What does maintenance look like?

Hi {{first_name}} -

I am presenting in October at our national dietitian conference on maintenance and long-term use of GLP-1 medications, so I have been digging into the research.

Right now, the accepted narrative among healthcare professionals is that if you want to maintain your results, you just need to stay on this medication for life. After attempting to get off the meds and failing (TWICE) I have personally decided to just stay on them until there is another solution to maintain my weight.

There is a lot of interest in this area, so new research and maintenance protocols are under investigation. Thursday’s podcast episode will be an interview with a Danish researcher who did one of these studies, so stay tuned for that.

But I wanted to share another study that recently came across my desk.

Researchers followed 30 adults who had lost weight and reached a plateau while taking weekly semaglutide or tirzepatide. Instead of stopping medication completely, most transitioned to taking their existing dose every other week.

They stayed on this reduced-frequency schedule for an average of about nine months.

And the results were encouraging.

Before beginning treatment, the participants’ average weight was 194 pounds. After losing an average of 17.2% of their starting weight on weekly medication, they reached an average of about 163 pounds.

While taking the medication less frequently, they did not regain that weight. In fact, the group lost another 2.3% on average. Their skeletal muscle mass remained stable, body fat continued to decline, and improvements in blood sugar, triglycerides, and blood pressure were maintained.

This is an important study that may help us figure out what maintenance can look like. Because for now most of the data we have on stopping GLP-1 involves people discontinuing treatment completely and then regaining 80%+ of the weight lost within a year. (This was my experience)

This study took a different approach:

What if maintenance does not have to mean choosing between a full weekly dose and no medication at all?

Reduced-frequency dosing could lower costs and make long-term medication use feel more manageable and realistic. Honestly, for me, I always dread my weekly shot. It doesn’t hurt, and I am not afraid of needles, but the thought of having to do it just kinda gives me an “ugh” feeling. Even after nearly 4 years, I still have to psych myself up. I would love to get off or do it less often.

But before you start dropping your dose, I want to point out some limitations of this study.

This was a small, retrospective case series, not a randomized clinical trial. The patients were carefully selected after responding successfully to treatment, and four people returned to weekly dosing because of weight regain. The published paper only reported the results of the 30 people who stayed on the every-other-week protocol.

So this study does not prove that everyone can begin spacing out their injections and maintain their results.

It also does not give us a standardized tapering protocol. There is currently no established clinical guideline telling providers exactly when to reduce your dose, how far to space doses, or which patients are most likely to succeed. The researchers themselves emphasized that larger randomized trials are needed.

My takeaway?

Maintenance may eventually become much more individualized than “stay on the same dose forever” or “stop completely.”

Some people may need weekly medication long-term. Others may be able to use a lower dose or take it less frequently. And some may attempt a reduced schedule only to discover that their hunger, food noise, blood sugar, or weight begins to change.

Please do not change your medication schedule on your own based on this study alone. Any dosing change should be discussed with the healthcare professional prescribing your medication. I’ll continue to keep you posted as we learn more! This is such an interesting area of research!