Do You Need to Take Zepbound or Wegovy Forever with Dr. Angela Fitch
Obesity Is Not an Transient Condition
So, why do some people treat it as such?
In this episode, we invited back Dr. Angela Fitch to explain why obesity should be regarded as a chronic disease—one that requires long-term management. She highlights the risks of taking medications like Wegovy and Zepbound intermittently without proper guidance.
Dr. Fitch is a physician, the immediate past president of the Obesity Medicine Association, and the 2017 Clinician of the Year for the same organization. She also served on the Clinical Management Committee of The Obesity Society in 2016. Currently, she is a physician and the Chief Medical Officer at Knownwell, where she is also a founder.
We discuss the dangers of treating obesity as an episodic condition—where treatment is received temporarily, and individuals are then expected to manage it alone without ongoing support from a weight management center or team.
Additionally, we explore what comprehensive obesity care looks like and emphasize the importance of understanding obesity as a chronic disease that requires a lifelong approach to sustainable health.
Do You Need to Take Zepbound or Wegovy Forever?
Obesity is more than just weight gain; it is a chronic disease that involves complex metabolic, hormonal, and genetic factors. Understanding this distinction helps clarify why managing obesity often requires long-term solutions, including medications like Zepbound or Wegovy.
Our bodies are not designed to lose weight easily. Weight loss is not a natural biological process like blinking or breathing. Instead, when we lose weight, our bodies activate mechanisms to restore what they perceive as a "healthy" weight. This includes hormonal shifts and a slowed metabolism, making it harder to maintain weight loss over time.
For example, studies on contestants from The Biggest Loser highlight this challenge. Participants who regained weight after significant loss found their metabolic rates permanently reduced. Even after returning to their starting weight, they burned fewer calories daily than before the weight loss—sometimes up to 500 calories less. This phenomenon illustrates how yo-yo dieting can have long-lasting effects on metabolism.
Pregnancy or short-term weight gain from medications like steroids can also affect the body's "weight thermostat," making it harder to lose weight later. However, for individuals with obesity—a condition characterized by excess adiposity—weight management involves more than addressing short-term fluctuations.
Medications like Zepbound or Wegovy play a critical role in long-term weight management. They help regulate appetite and metabolic pathways, providing essential support in maintaining weight loss. However, stopping these medications without a clear plan can lead to weight regain, as the underlying biological processes driving initial weight gain often persist.
It’s important to recognize that managing obesity requires a comprehensive approach. Medications alone are not the solution but are part of a broader strategy that includes lifestyle changes, such as regular exercise, dietary adjustments, and behavioral support. For those planning life changes, such as pregnancy, adjustments to weight management strategies may be necessary, but maintaining consistency wherever possible is key.
Obesity care is about more than achieving a specific number on the scale. It’s about improving health, addressing metabolic challenges, and creating sustainable habits. Whether or not medications like Zepbound or Wegovy become a lifelong tool depends on individual needs and circumstances. Working with healthcare providers to create a personalized plan is essential for long-term success.
What does comprehensive obesity care look like?
When we talk about comprehensive care in managing obesity, it’s not just about prescribing medication and sending someone on their way. It’s about having a conversation with patients, understanding their goals, and ensuring those goals are realistic. Often, people set expectations of losing a large percentage of body weight, like 30-50%, but that’s not always possible with current medications or even surgery. While some people may achieve significant weight loss, there are always individual variations.
In some cases, weight gain is due to factors that can be reversed, like medication or being immobile due to injury. In such cases, medication might help, but once the underlying issue is addressed, the weight loss could be maintained without long-term medication. But that’s not the case for everyone, and we need to set realistic expectations.
Comprehensive care can't just happen through filling out an online form. It requires ongoing, personal interactions—whether in person or virtually—so we can dig deeper and address issues that might not be apparent from a form. For example, PHQ-9s, which I use in my clinic as depression screenings, often reveal how patients rush through forms. I’ve encountered patients checking “yes” to questions about self-harm, and when I talk to them about it, they admit they didn’t truly mean it—they just rushed through the form.
This just goes to show how important comprehensive care is. If these nuances aren’t explored through conversations, critical issues could be missed, leaving patients without the support they need.
We also have to remember that weight management is a long-term journey, not just about a quick fix. Medications, diet, and exercise are part of the process, but they need to be maintained. If you start something like the ketogenic diet, it’s only effective if it becomes a permanent lifestyle. Similarly, medications support long-term weight management, but stopping them can lead to weight regain, which becomes harder to manage over time.
The issue with weight cycling is that it gets harder to lose the weight again once it’s regained. Metabolic adaptations and emotional stress complicate this process. And patients need to know that it’s never their fault when the weight comes back. The journey requires continuous support and adjustments, whether due to side effects, financial limitations, or major lifestyle changes.
Understanding Weight and Obesity as a Chronic Disease
Weight and obesity often get lumped together, but they’re not the same. Weight is just a measure of body mass, while obesity is a chronic condition influenced by biology, environment, and behavior. Losing weight can be especially tough because the body fights back—slowing metabolism and storing fat to regain what’s been lost. That’s why sustained weight loss takes more than just willpower.
Research, like Dr. Kevin Hall’s studies on The Biggest Loser participants, shows how challenging long-term weight loss can be. Even after regaining weight, participants burned far fewer calories than before they lost it—a lasting metabolic adaptation. This helps explain why weight cycling—losing and regaining weight over and over—makes it harder to manage weight in the long run.
Real obesity care isn’t just about dropping pounds. It’s about personalized, long-term strategies that tackle related conditions like sleep apnea or prediabetes and encourage healthy habits like staying active—things that improve overall well-being no matter what the scale says. Comprehensive care sees obesity as a complex issue that needs tailored solutions.
One of the most important parts of effective care is having real, meaningful conversations between patients and clinicians. These talks help set realistic goals, align expectations, and create a team effort. By understanding each person’s unique challenges, healthcare providers can deliver holistic care that empowers patients to improve their health in a sustainable way—focusing not just on the scale but on living a better, healthier life.
A Lifelong Approach to Sustainable Health
Treating obesity as a chronic condition requires ongoing management. Medications are part of a broader strategy and must be maintained for continued success. Stopping a medication often leads to weight regain, making it harder to lose the weight again due to metabolic adaptations. The misconception of using medications as a temporary "jumpstart" must be addressed—whatever method is used for weight loss often needs to be sustainable for lasting results.
Long-term care also involves adapting treatment plans as circumstances change. Side effects, lifestyle shifts, or specific needs, such as planning for pregnancy, might require adjustments. However, ceasing treatment without alternatives is not a helpful solution. For example, recommending patients stop medication when health coverage changes without addressing affordability or providing lower-cost options can lead to setbacks. Careful consideration and flexibility are vital to support patients effectively.
The complexity of obesity treatment highlights the need for clinician-patient partnerships. It’s not just about prescribing the right medication but ensuring patients understand the importance of consistency and the challenges of stopping and restarting treatments. Some healthcare providers may unintentionally undermine progress by suggesting discontinuation without understanding the long-term implications.
Understanding obesity as more than just a number on the scale can change how we approach health. It’s about long-term care, meaningful conversations, and focusing on overall well-being. If this resonates with you, don’t miss the full episode where we explore these topics in detail. Tune in now to learn more about comprehensive obesity care and what it really takes to achieve sustainable health!
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