Zepbound is one of many new medications that people are using successfully to lose weight. But shortages have people strategizing to maintain their weight loss when they can’t get the drug.
Shelby Knowles/Bloomberg via Getty Images
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Shelby Knowles/Bloomberg via Getty Images
Over the past few decades, Jonathan Meyers has endured multiple cycles of gaining, losing, and regaining weight after trying a high-protein, low-fat, calorie-restrictive keto diet. “I’ve had my ups and downs, but I always gain weight back,” says Meyers, a digital strategist at an environmental nonprofit.
But with Zepbound — the latest GLP-1 agonist drug launched — Meyers has lost 35 pounds and loves feeling free from hunger. Without what he calls “food noise” – the gnawing urge to eat – he consumes less and moves more.
But the medicine is rare and very difficult to find. Meyers even asked his family in Maine to ship him medicine in cold containers to Kensington, Maryland. Now he can’t find Zepbound anywhere and says his friends, family and people he follows on social media are all in the same boat. Some, he says, have turned to specialty pharmacies selling approximations of the drug online; others decreased their doses, stretching them out.
More and more people who have started taking the new GLP-1 agonist drugs are now facing the reality of their limitations; Medications like Wegovy and Mounjaro tend to help with lasting weight loss only while people are taking them. But due to the cost, for example negative side effects or supply shortages, many people have to give them up – while trying not to gain weight again.
For many people, like Meyers, this situation brings back familiar anxieties about past failures relying solely on diet and exercise.
Meyers says that before giving the injections, he felt that his hungry impulses always won out in the end. “That’s the most important part of all of this,” he says. Under treatment, he says he is no longer preoccupied with food and can walk past the candy bars in the grocery store without grabbing one.
But it’s not clear whether you can keep these distracting thoughts at bay in the long term without pharmacological support.
And so far, the clinical data seems to support Meyers’ suspicions. A first study showed that patients regained two-thirds of the weight lost during the first year after stopping treatment. A new analysis showed that 17% of people were able to maintain 80% of their weight loss after quitting. And while experts say lifestyle choices, like diet and physical activity, should be the cornerstone of any sustainable weight loss plan, they also recognize that these changes alone are often not enough. not for obese patients.
In other words: Chronic illnesses require chronic treatment, which is no different from kidney disease or high cholesterol. New treatments against obesity act on the different hormonal and metabolic factors of obesity.
“It would make sense that once we stop treating these biological problems, we would have a relapse,” says Dr. Eduardo Grunvald, director of the weight management program at the University of California, San Diego. He only notes exceptionally that one or two of his patients have stopped the injections and not I saw the appetite and weight return.
But these are not just blockbuster drugs: they have become a social phenomenon. And all the talk about their use on social media and in popular culture can confuse patients, says Dr. Rekha Kumar, an endocrinologist and former medical director of the American Board of Obesity Medicine. She says social media is full of posts from people claiming to use obesity medications short-term, to kick-start a diet, saying, “‘Oh, I’ll just take them for a short time and then stop.’ »
But Kumar says these drugs were intended to medical used to treat the disease of obesity, not used to aid in cosmetic weight loss. “A lot of these people we hear about don’t actually meet the strict criteria for the drug,” she says.
How a person responds to taking the drug — or stopping it — will depend on the particulars of their biology, genetics, or hormonal makeup. But for the vast majority of people, she says, biology favors recovery. “As humans, it’s evolutionary to want to store this fat and keep it.”
This potential for weight regain is a major deterrent with these medications. A survey last year by health research organization KFF found that only 14% of people remained interested in the treatment, after hearing that the weight tended to come back after stopping.
Drugmakers are already looking for longer-acting maintenance medications.
In the meantime, Kumar says that for those taking them long term, the transition from using and stopping the medications will be a reality that many patients will face, at least, due to other medical situations they are facing. might face, such as surgery or pregnancy. (To date, research on pregnant women and GLP1 drugs suggests that it is not linked to more birth defects than insulin, but the full impact of fetal exposure is not yet known (Women who have struggled with infertility report surprise pregnancies after using GLP1 drugs, and drug companies warn they could make birth control pills less effective.)
“So there will be scenarios, especially among young people, where we will have to stop taking medications whether they like it or not,” says Kumar.
What should patients faced with this situation do?
Obesity specialists recommend developing personalized plans with a doctor, for example reducing medications while increasing dietary advice.
But there are also many emotional changes to prepare for, says Dr. Natalie Muth, a pediatrician, obesity specialist and spokesperson for the American Academy of Pediatrics.
Many of his young patients who have taken this drug feel more hope, as well as increased mobility and a sense of control. So when some of his patients recently faced shortages, they also faced great anxiety. “They felt it, they missed it, they were really upset about it,” Muth says. She worked with patients and their families to refocus on behavior changes to manage their obesity as they transitioned.
Jonathan Meyers, the Maryland man researching Zepbound, has plenty of experience making the kind of drastic lifestyle changes that are necessary for him to lose weight without drugs. This requires diligently tracking every bite, scanning everything he eats in a mobile app and limiting himself to about 1,000 calories per day, just enough to leave him “absolutely hungry all the time.”
Instead, Meyers chose last month to purchase the similar drugs sold by a compounding pharmacy in Florida. He did so with his doctor’s careful blessing and despite various unknowns – like what exactly the drug contained, or how he might react to it.
After two weeks of replacement, the results are mixed, he said. He feels dyspeptic, but also hungrier. “It’s kind of like, ‘Oh, I want a little more,’ and it’s a little hard to push the plate away.”
There are plenty of other uncertainties, too — about supply shortages, fluctuating costs and their long-term effects — but he says even those hassles are worth it. “For me, if I have gastrointestinal issues for the rest of my life, but I don’t have a heart attack or I don’t have all the other things associated with obesity, I’m fine. “
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