Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.

Drugs like Ozempic are very effective at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger.

But does weight come back when you stop using it?

The short answer is yes. Stopping tirzepatide and semaglutide will result in weight regain in most people.

So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far.

It’s a long-term treatment, not a short course

If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone.

For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns.

Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.)

Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less.

Why do people stop?

Research trials show anywhere from 6% to 13.5% of participants stop taking these drugs, primarily because of side effects.

But these studies don’t account for those forced to stop because of cost or widespread supply issues. We don’t know how many people have needed to stop this medication over the past few years for these reasons.

Understanding what stopping does to the body is therefore important.

So what happens when you stop?

When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to move out of your system. As it does, a number of things happen:

• you start feeling hungry again, because both your brain and your gut no longer have the medication working to make you feel full

• blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a low glycemic index to stabilise your blood sugars
• over the longer term, most people experience a return to their previous blood pressure and cholesterol levels, as the weight comes back
• weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle.

While you were on the medication, you will have lost proportionally less skeletal muscle than fat, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat.

Is stopping and starting the medications a problem?

People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of yo-yo dieting.

When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to deal with spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can stress your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual.

Interestingly, the risk to the body from weight fluctuations is greater for people who are not obese. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight.

How can you avoid gaining weight when you stop?

Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include:

• getting quality sleep
• exercising in a way that builds and maintains muscle. While on the medication, you will likely have lost muscle as well as fat, although this is not inevitable, especially if you exercise regularly while taking it

• addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is fat-phobic and discriminates against people in larger bodies
• eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes.

Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important.

Read the other articles in The Conversation’s Ozempic series here.

Natasha Yates, General Practitioner, PhD Candidate, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Medical experts recommend antivirals for people aged 70 and older who get COVID, and for other groups at risk of severe illness and hospitalisation from COVID.

But many older Australians have missed out on antivirals after getting sick with COVID. It is yet another way the health system is failing the most vulnerable.

Who missed out?

We analysed COVID antiviral uptake between March 2022 and September 2023. We found some groups were more likely to miss out on antivirals including Indigenous people, people from disadvantaged areas, and people from culturally and linguistically diverse backgrounds.

Some of the differences will be due to different rates of infection. But across this 18-month period, many older Australians were infected at least once, and rates of infection were higher in some disadvantaged communities.

How stark are the differences?

Compared to the national average, Indigenous Australians were nearly 25% less likely to get antivirals, older people living in disadvantaged areas were 20% less likely to get them, and people with a culturally or linguistically diverse background were 13% less likely to get a script.

People in remote areas were 37% less likely to get antivirals than people living in major cities. People in outer regional areas were 25% less likely.

Even within the same city, the differences are stark. In Sydney, people older than 70 in the affluent eastern suburbs (including Vaucluse, Point Piper and Bondi) were nearly twice as likely to have had an antiviral as those in Fairfield, in Sydney’s south-west.

Older people in leafy inner-eastern Melbourne (including Canterbury, Hawthorn and Kew) were 1.8 times more likely to have had an antiviral as those in Brimbank (which includes Sunshine) in the city’s west.

Why are people missing out?

COVID antivirals should be taken when symptoms first appear. While awareness of COVID antivirals is generally strong, people often don’t realise they would benefit from the medication. They wait until symptoms get worse and it is too late.

Frequent GP visits make a big difference. Our analysis found people 70 and older who see a GP more frequently were much more likely to be dispensed a COVID antiviral.

Regular visits give an opportunity for preventive care and patient education. For example, GPs can provide high-risk patients with “COVID treatment plans” as a reminder to get tested and seek treatment as soon as they are unwell.

Difficulty seeing a GP could help explain low antiviral use in rural areas. Compared to people in major cities, people in small rural towns have about 35% fewer GPs, see their GP about half as often, and are 30% more likely to report waiting too long for an appointment.

Just like for vaccination, a GP’s focus on antivirals probably matters, as does providing care that is accessible to people from different cultural backgrounds.

Care should go those who need it

Since the period we looked at, evidence has emerged that raises doubts about how effective antivirals are, particularly for people at lower risk of severe illness. That means getting vaccinated is more important than getting antivirals.

But all Australians who are eligible for antivirals should have the same chance of getting them.

These drugs have cost more than A$1.7 billion, with the vast majority of that money coming from the federal government. While dispensing rates have fallen, more than 30,000 packs of COVID antivirals were dispensed in August, costing about $35 million.

Such a huge investment shouldn’t be leaving so many people behind. Getting treatment shouldn’t depend on your income, cultural background or where you live. Instead, care should go to those who need it the most.

People born overseas have been 40% more likely to die from COVID than those born here. Indigenous Australians have been 60% more likely to die from COVID than non-Indigenous people. And the most disadvantaged people have been 2.8 times more likely to die from COVID than those in the wealthiest areas.

All those at-risk groups have been more likely to miss out on antivirals.

It’s not just a problem with antivirals. The same groups are also disproportionately missing out on COVID vaccination, compounding their risk of severe illness. The pattern is repeated for other important preventive health care, such as cancer screening.

A 3-step plan to meet patients’ needs

The federal government should do three things to close these gaps in preventive care.

First, the government should make Primary Health Networks (PHNs) responsible for reducing them. PHNs, the regional bodies responsible for improving primary care, should share data with GPs and step in to boost uptake in communities that are missing out.

Second, the government should extend its MyMedicare reforms. MyMedicare gives general practices flexible funding to care for patients who live in residential aged care or who visit hospital frequently. That approach should be expanded to all patients, with more funding for poorer and sicker patients. That will give GP clinics time to advise patients about preventive health, including COVID vaccines and antivirals, before they get sick.

Third, team-based pharmacist prescribing should be introduced. Then pharmacists could quickly dispense antivirals for patients if they have a prior agreement with the patient’s GP. It’s an approach that would also work for medications for chronic diseases, such as cardiovascular disease.

COVID antivirals, unlike vaccines, have been keeping up with new variants without the need for updates. If a new and more harmful variant emerges, or when a new pandemic hits, governments should have these systems in place to make sure everyone who needs treatment can get it fast.

In the meantime, fairer access to care will help close the big and persistent gaps in health between different groups of Australians.

Peter Breadon, Program Director, Health and Aged Care, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.