Halifax bride-to-be questions long-term use of weight-loss drug as research on stopping raises concerns
As GLP-1 drugs surge in popularity for short-term weight loss, researchers are studying what happens when people stop taking them.
HALIFAX · Beverley Smith is trying on wedding dresses in a Halifax bridal shop while rapidly losing weight since starting a GLP-1 medication. The 32-year-old, who has polyendocrine metabolic ovarian syndrome, has lost more than 30 pounds since March using the drug tirzepatide and says related symptoms like joint pain have improved. Now, as she prepares for her wedding next summer, she is asking what happens when she eventually stops the drug that has changed her life for the better. "When you are going off it.... do you taper off of it or do you stop abruptly?" Smith wondered.
As blockbuster GLP-1 drugs explode in popularity, with more people using them off-label for short-term weight loss, scientists are striving to find an answer. Dr. Thomas Leung, a clinician-scientist at the University of Pennsylvania, is among the researchers studying this real-world situation. GLP-1 drugs work by suppressing blood sugar, controlling appetite and slowing stomach emptying by mimicking the hormone glucagon-like peptide-1. While these medications have been around for over two decades, their myriad new uses, often with minimal medical supervision, are relatively new.
Many patients are treating GLP-1s like a yo-yo diet rather than taking them long term to manage chronic health conditions. They are ever easier to get through online pharmacies, and pill forms are becoming more accessible. One recent Danish study on semaglutide use for obesity found roughly half of adults stopped treatment within just 12 months. Dr. Leung noticed this trend in his own social circle, as more friends wanted to try GLP-1s just to drop a few pounds before a vacation or to look good on Instagram, with a common desire to get off them as fast as possible.
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"No one had really studied what happens when you model what human behaviour is, which is starting and stopping these drugs," Leung said. His research team studied this in mice, cycling overweight mice through GLP-1 use every two weeks. They found those mice struggled to lose weight compared to mice who stayed on the drugs, and even after two months of consistent use at the end, the drug-cycling group remained 20 per cent heavier. Leung wonders what is actually happening inside the bodies of human patients who stop and start these drugs.
Dr. Sean Wharton sees this pattern regularly in his patients at the Wharton Medical Clinic for weight and diabetes management in Burlington, Ont. "People are using it off-label often. Maybe they heard about something on the internet or on Facebook. And if they're using it in this manner off-label, then it’s … buyer beware," he said. Wharton stressed these drugs have clear benefits as a long-term treatment for obesity, which can worsen other health issues like inflammation and cardiovascular disease. Research also suggests GLP-1s may help curb substance use disorders, cut sleep apnea severity or reduce cancer risk.
Yet increasingly, these drugs are moving into what Wharton calls the "aesthetic medicine space" for short-term use. He says the benefits likely vanish when patients rush back off these drugs. "If losing the weight was the reason why your metabolic condition, like your heart failure, your high blood pressure, got better, then regaining the weight usually means that that blood pressure is going to go back up." Last year, a major research review concluded that the health effects show the physiological consequences of GLP-1 discontinuation. A key need, according to that research team, was treatment guidelines to also address how to stop using the drugs.
With files from CBC News
Amara Okafor covers health, medical research and public health in Canada for Novello Desserts.