By following a gradual approach, you and your Embla health mentor have the opportunity to identify and address any unresolved issues before any weight is regained.

In conclusion, there is no quick fix when you are trying to overcome obesity, but combining various strategies can set you on a path to sustained weight control.

In this article
Nicholas Syhler
Nicholas Syhler
Founder, Co-CEO, Doctor, MBA

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