The following is a transcript of the “Wegovy Maintenance Dose” video posted on YouTube.

So perhaps you’re on Ozempic, Wegovy, or Mounjaro at a given dose, and maybe you’ve reached your target weight. Or you’re working your way down to your target weight. Of course, the question has come up: Well, what do I do when I reach my target weight? Do I come off of the medication altogether? Do I reduce my dose to a maintenance dose to maintain the weight that I lost? How exactly do we approach this once we’ve reached that target weight? 

Understanding Maintenance Doses

Most people who have reached out to me asking this question about maintenance doses have been looking and thinking about the idea that they’re going to take a dose that is less than the one they took to reach their target weight. There are a couple of reasons why people want to go on a maintenance dose; as I’ve already said, for one of them, they’ve maybe reached their target weight, and they don’t want to lose any more weight.

Or they may reach their target weight, and at a given dose, they continue to lose weight. So they want to back the dose off and want to know how to go about doing that, or certain people have gotten into the gym or various other activities and are killing it there. But they’re finding they need to eat more food to increase their performance. The drug doesn’t allow them to or makes it very hard to do, so they want to back off the dose to improve their performance and get more food into their system. 

And, of course, some people are just concerned about having drug in their system or having anything in their system. So they want to try and find a lower dose or try to come off the drug altogether to prevent or lower their risk of any potential harms that have yet to be proven and likely won’t be proven to come out with these medications down the road.

Million-Dollar Question

So, the million-dollar question that comes back to clinicians like myself is, what do we recommend as a maintenance dose for these various medications? And the answer to that question is quite simple. We simply don’t recommend a maintenance dose. A, we don’t have any data or trials for maintenance doses after you’ve reached your target weights. And B, we need to remember that obesity is a chronic and progressive disease. 

So, if you have developed obesity, it is going to be something you need to deal with and manage for the duration of your life. It’s progressive in the sense that your body is going to continue wanting to gain weight throughout your life, and if you have lost weight, your body is going to fight tooth and nail to get you to regain that weight back. Trust me, I know it sucks. But this is the reality of obesity.

Why Staying on Medication Matters

Now, let’s go through a little bit of data so that I can illustrate and drive my point home. So, first off, I want to address why I can’t just come off of Ozempic or Wegovy altogether. I’ve reached my target weight, and we have met the goal. Ultimately, I’d like to come off the medication, and again, to reiterate, obesity is a chronic and progressive disease, and the medication is helping you to manage that disease. If we take it away, the weight will likely return.

I want you to think about it now: anytime you’ve done any other kind of diet plan or program, you’ve likely been on it and lost weight while on the program or plan. You ultimately gain back the weight as soon as you come off that program or plan. So, I would like to show this point through the data from the STEP-1 extension trial.

In the STEP-1 extension trial, they took a group of individuals and split them into two groups. They had the placebo group, and the other group got Wegovy was titrated up to a dose of 2.4 milligrams once per week. 

As you can see on this lovely little graph here, the group in the Wegovy group lost weight, lost weight, and lost a significant amount of weight. 

At week 68, the authors then withdrew that Wegovy medication. Ultimately, what happened is that the people who were on Wegovy gained a majority of the weight back.

So once they took the drug away, waking then occurred.

Sustainability and Long-Term Benefits

Again, obesity is a chronic and progressive disease, and whatever we use to lose weight has to be sustainable and maintainable for the long term. Now, let’s look at the data from the STEP-5 trial.

What they did in the STEP-5 trial was they again took a group of people and split them into two. One group got the placebo, one group got Wegovy, and they followed them for two years.

As you can see on this lovely little graph here, again, the people that were in the Wegovy group lost a considerable amount of weight; their weight kept coming down until about that week 68 Mark, and then it plateaued, and it continued to plateau over the next year following of that study. 

It shows that all of these people were on Wegovy 2.4 milligrams once per week, which helped them maintain their weight for the long term over that two-year period. So, as a general recommendation, what we recommend for maintenance doses is that you stay on whatever dose of the medication allows you to reach your target weight to keep that weight off long-term. We do not recommend backing off the dose or anything like that. We recommend you stay where you’re at.

Tailoring Medication Doses

Now, of course, there’s going to be exceptions. And I certainly have had patients come to me who have said, I’m at my target weights at a given dose of X medication, I am still losing weight, and I don’t want to lose any further weight. Or I want to perform better at the gym or what have you. Then, we have to develop a strategy to help them find a lower dose of the medication to help them maintain the weight that they have lost but also help them achieve the goals that they’re striving for.

So it’s a process. Before I dive into this process, I, of course, need to have and put out the disclaimer that you need to do this in conjunction with your health care providers; you have to make sure that you’re doing it safely and effectively and all of that wonderful stuff. So please do not sue me. Now, the process for the select individuals that this might apply to this process will be slow. I’m going to use the example of Wegovy to illustrate the point.

What’s going to happen is, for example, you’re on Wegovy 2.4 milligrams once per week, and we want to find a maintenance or lower dose for you. What we’re going to do is we’re going to decrease you down to your previous dose of Wegovy that you were on. So if you’re on 2.4 milligrams once per week, we will decrease you down to 1.7 milligrams once per week. 

We’re then going to hold you at that dose for a period of at least four weeks. In reality, you should go longer, but a period of four weeks will allow the medication to stabilize in your system at that lower dose and concentration to give us a good idea of what kind of effect that dose will have in the system. At this point in time, you will need to monitor yourself. 

Monitoring and Adjusting Medication Doses

You must monitor: Are you achieving and working towards your goal? Has the weight loss stopped? Are you getting unable to eat more food, so your performance at the gym is going up? What exactly is going on, or that we need to look at: how’s your hunger, cravings, and all of that stuff? And is this going to be something that’s going to allow you to maintain and achieve your goals? And at that point, if all is stable, and maybe you’re still losing weight, or you’re still not quite reaching your goals that you want to, you can then look at going down to the previous dose again.

So if you’re at Wegovy 1.7 milligrams once per week at this point, you can decrease to Wegovy one milligram once weekly. And repeat that process all over again for a period of at least four weeks. Ultimately, suppose you decrease your dose, and you find that you’re unable to manage your hunger and cravings, or it’s not working for you, or what have you. In that case, you’re just going to go back up to your previous dose, and you’re going to hold yourself there, and that’s going to be your maintenance dose, and we can look at other strategies and such to help you achieve your goals.

Defying Stigma

Whatever dose allows you to maintain your weight, manage your hunger and cravings, and manage the biology in your brain will ultimately be your maintenance dose.

As a final point, if you need medication to help you manage your weight, it doesn’t mean you’re a failure. It doesn’t mean that you are cheating. It doesn’t mean any other crap that society and others might say.

If it is helping you to achieve your happiest and healthiest life, that is A-okay, and everybody else can really just catch a chicken, so that is everything you need to know on maintenance doses In reality, we don’t exactly recommend them at all, but hopefully that helps you out and answer some of the questions that I’ve been getting.

As always, you beautiful people, check me out on my other channels at the official Dr. Dan as well check out my website healthevolved.co. 

And until next time, always remember that small tweaks lead to massive peaks.

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References:

John P H Wilding, Rachel L Batterham, Salvatore Calanna, Melanie Davies, Luc F Van Gaal, Ildiko Lingvay, Barbara M McGowan, Julio Rosenstock, Marie T D Tran, Thomas A Wadden, Sean Wharton, Koutaro Yokote, Niels Zeuthen, Robert F Kushner; STEP-1  Study Group. (March 18, 2021). Pub Med. Once-Weekly Semaglutide in Adults with Overweight or Obesity. Retrieved by:  https://pubmed.ncbi.nlm.nih.gov/33567185/ 

John P H Wilding, Rachel L Batterham, Salvatore Calanna, Melanie Davies, Luc F Van Gaal, Ildiko Lingvay, Barbara M McGowan, Julio Rosenstock, Marie T D Tran, Thomas A Wadden, Sean Wharton, Koutaro Yokote, Niels Zeuthen, Robert F Kushner; STEP-1  Study Group. (August 24, 2022). National Library of Medicine. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Retrieved by: https://pubmed.ncbi.nlm.nih.gov/35441470/ 

W Timothy Garvey 1, Rachel L Batterham 2 3 4, Meena Bhatta 5, Silvio Buscemi 6 7, Louise N Christensen 5, Juan P Frias 8, Esteban Jódar 9, Kristian Kandler 5, Georgia Rigas 10, Thomas A Wadden 11, Sean Wharton 12; STEP 5 Study Group (October 28, 2022). National Library of Medicine. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Retrieved by: https://pubmed.ncbi.nlm.nih.gov/36216945/

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Dr. Dan

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