The Ongoing Journey of Healthy Weight Loss

There are numerous reasons why research holds significant value for us. For instance, research can lead to the development of a new therapy (such as Alexander Fleming’s discovery of penicillin), innovative concepts (like Einstein’s relativity theory), or alternative approaches (e.g., Dr. Doudna’s CRISPR gene-editing technique). The introduction of new ideas is a central aspect that underscores the importance of research.

However, there are occasions when research matters not because it presents innovations, but because it reinforces older concepts that we have been hesitant to acknowledge. A recent study regarding weight gain following the cessation of tirzepatide (Zepbound) exemplifies this situation.

Zepbound is an effective GLP-1 (glucagon-like peptide 1) medication that assists numerous individuals in achieving significant weight reduction along with improvements in metabolic conditions (such as diabetes, fatty liver disease, and sleep apnea). In the Phase 3 clinical trial involving Zepbound, patients lost an average of over 50 pounds during a year of treatment. This degree of weight loss has yet to be matched by any non-surgical method. However, this new study posed a different inquiry: what occurs when individuals discontinue Zepbound?

The findings suggest that the experiences mirror those associated with all other examined weight loss strategies thus far.

• A total of 83% of participants regained substantial amounts of weight (more than 25% of the weight lost during treatment).
• Among those who regained weight, health improvements reverted in metrics such as waist size, blood pressure, and cholesterol levels.
• The trends of weight gain and health deterioration for numerous individuals began almost right after treatment was stopped.
• For many years, various diets, exercise regimes, bariatric procedures, and weight loss medications have presented the allure of achieving lasting weight loss through temporary solutions. Each time, the hard truth of weight re-gain has dashed these expectations, merely to be rejuvenated for the next trendy solution. In several extended studies, GLP-1 weight loss medications are now displaying the same pattern of weight regain after treatment is stopped.
• Why does weight regain generally seem inevitable in the absence of ongoing treatment?

While every weight reduction strategy carries the risk of regain, insights from the National Weight Loss Registry reveal that some people can successfully sustain significant weight loss. For instance, individuals who manage to both lose and maintain considerable weight loss typically:

• Consume meals consistently and keep an eye on portion sizes indefinitely, without adhering to a particular diet.
• Incorporate physical activity into their routine regularly.
• Regularly check their weight.
• Minimize time spent on inactive activities such as watching television and using social media.

The primary lesson from the National Weight Loss Registry regarding sustained weight loss is that lasting weight reduction necessitates continuous management. While various approaches like diet and exercise plans, weight-loss surgeries, and GLP-1 medications lead to weight reduction through diverse biopsychosocial methods, they all share the common requirement for ongoing treatment—this could involve making lasting lifestyle adjustments, continuous medication consumption, or strict compliance with post-surgery dietary guidelines.

For the majority, sustaining weight loss becomes a lifelong struggle against their own biology. This uncomfortable reality emphasizes the need for continual management. Fat cells, for example, are not simply storage compartments for energy as is often believed. Instead, they function as small organs that release certain hormones (such as leptin) to the brain when weight loss occurs, triggering increased hunger and reduced feelings of fullness. Interestingly, fat cells retain “memories” of their former states prior to weight loss in the form of epigenetic gene expression patterns. These epigenetic recollections can drive individuals to regain weight long after they have lost it. Combine these influences from fat cells with significant alterations in the brain’s reward system that arise during periods of being overweight or obese, and even the most determined individuals can discover that their intentional weight loss objectives are overshadowed by ingrained biological responses honed over millions of years to favor weight restoration rather than loss.

Overweight and obesity as long-term health issues

Recent studies on weight recovery after GLP-1 medication treatment suggest a conclusion that is increasingly accepted in various aspects of our lives. What transpires with physical fitness when exercise ceases? How enduring is love if we neglect our relationships? We continue our daily dental hygiene routines because we understand that halting these practices leads to the onset of cavities. Most individuals don’t require a Phase 3 clinical trial to recognize this: All beneficial aspects of life need protection. Perhaps we can now include weight loss in this category of valuable pursuits.

Science and the medical community have only recently accepted that having excess body fat (i.e., being overweight or obese) constitutes a chronic illness that demands long-term management and treatment. If this seems obvious to you, keep in mind that the American Medical Association only formally classified obesity as a chronic disease in 2013. Since its founding in 1847, the experts within this prestigious medical organization considered overweight and obesity similarly to immediate health issues and injuries that could be addressed with temporary solutions. It took a considerable amount of time for perceptions about obesity to evolve.