Long Term Weight Loss Medication

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Do You Need to Stay on Weight Loss Medication Long Term? What a New Maintenance Study Found

After losing weight with medical treatment, many people ask:

"Do I need to stay on the same dose long term?"

This often comes up after someone reaches a target weight or a weight they feel ready to maintain. It may also come up if the current dose is causing nausea, reflux, constipation or very low appetite, or if the cost is becoming difficult.

A recent study published in The Lancet looked at this stage of treatment. After people had already lost weight on weekly injectable treatment, researchers compared three options: staying on the higher study dose, stepping down to a lower study dose, or stopping active treatment.

People who stayed on the higher study dose maintained the most weight loss. People who stepped down to the lower study dose did not maintain as much weight loss as the higher-dose group, but they did better than people who stopped active medication.

That pattern may not surprise many doctors or patients. If a medicine is helping with appetite and weight regulation, continuing some treatment may help more than stopping altogether. What this study adds is a direct comparison with a lower-dose group.

What did SURMOUNT-MAINTAIN test?

The study was called SURMOUNT-MAINTAIN. It looked at what happens after people have already lost weight on treatment and move into the maintenance phase.

These were not people starting treatment from scratch. They had already used weekly injectable treatment, had already lost weight, and had been able to tolerate treatment during the first part of the trial.

Who was in the study?

Researchers enrolled 441 adults in the United States who were living with obesity, or overweight with at least one weight-related health issue.

Everyone first had 60 weeks of weekly injectable treatment and lifestyle support, including dietary and physical activity counselling.

After that first phase, 378 people entered the maintenance part of the study. To enter this stage, they needed to have lost at least 5% of their starting weight and to have tolerated at least 10 mg during the trial.

The people in the maintenance phase had an average age of 47 years. About 65% were women. Their average BMI was 40.1 kg/m2, and the median duration of obesity was 13 years.

What happened during the maintenance phase?

For the next 52 weeks, participants were randomly placed into one of three groups:

stay on the dose they had tolerated during the weight-loss phase
step down to a 5 mg study dose
switch to placebo, meaning they stopped active medication

All groups continued to receive lifestyle support. The maintenance phase was double-blind, which means participants and study doctors did not know which group each person was in.

What happened after 112 weeks?

By the end of the full 112-week trial, people who stayed on the higher dose had maintained the most weight loss.

People who stepped down to the lower study dose maintained less weight loss than the higher-dose group, but more than people who switched to placebo.

From the original starting weight, the average weight change was -21.9% in people who stayed on the higher dose, -16.6% in those who stepped down to the lower study dose, and -9.9% in those who switched to placebo.

Researchers also looked at how many people regained at least half of the weight they had lost:

8% of people who stayed on the higher dose
25% of people who stepped down to the lower study dose
67% of people who switched to placebo

Put another way, most people in the lower-dose group did not regain half of the weight they had lost during the maintenance phase. But regain was still more common than in the higher-dose group.

The active treatment groups also had better results than placebo for measures such as BMI, waist circumference, blood glucose markers, blood pressure and cholesterol.

Side effects were more common with active treatment than placebo during the maintenance phase. Mild-to-moderate digestive symptoms were the most common.

Did people maintain weight loss on the lower dose?

Yes, many did maintain a substantial amount of weight loss on the lower study dose.

The lower dose did not preserve weight loss as strongly as staying on the higher dose. Even so, it performed better than stopping active medication: people kept off more weight on average, and fewer regained half or more of the weight they had lost.

In day-to-day care, this is most relevant once someone has reached a goal weight or kept their weight stable for a while. It may also be relevant if the current dose is becoming hard to continue because of nausea, reflux, constipation, very low appetite or cost.

For more on what low-dose maintenance, micro-dosing and stretching dose intervals mean, see low-dose weight loss medication maintenance.

When might a doctor be cautious about reducing the dose?

The strongest result in the study was still seen in the higher-dose group.

A doctor may be cautious about reducing the dose if:

weight regain has already started
appetite, hunger or cravings have increased again
blood glucose, blood pressure, cholesterol or liver results still need close attention
the current dose is being used for reasons beyond weight alone
there is no suitable lower dose for that medicine

If the dose is reduced, it is worth agreeing on when to check weight trend, appetite, side effects and any relevant blood results.

Where lifestyle support fits in the study

SURMOUNT-MAINTAIN did not test medication in isolation. Participants also received lifestyle support, including dietary and physical activity counselling.

Food intake, protein, resistance exercise, sleep, alcohol, side effects and follow-up can all affect whether weight loss is maintained.

The bottom line

SURMOUNT-MAINTAIN adds to what we know about long term weight loss medication because it included a lower-dose maintenance group, not only a continue-versus-stop comparison.

In the study, staying on the higher study dose gave the strongest weight-maintenance result. Stepping down to the lower study dose maintained more weight loss than stopping active medication, but less than staying on the higher dose.

If you are already using treatment and want to talk about dose, side effects, cost or what happens next, you can book a weight loss review consultation.

Frequently asked questions

Can a lower dose help maintain weight loss?

Yes, for some people. In SURMOUNT-MAINTAIN, people on the lower maintenance dose kept off more weight than people who switched to placebo, although the higher dose maintained weight loss more strongly.

Was the lower dose as effective as staying on the higher dose?

No. The higher dose had the strongest result in the study. The lower-dose results were between the higher-dose group and the placebo group.

Should I reduce my dose once I reach my goal weight?

Only after medical review. Dose reduction depends on your medicine, response, side effects, weight trend, health markers, cost and follow-up plan.

Does everyone need full-dose treatment long term?

No. Some people may continue full-dose treatment, some may reduce, and some may stop. The right approach is individual and should be reviewed with a doctor.

Could a lower dose reduce side effects?

It may help some people, especially with nausea, reflux, constipation or very low appetite at higher doses.

Could a lower dose reduce cost?

Sometimes, but not always. It depends on the medicine, dose, pen device, pharmacy pricing, supply and PBS eligibility. A doctor or pharmacist can help check whether a lower dose would actually change the cost.

What if I regain weight on a lower dose?

Some regain can happen, but a clear upward trend may mean the lower dose is not giving enough support. The prescribing doctor can review appetite, side effects, cost and weight trend, then consider whether the treatment plan should change.