Consideration: There is no "stopping" these meds.

[littledragon25]

I'll be titrating down over the course of a couple of months until I can come off completely. I'll be continuing my habit of daily weigh ins, daily cardio, and weightlifting 4-5 days per week. I was doing all of this before going on Reta, and I was losing weight fine without it, but I've had essentially zero cravings while on Reta. It has definitely been easier to lose these last few pounds than it would have been without.

If I gain a bit of weight back, I'm fine with that. I want to try to put on some muscle over the winter anyway, and with my current level of hunger being basically zero that would be impossible. If I need to go back on Reta in the spring to lean out again, I'm fine with that.

See, this is where I think there is a difference in the 2 types of people taking GLP1s. There are the people who sound like they were fit and healthy before and just used it to get really shredded (which you sound like you fit here, as you have lots of healthy lifestyle habits anyway which you were able to stick to without the reta) and the people who were obese and struggled with controlling their intake before the meds.

Group 1 will be able to stop the meds. Group 2 will struggle if they do.

 

[lessthanhalf]

I think it depends a bit on why you are taking it, if you are 5 to 10 kilos overweight or don't have a long term problem with obesity, then maintaining a good diet might work, without having to stay on glp's long term. Exercise is definitely good for you but there is not a lot of evidence it makes much difference to weight. It also would depend on how old you are and if you have other health problems. Any of hypertension, diabetes, pre diabetes, high cholesterol, heart disease, kidney disease, arthritis etc are good reasons to stay on it because they improve long term outcomes.
Assuming you have severe obesity or a lifelong problem, there is zero doubt that staying on them long term is a good idea. Losing weight is not the hard part, keeping it off is. In all the research I have read, with the exception of bariatric surgery 90 to 95% of people who lose significant amounts of weight through diet and exercise, put all or most of it back on over the next few years, even with expert help from multidisciplinary teams. And if you lose weight with glp's and then stop them the research says the same. Nearly everyone will gradually put the weight back on. Unfortunately self control is not an infinite resource, if you are having to consciously control how much you are eating with mental effort, it wears out eventually in nearly everyone no matter how much you don't want it to. There are not yet any very long term studies on glp's, I think 60 months is the longest , but they all show that if you stay on the dose that worked, then the weight loss is maintained.
A lot of people on here think that maintenance can be done with lower doses than were used to lose the weight, and that may apply if the weight loss was not massive or was still falling at a decent rate when you got to your target weight, but otherwise the maintenance dose is likely to be the dose that got you there. All the research on weight loss maintenance with glp's is at the final dose not at lower doses. The biggest problem with them for a lot of people like me, who are or were very overweight, is they are not quite effective enough yet, the best result being low 20% range from reta, and a lot of people want to lose more than that resulting in the experiments with multiple glps or other peptides. The drug companies seem to be looking into this as well, quite intensively, from what I have read, but apart from cagrisema, and a few early phase 1 and 2 trials, there are no results yet. But even 20% loss if you are 30 or 40 % overweight is still enough to make a huge difference to long term health consequences. And staying on glp's reduces the risks of most of the most common and serious health problems - cancers, heart disease, probably dementia and lots of others.

 

[desinr-gal]

Oh no, though anyone whose situation is more complicated than mine is welcome to. My stuff (minus the grey part) is right out there on FB. I don't talk to judgy people, and I'm over the moon to get what feels like proof that it was never a moral failing and now it's over. I want EVERYONE to know.



I'm starting to suspect the answer might be "money." Like, they've accepted that this means five hundred dollars a month (so many of them don't even know about compound), and know that's just not doable for a decade or more until generic comes. Or they're still in "being fat is a moral failing and after I'm a thin person, I'll be able to act right and eat less" thoughts. Either way, it's likely to hurt their hearts so much when they go off and say "all done" and I wish whoever's job it was to make that clear to people was working harder to make that understood.

Yes Money! If it were available and covered by insurance like my Levothyroxine, no one would be stopping. IMHO It is cruel and so greedy of EL to charge what they do.

 

[brownb56]

For me the only real alternative I saw was having a doc slice up and rearrange my guts. And dealing with the lifelong consequences with that and no guarantee of long term success.

I've struggled all my life and needed some kind of help. Watched a bunch of my family go through gastric by-pass. Know quite a few others. And only very few of them were successful. And dealt with issues such as vitamin deficiency. Getting to be standard now that people are put on glp meds a year or two after by-pass to help them maintain weight.

People are on all kinds of other meds for the rest of their lives. I see no reason this should be looked at differently. I'd rather be on a glp that I take once a week. Rather than blood pressure, diabetes or pain meds that are taken daily.

 

[psycho_driver]

A couple of factors here.

When a person puts on weight their fat cells inflate with stored energy up to a point, then when they get to a certain size they're like "Oy! Enough of that!" and they split into two half-full fat cells. Rinse and repeat, over and over, as a person gets more overweight.

When we lose weight the fat cells do not disappear. They shrink. When they shrink they start grumbling to your brain via chemical signalling that they're starving. As we lose more weight we have more grumbling fat cells, and your brain starts to think "maybe I really am starving" and it tries to trick you into eating caloric-dense foods to re-inflate your poor starving fat cells. Thus why people generally need to titrate doses up as they lose weight to continue to achieve comparable appetite control.

Fat cells have an average lifespan of 8-10 years. If we can keep them in a starved state until the end of their lifespan they might just go away instead of the body replacing them as it would normally try to do. Therefore the need to remain on a GLP-1 might decrease over a long period of time as fat cells finally disappear.

The second factor is insulin resistance. Being overweight tends to mean you have at least some level of insulin resistance. If you're pre-diabetic or diabetic then you definitely have a good amount of insulin resistance. Insulin resistance plays all kinds of havoc on your metabolic processes. GLP-1s work magic when it comes to glucose metabolism and insulin sensitivity. If you can lose down to a healthy weight and maintain a healthy diet for a long period of time it's believed most people can reverse insulin resistance. Probably the younger and healthier you are combined with how long you can maintain a healthy balanced diet will determine how fast and far you can reverse insulin resistance. This would also be a long-term process but over time might allow for GLP-1 maintenance doses to slowly decrease.

 

[MsGizmo]

For me the only real alternative I saw was having a doc slice up and rearrange my guts. And dealing with the lifelong consequences with that and no guarantee of long term success.

I've struggled all my life and needed some kind of help. Watched a bunch of my family go through gastric by-pass. Know quite a few others. And only very few of them were successful. And dealt with issues such as vitamin deficiency. Getting to be standard now that people are put on glp meds a year or two after by-pass to help them maintain weight.

People are on all kinds of other meds for the rest of their lives. I see no reason this should be looked at differently. I'd rather be on a glp that I take once a week. Rather than blood pressure, diabetes or pain meds that are taken daily.

I've had the vertical sleeve surgery .. and that often doesn't work long term either. If only GLP1s existed back then.

 

[MsGizmo]

A couple of factors here.

When a person puts on weight their fat cells inflate with stored energy up to a point, then when they get to a certain size they're like "Oy! Enough of that!" and they split into two half-full fat cells. Rinse and repeat, over and over, as a person gets more overweight.

When we lose weight the fat cells do not disappear. They shrink. When they shrink they start grumbling to your brain via chemical signalling that they're starving. As we lose more weight we have more grumbling fat cells, and your brain starts to think "maybe I really am starving" and it tries to trick you into eating caloric-dense foods to re-inflate your poor starving fat cells. Thus why people generally need to titrate doses up as they lose weight to continue to achieve comparable appetite control.

Fat cells have an average lifespan of 8-10 years. If we can keep them in a starved state until the end of their lifespan they might just go away instead of the body replacing them as it would normally try to do. Therefore the need to remain on a GLP-1 might decrease over a long period of time as fat cells finally disappear.

The second factor is insulin resistance. Being overweight tends to mean you have at least some level of insulin resistance. If you're pre-diabetic or diabetic then you definitely have a good amount of insulin resistance. Insulin resistance plays all kinds of havoc on your metabolic processes. GLP-1s work magic when it comes to glucose metabolism and insulin sensitivity. If you can lose down to a healthy weight and maintain a healthy diet for a long period of time it's believed most people can reverse insulin resistance. Probably the younger and healthier you are combined with how long you can maintain a healthy balanced diet will determine how fast and far you can reverse insulin resistance. This would also be a long-term process but over time might allow for GLP-1 maintenance doses to slowly decrease.

Hmm ... so what I get from that is we need to have an 8 year supply tucked away in our freezers.