How I Maintained Weight Loss with Semaglutide
February 10, 2024
If you read my prior blog about using semaglutide, I did the typical 10-week treatment and lost 17 pounds towards the end of 2022, ending at 165.6 pounds. I stopped cold turkey to see what would happen – at about 6 weeks, I noticed that everything tasted so delicious that once I started eating, I couldn’t stop. That was the pleasure response to food coming back after being suppressed by semaglutide, and it contributed to some weight gain over the subsequent 3 months (~3 pounds). That is also why we recommend going on a maintenance dose for 6 months when you reach your goal weight. I decided to go back on a low dose for maintenance, starting at 168.8 pounds on March 11, 2023.
Over the subsequent 11 months, I stayed on a dose of 0.25mg/week (lowest starting dose for non-diabetics) to 0.375mg/week the entire time. I ended off the last 3-4 months on the lowest dose. I did not weigh myself and I did not monitor macros or calories. Because of life and work obligations, my workout routine became sporadic where I would only be able to work out 2-3 times a week, and I was not able to work out at all during the last 3 months. I just recently weighed myself on February 10th, 2024 and my weight was 170.2 pounds – only 1.4 pounds heavier. The heaviest I have ever been is 202.2 pounds and my set point was around 180-182 pounds for as long as I can remember. I was 182.4 pounds when I started semaglutide back in November 2022 (read blog post by clicking here).
Many people (and providers) make the mistake of thinking weight loss treatment with GLP-1 receptor agonists like Semaglutide is like a switch – either it’s on and you are losing weight, or it’s off and you are not. It’s better to think of it as a dimmer that has numerous settings between on and off (see figure below). In addition to on and off, there is a “prevent weight gain and bad habits” setting (blue arrow), “mild weight loss and prevent/break bad habits” setting (green arrow), and “moderate weight loss and break bad habits” setting (yellow arrow). By adjusting the weekly or monthly dose, you can move between the different settings to achieve your goals.
During my initial 10-week treatment, my setting was at the yellow arrow. I had the typical amount of nausea, which occurred 2-3 times per week and lasted approximately 5 minutes. When I went on the low weekly maintenance dose (blue arrow), I only experienced mild nausea at 0.375mg/week and did not experience any side effects at lower doses. This is why I eventually settled on 0.25mg/week for the last 3-4 months – I did not have any side effects. And that dose was effective enough to prevent weight gain and late-night snacking.
Another key consideration is the potential health benefit of these weight loss treatments that go beyond simply losing weight. Below is a chart showing the top 10 causes of death in the United States for 2022. The top 3 contributing factors for the majority of these diseases are 1) calorie excess, 2) poor dietary choices, and 3) sedentary lifestyle. Semaglutide treatment can prevent calorie excess and contributes to improved dietary choices. When coupled with either aerobic or anaerobic exercise, even low dose treatment with these weight loss medications has the potential to improve lifespan and quality of life for millions of Americans. Just a few months ago, Wegovy was shown to reduce heart attack risk by 20%. I predict we will see improvements in several of the top causes of death as these weight loss treatments are more widely accepted and used.
Even though I didn’t monitor macros/calories or exercise regularly, there were a few key behaviors I maintained to prevent weight gain and developing bad habits:
- Good food choices: The majority of my meals were a healthy balance of carbs, protein and fat. For protein, most meals were chicken, eggs, turkey or cottage cheese. For carbohydrates, I avoided sugar and tried to choose whole grains over processed/refined carbs. For fats, I primarily used olive oil, egg yolks (2 per day), avocado, and nuts. Even when ordering out, I tried to find something relatively healthy on the menu.
- Limit portion size: This was easy because of the semaglutide, which continued to provide appetite suppression even at the lowest dose.
- Avoid late night snacking: My bad habit is eating after dinner, especially while working night shifts. I made a conscious effort not to eat unhealthy snacks after dinner. I kept beef jerkey and pretzels in my office if I needed something to snack on. Every once in a while, I would eat toffee brownie brittle – just enough to enjoy but not feel full.
Today is Sunday February 10th, 2024, and I have now been off semaglutide treatment for 2 months. Regaining the weight after stopping treatment is a common complaint, so I am going to see what happens over the next year off treatment. My suspicion is that most people regain the weight because the treatment was short-term, focused on weight loss rather than developing better habits, and resulted in loss of muscle, which reduces your basal metabolic rate and makes you more likely to gain weight. This is why we recommend that patients lose no more than 1-2 pounds per week, get at least 20% of their calories from protein, and add weight bearing exercises to their workout routine 2-3 times per week. My goal for 2024 is to gain 2-4 pounds of muscle, so I have increased my caloric intake to more than 2500 calories a day combined with hypertrophy-specific training workout routines 3 times a week and healthy eating. Check back early 2025 to see how I do.
Links to other blogs about weight loss
