Experts say new appetite controlling drugs must be taken for life. But here, one woman tells how she’s trying to wean herself off and keep the weight off naturally

Just over two years ago, Rhiannon Doyle had finally had enough of failed diets and awkward appointments with her GP – he had told her she’d reached over 100kg and was considered obese, with signs of pre-diabetes and high cholesterol. She decided to investigate the injections he’d been hearing so much about.

It didn’t come up in conversation with her doctor, but when she got home she Googled ‘Ozempic’ – the brand name of the drug semaglutide – and bought a course of the drug via an online pharmacy, which she started to use. Ozempic is approved for the treatment of diabetes but is often used off-label for weight loss, too.

“I didn’t really have any advice on how to approach it apart from the simple instructions on the prescription,” says Doyle, a businesswoman who lives in London. “For the first few months I was exhausted and had quite a bit of reflux and nausea – but I kept going. In comparison to the risk of having a stroke or a heart attack due to my weight, I was prepared to deal with some minor side effects.”

Soon, on the advice of a medic friend, she switched to getting her prescriptions from a doctor privately and after around a year, happy with her roughly 30kg weight loss, she decided to come off the drugs and lose the last few pounds alone.

Here is where she came unstuck. “All that food noise that had been silenced came flooding back, and along with it the weight was coming back on, too,” she says. “My friend suggested I needed to deal with the emotional side of my eating, so I went back on the medication and this time spoke to a dietitian and a psychotherapist, too.

“I’m not one to blame stuff on my childhood, but they helped me realise that I had a lot of self-esteem issues and that perhaps there was a sense of trying to hide myself behind food and the fat I put on. Once I’d unknitted all these issues in therapy I came to understand that it had made me invisible in a way that shielded me from a lot of potential pain.

“I’m now down to 65 kilos, I’ve just been taking a very low dose for months now and I’m very close to ready to come off that completely,” she says.

Rhiannon Doyle has now lost over 35kg by taking Ozempic

If she proves successful in weaning off entirely, Doyle, now in her mid-forties, will become one of very few patients who’ve lost weight on these ever-more-popular medications to come off the drugs and maintain her new weight permanently. But she believes that with psychological help and dietary education, it’s completely possible patients won’t be on the drugs forever. And, inspired by her own experience, Doyle has now co-founded a company that prescribes weight loss jabs alongside professional dietary and mental health support with this very goal.

“You don’t want patients who have used these medications to find it becomes just another failed ‘diet’,” says Dr Courtney Raspin, a psychologist specialising in eating disorders and eating behaviours. “With help, we hope they can actually address the issues that might have led to their struggles with their weight, and to help them develop a new relationship with food and a more compassionate relationship towards their body.”

However, thoughts among the medical community are mixed, with many experts in the field considering long-term prescription of GLP-1 appetite suppressant drugs to be unavoidable.

Dr Ralph Abrahams is a consultant physician and expert in endocrinology and diabetes who has been prescribing these drugs – and their precursors – for more than a decade, primarily to patients with diabetes.

“In general, the evidence is that when you come off the drugs, you will regain all the weight or more,” he says. “So I’d not readily recommend anyone do so. That doesn’t mean there’s not one or two people somewhere in the world who have succeeded in doing that. But in general, once someone is at the right weight I would advise them to lower the dose and see if they can maintain their new weight on that lower dose, and to continue to do so on as low a dose as possible. There won’t be one prescription for everyone at which that’s doable, it will vary from patient to patient.”

And yet the fact remains that we still know very little about the long-term effects of staying on these drugs – at whatever dosage – for years on end. In trials, patients have only been kept on them for two years, and even now, those who started taking Ozempic the minute it became available to them (for diabetes) in the UK can only have been on it for a maximum of six years, while the even newer Mounjaro has only seen UK patients able to access it for less than two years.

In his new book, Food Noise: How Weight Loss Medications & Smart Nutrition Can Silence Your Cravings, Dr Jack Mosley (son of the late Dr Michael Mosley) expresses some concerns about weight-loss medications. In a recent interview he said: “My dad thought there was huge potential for these drugs, as do I. But the more research I did, the more I was convinced it’s like the Wild West out there. People need to know how to use the GLP-1s and the significant consequences of misusing them.”

He points to research which suggests that 40 per cent of weight lost may be lean body mass (muscle), and when people regain weight, they tend to gain it back as fat rather than muscle. Users can also become malnourished despite losing weight, especially if they are consuming nutrient-poor ultraprocessed foods. What’s more, the drugs are designed for people with obesity or poor metabolic health, not for those seeking to lose a few pounds for aesthetic reasons. Many people are accessing these drugs without proper medical guidance or consideration of their actual health needs.

Dr Abraham is more positive, arguing that for most people on GLP-1 drugs. Side effects such as fatigue and nausea are typically short lived (if they’re not, the dose is wrong, says Abraham) while problems regarding muscle loss are believed not to be some unique effect of the drug, but the result of inadequate protein intake due to loss of appetite. This issue will be resolved by eating more protein combined with resistance training, he says.

More importantly, shedding the excess pounds should have the knock-on effect of improving a variety of important health markers – bringing down insulin resistance in diabetic patients, lessening the load on joints, reducing the risks of various cancers, and lowering blood sugar and blood pressure into a healthier range.

However, as powerful as these drugs are, they can’t reverse the clock to the degree that a person’s body and health outlook won’t bear any mark at all of having once been very overweight. “You can’t ever go back ‘to the beginning’, partly because you will be years older than you were and may have spent many years overweight,” says Dr Abraham.

“The way I look at it is that these patients have optimised their health and their risk factors, but not entirely reversed them. You may still have a risk of diabetes, you can still have some of the long term side effects of obesity – people who’ve been seriously obese for 30 or 40 years have very damaged musculoskeletal systems, arthritis, bad hips and bad knees, and may still need these joints replaced. Similarly, people who have had high cholesterol will already have had thickened arteries for 20 or 30 years of previous high cholesterol.”

Another legacy some patients are finding themselves left with is that of loose skin. For most, this is just a minor cosmetic issue – but for those who have lost many stones in weight, the excess loose skin can be both a physical and psychological burden.

Operations like abdominoplasty and other skin removing or tightening procedures are not available on the NHS unless a comprehensive series of criteria are met. Privately, the costs of this kind of surgery can cost tens of thousands of pounds, depending on the amount of skin needing to be removed.

In the longer term, what more unexpected consequences will people find themselves dealing with? There are anecdotal reports that these drugs may affect libido or increase rates of erectile dysfunction, and links to potential problems with vision. Even the experts admit that we don’t know everything about these medicines yet – so surely there should be some more attention paid to the possibility of living without the drug.

“I’m a great supporter of the fact that the world has access to these drugs,” says Dr Abraham. “But what’s going to happen with 20 or 30 years of use of these drugs is an open question.”