Episode #155: Would You Take a Medication Forever if It Changed Your Life?

Would you take a medication long term if it truly improved your health and quality of life? In this episode of Conquer Your Weight, Dr. Sarah Stombaugh explores the role of GLP-1 medications like Wegovy and Zepbound in the long-term treatment of obesity. We discuss why obesity is a chronic, biologically driven condition, not a failure of willpower—and why long-term treatment is common in medicine.

You’ll learn what research shows about weight regain after stopping GLP medications, why this happens, and why it doesn’t mean the medication “failed.” We also talk through common reasons people feel resistant to long-term medication use—fear of dependency, stigma, diet culture, cost, and safety concerns—and how to reframe those thoughts with compassion and evidence.

Finally, we discuss how “forever” isn’t the goal. The goal is ongoing, informed reassessment—using the right tools, for the right person, at the right time.

This episode will help you decide whether long-term medication support is a helpful part of your weight and metabolic health journey—without shame or pressure.

Ready to get started on your weight loss journey? We’re now enrolling patients for in-person visits in Charlottesville, Virginia and for telemedicine throughout the states of Illinois, Tennessee, and Virginia. Learn more and get started today at https://www.sarahstombaughmd.com

Transcript

Dr. Sarah Stombaugh:

This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast.

Announcer:

Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician, and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:

Today we are going to be addressing the question: would you take a GLP medication forever? This is one of the most common questions that I get from my patients. And honestly, anyone I talk to about the GLP medications, medications like Ozempic, Wegovy, Zepbound, and Mounjaro, people are asking me, Doc, do I have to take this medication forever? Can I take it for three months, six months? The answer is going to really be, it depends. But I want to think and change how we think about obesity as a disease, and then how we think about long-term treatment. One of the questions I often get with patients is they're reluctant to take these medications long term, but they may not hold that same reluctance for other medications. 

You could imagine, for example, being diagnosed with high blood pressure. You go in, you see your doctor, your blood pressure is elevated, and they say, Hey, I do recommend this diet, I recommend these lifestyle changes, but your blood pressure is pretty high today. And it is going to be the safest option for you to start a blood pressure medication. And this is the medication that I recommend. So let's say you start that medication, it goes pretty well, there's no side effects to that medication. You come back and see your doctor maybe one or two months later, they chuck the blood pressure and they're like, it is 120 over 80. That is textbook normal. You are great. What would your doctor tell you to do? What they are most likely to tell you to do is, hey, you're doing a great job. Keep up with any of the changes that you've made. Are you working on diet? Are you working on exercise? Maybe you'll spend some time talking through that. And let's continue that medication that we started, that medication that you've been taking over the last couple of months that's really made a difference in your blood pressure. And so you wouldn't say, oh, my blood pressure is cured. I no longer have hypertension or elevated blood pressure. You would say, okay, I've got treated blood pressure. My blood pressure is adequately controlled. It's well controlled. So therefore, I'm going to continue this medication. You wouldn't just stop the medication because your blood pressure has come down to the normal range. Now, we see that happen, certainly, and people will discontinue the medication. Some time goes by, they recheck the blood pressure, and it's right back to that elevated number. And we think about blood pressure in that way, we can realize that there's a lot of similarities between that and how we think about obesity. Now, you might be listening and you're like, well, Jack, I don't want to take a blood pressure medication either. We can extrapolate this over to something else. Imagine you get diagnosed with asthma. Would you say, oh, I feel weak because I don't want to take an inhaler. I shouldn't have to do this. I should be able to do it on my own. Maybe, but more likely you would say, okay, I've got this asthma. Maybe I've got a daily inhaler. Maybe I have a rescue inhaler. I've got both of those things. And these are things that I'm going to do in order to keep my asthma under control. 

Or me, for example, you may not know, but I wear contacts because I am super blind. I do have glasses. I rarely wear them in the context of social media or videos or anything like that. But I have glasses, I have contacts, and it's bad, you guys. Like if I take out my glasses, I take out my contacts, I cannot see something, you know, this far away in front of me. Sometimes my husband will joke in the evening. He'll show me his cell phone, like, hey, look at this thing that I saw. And even from across the bed, for example, if I don't have glasses on, if I don't have contacts on, it's not something that I can see. And so I use glasses, I use contacts as a long-term solution in order to support myself. I'm so grateful that I don't live in a time, you know, 200 years ago where there were not the same ready access to glasses that we have in 2025. And I do have glasses and contacts available to me because otherwise I would not be able to be the functional person that I am because they are a tool for me. And so whether it's blood pressure, whether it's asthma, whether it's glasses, we can think about obesity similar to this. I think there's been this really big shift in the way that we think about obesity. And today we're going to talk about obesity as a chronic disease process and why that deserves long-term treatment. That may mean medications, but the other pieces as well. We are not ignoring lifestyle factors. A lot of times people will say, hey, these medications are cheating or I don't want to have to rely on the medications. You're not. They're just one tool with other lifestyles. 

So we're going to talk about that. We are also going to talk about what happens when you stop the medication. We'll review some of the data from the clinical trials of Wegovy and Zepbound, which are the two medications that are approved for the treatment of weight. We'll look at that data so that you can see, okay, what happens on average for people who stop these medications? Then I want to give you some skills and strategies. If you're having this resistance come up, there's a reluctance to maybe even start these medications or a fear about what long-term might look like. Let's dive into some of those pieces. So let's start first and talk about obesity as a chronic disease. I think one of the biggest challenges is that we as a society for the longest time, because we can see weight on the outside of our body, we think of it a lot differently than other health conditions. Other people are privy to what the size of our body might be looking like. And therefore, it's something that our culture has taken on a much more significant meaning beyond just health. There's a lot wrapped up in diet culture and beauty standards, beyond just what is weight and what is health. And because of that, we don't always think about obesity as a disease process in the way that we think of other conditions. When we look at obesity, though, it is this very chronic disease. There's so many factors that contribute from our biology, things like our genetics. If you look at families, very commonly obesity will run in families. There's also our epigenetics, which is how our genes interact with our environment. That can be everything from when you are a fetus growing inside your mother to the environment that you live in and the exposures of the environment you have around you. That can be things like our physiology and the hormonal signaling and changes that can happen, either because of other health conditions, because of chronic diet and weight loss and weight regain, that weight yo-yoing that can happen. We have an emotional relationship with our food. And so our day-to-day behaviors, the environment that we live in, the food that's offered and available to us, the sleep, the movement, all of these things are going to play a role in the size and amount of fat mass that is on our body. So there's all these factors beyond just what is within your control. We also look at obesity as a relapsing process, meaning that if you think about yo-yo dieting, for example, having weight gain, weight loss, weight gain, weight loss, that is not because of a lack of willpower. That's actually because of very strong hormonal signaling that is helping your body to maintain or even gain weight. The body really resists weight loss. 

And what we see is that when people outside of medications, people lose weight, whether we're talking about medications, bariatric surgery, diet and exercise, when people lose weight, the body fights back. The body will have changes in hormonal signaling that makes the body feel more hungry and put on weight. This can look like increases in hormones like ghrelin. Ghrelin is our hunger hormone. You can think of it like grr, I'm so hungry right now. Ghrelin increases when we've lost weight to tell the body, like, I am more hungry, I should be seeking more food and eating more right now. We also often see a slowing in metabolic rate because our body is trying to conserve energy. So we see that the basal metabolic rate slows down. The body's like, How can I be more efficient? I've lost weight. Maybe there's food scarcity, there's a famine going on right now, and I want to make sure that I'm conserving energy. So our body slows down that metabolic rate. So what we see is that people lose weight and they have to sort of work harder and harder, eat less and less in order to continually lose weight because these bot the body has these fighting back mechanisms, which is why we see the relapse where people have lost weight, then this hunger becomes overwhelming. And again, it's not a willpower thing. It's literally you've got hormonal signaling, like, oh my gosh, I'm ravenous right now. So you've got this ravenous hunger coming back, maybe a slowing down of the metabolic process, and you start to see weight regain happening. And so there can be this very much relapsing piece of the disease. And it's chronic. People often deal with their weight for long term. And that's why when we think about treating it, we're thinking about all of those different pieces. I think one of the biggest things, as I mentioned earlier, is that we think about medications sometimes, like it's just the whole picture, but it's not, it's part of the picture. We want to be thinking about lifestyle, nutrition, exercise, sleep, behavioral modifications, all of those pieces are important. 

But the GLP medications, medications like Wegovy, medications like Zepbound, these can be the physiological tools that allow all of those other things to take place. Sometimes we feel like, okay, I have to be doing all those things first. And the reality is a lot of times you've been trying really stinking hard to do those things and your body is fighting back. You might be trying to eat really healthy, but if your body is sending signals of being ravenously hungry, for example, it is hard to eat small portions if your body is ravenously hungry. If you are dealing with insulin resistance, your body is going to be craving more carbohydrates, craving more sugar. So it's really hard to eat a diet of vegetables and lean protein when your body is ravenously craving sugar. So sometimes we're like, okay, I have to get the diet and exercise in order and then I'll start the medication. But a lot of times starting the medication is the tool that allows the other things to get into order because we're not fighting against ourselves. The medication becomes the tool that allows all of the other things to happen. And once we can do that, it's amazing how some of the other things that we've been working on that we've been trying so stinking hard for such a long period of time, how they finally start to take place in this way that can be really, really powerful. 

Now, when we think about forever use of the medications, one of the questions that we're also thinking about too is what does the data show for people who are in clinical trials of these medications? If they've continued the medication, if they've discontinued the medication, what happens? And this has been studied in two different trials. In the Wegovy trial, so that's the semaglutide medication, same as Ozempic. In the step one trial, there was an extension when people had discontinued the medication. They looked at the weight regain that had happened. In the Zepbound trials, that's their tissue medication, the exact same as Mounjaro. That medication had a trial called SURMOUNT-4, where patients started on the medication, continued for a period of time, then half the patients discontinued the medication, half the patients continued the medication, and then they compared what happened. And I'm gonna show you a graph that I just made up that summarizes really both of these two trials. So step one with Wegovy and then SURMOUNT-4 with Zepbound, what happens for patients on average? So what we're looking at here is weight here on the up and down ax, time going across, and we're looking at over time what is happening from weight. You can imagine that up here is starting body weight. And for patients, let's say taking Zepbound, everybody in that trial, the SURMOUNT-4 started the medication and they continued on it for the first, I think it was 36 weeks of the trial. At that point, half the patients discontinued, and don't quote me, it might have been 20 weeks. I think it was 36 weeks. Half the patients continued the medication and continued from there. The other half of the patients discontinued the medication. And what we saw on average was that patients who continued the medication on average continued to lose weight. Patients who discontinued the medication saw weight regain. Now, what's really interesting is this is the average person. So this is their starting body weight, and we see that they've still maintained some weight loss. On average, they maintain like nine per 10, 9 or 10% weight loss from starting. And this is just the average. 

So what you will see is if you look at a waterfall distribution, so you look at all the patients in that clinical trial, and we made each of them like a single data point, you'd see that those data points extended about this way, and that there are some people who discontinued the medication and they regained all the weight. Some people regained all the weight plus a little bit more, where other people discontinued the medication and they maintained their weight loss, for example. So there's this really broad distribution of people who regained all of the weight plus more, people who maybe regained most of the weight, people who regained some of the weight in this range, and people who maintained, maybe even some people who lost a little bit. But there's this really broad distribution that happens. And this is where the data becomes really confusing because you are not an average. You know, you can't guarantee that if you stop the medication that you'll be here the average, you might be the person who regains it all plus more. You might be the person who maintains. And so you have to be really careful when you're looking at anecdotal data. When I say anecdotal, I mean like the person on social media, for example, who's like, I took the medication for a period of time and then I stopped it and I maintained my weight loss, and good for me. Um, a, we have no idea what that person's actually doing. Their medication history is their own private information. And so are they being truthful? Are they not being truthful? You know, we can't know, and it doesn't matter because it's not really our business. So they might say, Hey, I've discontinued the medication, but they haven't. Maybe they're still taking the medication, or they have discontinued the medication. They've been able to maintain the weight loss. That's great for them, but that is not going to be the story for everybody. They would definitely be an outlier if they are someone who has maintained or even continue to lose weight despite stopping the medication. We also saw the exact same thing if you look at step one, where there was a step one extension where patients discontinued the medication and then they looked at what happened over time. 

On average, patients regained weight, and on average, about two-thirds of their weight was regained. So they did still have some average weight loss maintained after a period of time, but had regained two-thirds of the weight that they had lost. So, what we're seeing on average is that patients who continue the medication continue to see weight loss. Patients who discontinue the medication see weight regain, typically regaining about half to two-thirds of the medication, or half to two-thirds of their body weight rather, from what they had lost in total, from where they had started. So, what does that mean for you? If you are going to start these medications, I want you to be open to long-term use of the medication. What's really important is that you are the boss of your body. Nobody gets to decide long term what you do besides you. And in starting the medications, I want you to be open-minded. Would I consider using this medication long term? Is this something that in combination with the diet, in combination with the exercise and the sleep and the behavioral pieces, the management of other health conditions, in combination with all of those things, would I consider using this medication long term? As long as the answer to that question is yes, then we get to decide, okay, it's worthwhile taking a chance. If someone says, absolutely not, I just want this for three to six months, you can do that. You know, that's absolutely your decision. But I worry that that is going to put you in a situation where this is just another failed diet. This is just another yo-yo where you lose weight and then see it is regained back. 

So I want you to be really, really careful if you're thinking about short-term use of this medication. Now we think about you're still having resistance of like, Dr. Stombaugh, I don't know. Like I'm not really sure if I want to consider this medication long term. There's three things I really want you to consider. One, is it effective? Two, is it safe? Is it tolerable for me? And three, is it feasible? You know, do I have insurance coverage? Can I continue to afford it? Addressing these three questions, both at the beginning of your journey, but honestly, even throughout your journey, is going to be a really effective way to determine does this medication continue to make sensory? So one, is it effective? There are people who are non-responders to this medication or to these medications. It's very rare, but there are people who are not going to see weight loss on this medication. So let's say you start these medications, you're doing them, you're trying it alongside diet and exercise, and you are not seeing any weight loss. It makes sense that you would say, well, this medication may not be doing anything for me. Now, one thing I will caution you against is that sometimes if you've been in a situation where you've been gaining, gaining, gaining, sometimes this medication can be the medication that halts the gain. And you might find that you're in a plateau or having just marginal weight loss. And then upon stopping the medication, you see, okay, now I'm gaining. So sometimes upon stopping, we see that the medication was actually more effective than we realized. However, if you're taking the medication and it's not doing anything for you, it makes sense that you should not continue this medication. So is it effective? Yes. Continuing makes sense. No. Discontinuing makes sense. Two, is it tolerable and is it safe? 

When we think about the safety profile of these medications, certainly there's side effects that come up with this medication. There are some potential severe consequences of these medications, which are exceedingly rare, and they are things to be aware of. We're not going to dive into that too much as the conversation today, but if you have medullary thyroid cancer or someone in your family has had that, it does not make sense to even start these medications. A doctor is not going to recommend you use these. Let's say you have a history of pancreatitis. It may make sense to use these medications in very specific circumstances, but let's say you develop pancreatitis again while you're on these medications, you'll have to question if that really makes sense and may make more sense to discontinue the medication. Other risks like gastroparesis, for example, like a frozen stomach, other eye concerns are much, much more rare when they occur. But you'll have to weigh what is the potential risk of these medications to the potential benefits of this medication? A lot of times we think about fat tissue or adipose as this, you know, sort of blob of tissue that sits in our body. But the reality is adipose tissue is actually very hormonally active in ways that uh perpetuate the cycle of obesity, but also in this inflammatory way that can increase risk of things like cancer, increase risk of things like heart disease, of dementia, and all of these things interplay together. So by losing weight, we find that people reduce the risk of heart disease, of stroke, we find that people reduce their risk of cancers, reduce their risk of dementias, reduce the risk of many different health conditions. And so we have to weigh what is the potential benefit of these medications compared to the theoretical or maybe known risk if you're having certain side effects. So you continue to weigh how is this medication feeling in my body? Is it effective? Is it tolerable and safe for me? 

And then three, is it feasible for me? One of the biggest challenges that we continue to face with this medication is the up and down insurance coverage. People may change employers, they may go to Medicare, they may go to Medicaid, they may stay with the same employer, but the employer changes insurance benefits. And the coverage of this medication may be frustrating. Like you may have coverage and then not have coverage, and that can be really challenging. This is something where, unless you know you're leaving your employer imminently or having a really soon change, it's something that I don't worry too much about. As we've seen cash pay options become a lot more affordable with this medication, that's always an option we can consider. We can also look at supplementing with other medications or switching to other medications that are much more cost effective. There's a lot of older Medications on the market, medications like metformin, Qsymia, which is a combination of phentermine and topiramate, or either of those medications independently, Contrave, which is a combination of bupropion and altrexome, or again, either of those medications independently. We can look at these different medications and can consider do we layer on some of these other pieces or multiple other pieces of those medications to continue to support someone even if they do not have ongoing coverage? Because certainly it may be out of budget for you if your insurance no longer covers it. And so, of course, it may make sense to stop in that situation. So when we think about this medication, would you take it long term? Ask yourself this question: what's the resistance coming up? Does it feel like it's cheating? Are you worried what will happen if you stop? Are you worried about coverage? Finding out what are the concerns that you have and then bringing up with your doctor will be really important. 

I see patients in Charlottesville, Virginia and in person there and by telemedicine throughout the states of Illinois, Tennessee, and Virginia. One of the best things you can do is find a board-certified obesity medicine physician near you. So you can go to the ABOM, the American Board of Obesity Medicine, and look for an obesity medicine provider near you. This is likely someone, uh certainly someone who's studied in this area and then someone who's likely to be more experienced in navigating these issues and helping support you through them. So you might realize, okay, I'm worried about insurance, I'm worried about side effects, I'm worried about, you know, just the guilt or shame that could come up with these, bringing those up with your doctor will be the most important thing that you can do. If you're listening here on the podcast, I appreciate your ongoing support. This is available now on YouTube. So if you've been listening here in the audio version and you're excited to have it on YouTube, maybe see the video version, pop on over there so you can see the graph that we're talking about earlier in the program. Thank you so much for joining me for today's episode. We'll see you all next week.