The Unspoken Plateau of GLP-1 Agonists”

Sep 26, 2023

Patients who use injectables like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) to lose weight will eventually experience a point where their weight stabilizes, just as with any other treatment. This phase is referred to as a “plateau,” during which the body establishes a new equilibrium, and weight, as well as other metabolic markers like blood pressure and HBA1c, stabilize or only fluctuate slightly. Some people may notice a gradual increase in appetite during this phase, while others may maintain their current weight.

Studies have indicated that, on average, this plateau occurs at around a little over a year with semaglutide. Nevertheless, it can be surprising for some patients to learn that there’s a limit to what these medications can achieve. Everyone will eventually reach a plateau, but it’s challenging to predict when and how much weight loss will occur when starting the medication.

This plateau phenomenon is not unique to these medications; it occurs in various medical scenarios. For example, blood pressure medications won’t continue reducing blood pressure indefinitely, and diabetes medications won’t keep lowering blood glucose levels forever. This natural balance is essential for our health, preventing extreme changes.

While it’s unclear what factors predispose some patients to longer or shorter responses to GLP-1 agonists, early responses often indicate later outcomes. Patients who experience significant weight loss on lower doses of semaglutide, for instance, may remain on a lower dose for an extended period. Patients with a history of childhood obesity or suspected genetic factors may be more prone to a subdued response.

Clinicians emphasize the importance of discussing these expectations, including potential plateaus and non-responses, with patients before prescribing these medications. Clinical trials have shown that weight loss tends to taper off after a certain duration, and individual responses can vary widely due to factors such as medical history and medications.

In the future, research may focus on identifying characteristics, like genetics, to predict patient responses to GLP-1 agonists, reducing the trial and error involved in treatment. This personalized approach could streamline the prescribing process and save time and resources for both patients and healthcare providers.

Patients’ desires and societal pressures often conflict with clinical realities. Many patients aim for specific weight loss goals, sometimes unrealistic ones, despite achieving positive health outcomes with GLP-1 agonists. Clinicians have strategies to address plateaus, such as increasing doses or adding complementary medications like phentermine (Lomaira). However, “drug holidays” or stopping and restarting GLP-1 agonists typically don’t break plateaus.