Obesity is an incredibly common yet complex disease. As a chronic condition, it is linked to several issues such as high blood pressure, type 2 diabetes, cardiovascular disease, and high cholesterol. Obesity can also cause a slew of other health complications, resulting in a total of five million deaths globally in 2019.
The mainstay of obesity treatment involves implementing a healthy, low calorie diet in conjunction with routine exercise. Additionally, several pharmacologic options are available for those wishing to take a more intensive therapeutic approach. These medications are incredibly effective in reducing body weight; however, they must be used appropriately to lose an maintain healthy weight. This article will discuss the potential for weight rebound and how to mitigate this risk via pharmacologic and lifestyle strategies.
In obese individuals, treatment with medication may be necessary in addition to lifestyle changes. Several weight loss drugs are on the market, including glucagon-like peptide-1 (GLP-1) analogues. Other medications for comorbid conditions can also induce weight loss such as Majorna, a recently approved drug for type II diabetes. Long-term pharmacologic management is often required to maintain a healthy weight, as stopping medication often caused rebound weight gain despite lifestyle intervention.
Semaglutide, also referred to as Ozempic and Wegovy, is an FDA approved GLP-1 analogue that assists with chronic weight management in addition to lifestyle changes. Though semaglutide is safe and efficacious for managing weight, discontinuation is associated with weight regain. One observational study examined the extent of this effect in obese individuals previously on semaglutide once weekly given subcutaneously. One year after discontinuation of semaglutide, individuals had gained two-thirds of their previous weight loss. Additionally, cardiometabolic parameters demonstrated similar effects1. In a similar study, individuals who remained on semaglutide after the initial 20-week period continued to lose weight thereafter, dropping another 7.9 percent of their body weight. Those that switched back to placebo saw the reverse occur, gaining around 6.9 percent of their body weight back2.
Results from these studies indicate that individuals are at risk of weight regain after discontinuing their weight loss medication. Obesity is a chronic disease, and therefore, long-term treatment is needed to maintain a healthy weight and health. Moreover, patients may see additional weight loss if they remain on the medication for a longer period of time.
As the previous studies demonstrated, maintaining a healthy weight after a dramatic weight loss is fairly difficult. The good news is that 20 percent of people who try to lose weight are able to both lose and maintain a 5 percent decrease in their weight for at least a year. To best uphold one’s progress, continued intervention is required through pharmacologic-, exercise-, and diet-based treatment. There are several behavioral strategies that can assist in achieving continued weight loss3.
Programs that restrict daily calories typically include a reduction of 300 to 500 kcal per day. Additionally, fat calories usually account for less than 30 percent of one’s daily calories in these programs. With this diet, individuals are expected to lose up to one pound weekly and have a five percent reduction in weight after six months. At year three, weight reduction is expected to be three percent3.
Diet changes alone are more effective that exercise changes alone. However, combining both exercise and diet programs together is the most efficacious. One analysis evaluated the weight loss outcomes of 17 studies in which participants enrolled in a diet and exercise program. At four years, participants lost an average of four percent of their body weight3.
Unlike diet restriction, low-calorie diets (LCDs) limit daily calories to between 800 to 1600 calories daily. Typical weight loss is 9.7 percent of original weight at six months and 5 percent at one to two years3.
Meal replacement (MR) programs are similar to LCDs. The difference is that MR programs eliminate the need for individuals to count calories and portion control themselves. Two studies indicated that MR programs had more sustained weight loss maintenance than LCDs at one year3.
Very-low calorie diets (VLCDs) are much more intensive than LCDs, with a daily caloric intake of 400 to 800 calories per day. Because of their intensity, individuals must undergo them under the supervision of a doctor. Though VLCDs incur a significant weight reduction, studies show that weight maintenance ends up being the same as LCDs after two years3.
Behavioral therapy can be very beneficial for treating obesity in combination with diet and exercise regimens. This method focuses on the psychological aspect of weight gain, incorporating strategies related to stimulus control, nutrition counseling, exercise, and diet. Behavioral therapy programs are typically four to six months in duration. After 18 months, individuals maintained a weight reduction of eight percent. After two to four years, weight loss was around 3.8 and 1.8 kilograms (kg), respectively3.
Commercial weight loss programs such as Weight Watchers can assist in losing significant amounts of weight. Weight loss was sustained for participants in one trial at three percent at two years3.
As previously mentioned, medication can be an advantageous component to a weight loss journey. When choosing to continue weight loss medication, individuals on pharmacologic therapy were able to maintain their weight reductions at 7 to 11 percent for up to three years. As aforementioned, however, stopping therapy is associated with weight regain3.
With over 72 million adults suffering from obesity in the United States, obesity represents a prevalent public health issue. It has long-term implications to one’s overall health as it is associated with other conditions such as diabetes, high blood pressure, high cholesterol, and infertility. Solutions such as weight loss medication can result in significant weight reductions in obesity. However, weight regain is a major concern with therapy discontinuation. Literature describes several behavioral strategies aimed at preventing weight regain, including diet, exercise, behavioral therapy, low calorie diets, meal replacement programs, and medication. In general, these methods yield a weight reduction between eight and ten percent at six months. The sustained effects of such programs are mixed3.
