Sydney University endocrinologist Associate Professor Samantha Hocking said the research finding was in keeping with her expectations because obesity, like conditions including high blood pressure and high cholesterol, is a biological condition.
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“Rather than being something that is solely personal responsibility, we know there are biological drivers in weight regain in response to losing weight,” Hocking said.
“One of the things bodies do when we lose weight is increase hunger hormones and lower satiety hormones, driving increased appetite and hunger.”
Without the ground-breaking medications, which almost all Australian patients must still pay for privately at a cost of up to about $700 per month, people’s bodies respond to weight loss with biological strategies to recover it.
Hocking said the more significant story reflected in the research was the wide-ranging health benefits of the new medications.
The paper stated that “these new weight management medications (WMMs) have been shown to lead to notable short-term improvements in liver fibrosis, renal outcomes, and sleep apnoea and in reduced incidence of cardiovascular disease”.
“A recent trial showed that continuous use of semaglutide [Ozempic/Wegovy] over four years reduced major cardiovascular disease events in individuals with existing cardiovascular disease,” the authors stated.
Associate Professor Dominika Kwasnicka, a behavioural scientist and public health researcher at the University of Melbourne, said the findings did not suggest weight-loss medications do not work, but highlighted that medications act on biological pathways and do not establish behavioral or systemic changes.
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“For Australia, this [study] has important policy implications,” she said. “Access to these medications is expanding, often with substantial out-of-pocket costs and limited structured follow-up.
“These results support the need to embed pharmacotherapy within comprehensive, long-term models of care that include behavioural support, continuity of care, and realistic discussions about duration of treatment, rather than viewing these medications as short-term solutions.”
The study’s authors found it is common for people using the medications to stop taking them within the first year, which shows “the need for caution when it comes to short-term use of weight loss drugs”.
Professor Garron Dodd, head of the metabolic neuroscience laboratory at the University of Melbourne, said the study reinforced that while the GLP-1 drugs had changed the conversation around treatment of obesity and type 2 diabetes, it also demonstrated they are not a silver bullet.
“They are a very exciting start, and we must not be deflated [by the finding that weight returns when people stop the drugs]. If anything, it opens up huge possibilities: now the world is looking at obesity therapeutics and where it’s going next, there is arguably no more exciting area in science right now,” he said.
Research to understand why the body actively defends its weight and responds to weight loss was under way, he said, and sustainable combination treatments were likely to arrive in future that “reshape how the brain interprets energy balance, not just how much people eat”.
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