Neglect is a strong word. But if we want to be honest about the excessive emphasis on weight loss in obesity care, it seems appropriate. Research on new therapies for obesity have long neglected the challenge of maintenance therapy for this chronic disease. A new study in Obesity makes this gap plain to see.

A Retrospective Case Series

In a retrospective case series of 38 patients, Michelle Wong, Ash Wu, Pawanjot Garhe, and Mitch Biermann found that patients could maintain and even have further improvements in metabolic parameters and adiposity while stepping down from weekly dosing of semaglutide and tirzepatide. Most of them did well with dosing that was every other week.

Of the 38 patients recruited for this study, four declined to step down from weekly therapy. Four went back to weekly therapy because they started regaining weight. The remaining 30 wound up with dosing regimens that ranged from 10-14 days (six patients) to every other week (17 patients), or even longer intervals (seven patients). One of the patients did well with maintaining their results while dosing of tirzepatide every five to six weeks.

Researchers followed the patients on reduced frequency dosing for 11 to 115 weeks. The average duration recorded on these maintenance regimens was 36 weeks.

Much More to Learn

Obviously this report only provides a hint that improved dosing regimens for maintenance therapy in obesity are possible. It’s merely a case series and the degree of rigor and control is meager. Obesity medicine physician Disha Narang explained:

“This was a small cohort of patients, so while the early data are encouraging, it isn’t enough to change practice broadly. Larger, controlled studies are needed before de-escalation could be considered standard of care. Clinicians may discuss this approach selectively with well-controlled, stable patients, but it should be individualized and closely monitored.”

The bottom line, says Harvard obesity expert Fatima Cody Stanford, is that “chronic treatment does not necessarily mean maximal weekly dosing forever.”

Should we be surprised that individual tailoring of doses for such a heterogeneous disease as obesity might turn out to be best? Absolutely not.

Click here for the study, here and here for further perspective.

Evening in the Field, painting by Isaac Levitan / WikiArt