A MARTÍNEZ, HOST:
New obesity treatments like Wegovy or Zepbound help with weight loss, but usually only while people are on them. And because of cost, for example, or bad side effects, many have to transition off while trying not to regain the weight. Here's NPR's Yuki Noguchi.
YUKI NOGUCHI, BYLINE: Over the past few decades, Jonathan Meyers put on pounds he could not shed.
JONATHAN MEYERS: With a bunch of different diets. You know, keto, high protein, low fat, and I have had success up and down, but I always regain the weight.
NOGUCHI: In February, he started taking Zepbound. It was the newest GLP-1 agonist drug to launch - in hot demand and very hard to find. But Meyers was committed. He even had family in Maine ship medicine in cold containers to him in Kensington, Md.
MEYERS: The thinking is that it's more rural up there, and there's not as many people who know about the drug, and there's not as many people are going to be willing to pay the out-of-pocket fee for it, which, you know, is like $550 with the Lilly discount card.
NOGUCHI: Meyers swiftly lost 35 pounds. He no longer has high blood pressure. But what he loves most is freedom from hunger.
MEYERS: That's the biggest component of this whole thing. And so you don't think about food like you used to. When you see, like that candy bar on the aisle, you can just kind of walk past it.
NOGUCHI: He calls this buzzing compulsion food noise. Without it, he ate less and exercised more. But now Meyers, along with many others, can't find Zepbound anywhere. Some are turning to compound pharmacies selling approximations of the drug online. Others are stretching out their doses. Meyers fears backsliding.
MEYERS: I'm worried about the noise coming back because it's so powerful.
NOGUCHI: Either by choice or for reasons outside their control, many people are thinking about how to live life after success on the new obesity drugs. For many, like Meyers, it resurfaces age-old anxieties about past failures with diets. Clinical data so far isn't running in their favor. A majority of patients regained much of the weight lost within the first year of stopping, and experts say that while lifestyle choices like food and activity are the cornerstone of lasting weight loss, they also recognize those changes alone are often not enough. Chronic disease requires chronic treatment. Eduardo Grunvald, director of the weight management program at the University of California, San Diego, says only a handful of his patients have stopped the injections and not seen appetite and weight return. He says that's because the drugs act on various hormonal and metabolic drivers of obesity.
EDUARDO GRUNVALD: It would make sense that once we stop the therapy for those biological problems, that we would have relapse.
NOGUCHI: But there's so much chatter, it can be confusing. Rekha Kumar says social media is full of posts claiming to use obesity drugs short term as a kickstart to a diet.
REKHA KUMAR: We're hearing this, oh, I'm just going to take it for a little bit and stop.
NOGUCHI: Kumar, a physician and former medical director of the American Board of Obesity Medicine, notes that these drugs were intended for medical, not cosmetic, use.
KUMAR: Many of these people that we're hearing that from don't actually qualify for the strict criteria of the medicine.
NOGUCHI: And responses to the drug, or to halting it, will depend on every person's biology, genetics or hormonal makeup. But overall, she says, biology favors regain.
KUMAR: We as humans - it's evolutionary to store this fat and want to keep it on.
NOGUCHI: That potential for weight regain is a major deterrent for these medicines. A poll from the research organization KFF last year found only 14% of people remained interested in treatment after hearing weight often returns after stopping. Drugmakers are already chasing longer-acting maintenance drugs. In the meantime, Kumar says, for those on them longterm, transitioning on and off the drugs will be a reality, if nothing else, because of other medical situations such as a surgery or pregnancy.
KUMAR: So there are going to be scenarios, especially in young people, that we will have to come off the medicine whether they like it or not.
NOGUCHI: So what should patients faced with that situation do? Obesity specialists recommend developing personalized plans with a doctor - tapering off the drugs, for example, while stepping up dietary counseling. That was one option for Jonathan Meyers, the Maryland man still searching for Zepbound. For him, that would mean diligently tracking every bite.
MEYERS: You know, scanning it, using mobile apps, eating, like, a thousand calories a day and just absolutely starving all the time.
NOGUCHI: Instead, Meyers decided to buy the similar drugs sold by a compound pharmacy in Florida. He did so with his doctor's cautious blessing. A week and a half after his first compounded dose, I checked back in with Meyers.
MEYERS: It comes in a vial and syringes and...
NOGUCHI: It's a mixed bag, he says. He feels less dyspeptic on the substitute, but also hungrier.
MEYERS: It doesn't feel exactly the same. It's kind of like, oh, I want a little bit more. And it's not as easy to push the plate aside.
NOGUCHI: There's also plenty of other uncertainties - about the short supply, fluctuating cost and their longterm effects. But he says it's still worth it.
MEYERS: To me, like, if I have GI problems, you know, for the rest of my life, but I don't have a heart attack, you know, or don't have all the other things associated with obesity, it's fine.
NOGUCHI: Yuki Noguchi, NPR News.
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