Weight Loss

Terri D’Arrigo

Obesity medications such as GLP-1 receptor agonists can help patients lose significant amounts of weight. However, up to half of patients who take a GLP-1 stop taking it after a year, and often regain most of the weight they lost. Now a study published in the March 2024 issue of The Lancet suggests that engaging in supervised exercise while taking a GLP-1 may help patients maintain their weight loss even after they stop taking the medication.

In the study, 195 adults with obesity who initially lost 28.9 pounds (13.1 kg) on an 8-week, low-calorie diet were randomized to one of four weight loss maintenance groups for 52 weeks: 3 mg of S.C. liraglutide per day, exercise plus liraglutide, exercise plus placebo, or placebo only. Those who were randomized to the exercise groups were encouraged to attend two supervised group exercise sessions per week and to exercise individually twice per week. Overall, 166 participants completed the full 52 weeks, at which time the interventions ended. These participants returned at week 104 for follow-up.

In the year following treatment, the liraglutide-only group regained on average 13.2 pounds more than the exercise-only group and 5.5 pounds more than the combination exercise plus liraglutide group.

“When GLP-1 receptor agonist treatment is stopped, appetite inhibition and improved eating behaviours are lost, and the participants do not have any available means to counteract these changes, which is the likely cause for the observed rapid weight regain,” the researchers wrote. “This contrasts with physical activity interventions, where increased physical activity in principle can be continued in a real world setting after intervention termination and, thus, treatment effects can be maintained.”

Encourage healthy living

“This study provides further support for the idea that obesity and weight management are chronic in nature,” said Kayla Haverkamp, PharmD. “In all [intervention] groups, weight regain occurred after discontinuation of the intervention, which is consistent with current practice guidelines recommending long-term treatment.” Haverkamp is a clinical pharmacy lead at the Phoenix VA Health Care System (but not a spokesperson for the VA) and lead author of a November 2021 study in JAPhA wherein a pharmacist-led weight loss clinic resulted in significant weight reductions in patients seeking weight loss services.

“Patients should know that liraglutide is not a magic wand that will reduce their weight after taking it for just a couple of months and have effects that last forever,” Haverkamp said. “However, certain circumstances may arise where someone may not be able to continue weight loss medication … Therefore, it is good to set the expectation that lifestyle changes are still a necessary component of the weight loss treatment package.”

Laura Challen, PharmD, an associate professor of pharmacy practice and a clinical pharmacist in the JFK Clinic at Mercy Hospital in St. Louis, said that pharmacists can advocate for lifestyle changes for patients who take obesity medications. Challen is coauthor of a September 2021 study in Innovations in Pharmacy demonstrating that pharmacist involvement in interdisciplinary weight loss management can improve weight loss in patients compared with standard care.

“It is important for patients to look at their diet and exercise patterns. Medications cannot replace unhealthy lifestyles and they work best when they are combined with a healthy lifestyle,” Challen said.

Challen acknowledged that while exercise can help maintain weight loss, some patients face barriers such as time constraints or the expense of joining a gym.

“In those situations, I often mention that every little bit helps,” she said. “Walking is free and can be done at home or in the neighborhood. Strength training can also be accomplished at home with weights or lifting heavier common household items if weights are unaffordable. Free internet exercise videos exist and streaming virtual exercise classes can sometimes provide an affordable alternative to joining a gym or hiring a personal trainer.”

Tips for GLP-1 use

Haverkamp noted that GI adverse effects are a fairly common reason patients stop taking GLP-1s.

“General counseling should include recommendations to eat slowly, avoid overeating, and focus on smaller, more frequent meals,” she said. “Patients should stay hydrated and avoid fried, greasy, or sweet foods. OTC remedies may help manage side effects, such as calcium carbonate for heartburn or a laxative for constipation. If these [strategies] are beneficial, they may help patients avoid having to stop the medication for intolerable side effects.” ■