With regular exercise, medical weight loss treatment does not have to be permanent

For nearly a year, we have been debating weight loss drugs like Wegovy, Zepbound, Saxenda and similar products and what happens when people stop taking them. Are they able to maintain weight loss? A new Danish study sheds light on the matter.

You have probably noticed that weight loss drugs like Wegovy have been the subject of debate for some time now. And for good reason. Because in a world where more and more people live with obesity, they help people lose excess fat.

Unfortunately, there is a downside. The general perception is that those who stop taking the medication will have difficulties maintaining weight loss. But that is not necessarily the case. So says Professor Signe Sørensen Torekov from the Department of Biomedical Sciences, who is leading a new study conducted at the University of Copenhagen and Hvidovre Hospital.

"It is actually possible to stop taking the medication without large weight regain, if you follow a structured exercise regime. Our study offers new hope, as we have shown that the majority of those who take weight loss medication and exercise regularly are able to maintain the beneficial effects a year after treatment termination," she says.

The team of researchers has studied the effects following treatment for obesity, and they have been able to answer some of the key questions about these relatively new types of drugs. The study, "Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomized placebo-controlled trial," was just published in eClinicalMedicine.

And the results speak for themselves. So says Postdoc Simon Birk Kjær Jensen, who is first author of the study, which formed part of his Ph.D. thesis.

"Even though medical treatment for obesity is effective, people who stop taking the drugs have difficulties maintaining the beneficial effects. Within a year, they will typically have gained more than two thirds of the lost weight. However, our study shows that people who exercise during treatment do not have the same propensity to put on weight post treatment," he says.

Two hours of exercise a week is enough

The study included four groups of test participants. One group was given a placebo, another group was given a weight loss drug, Saxenda, liraglutide 3 mg to be exact, a third group was asked to exercise, while a fourth group was given the weight loss drug and exercised regularly. Before being divided randomly into groups, all the participants had eaten a diet low on calories.

The results of the study show that those who exercised during treatment did not have to spend more than a couple of hours a week in training shoes to maintain the beneficial effects of the treatment.

"All it takes is two hours of exercise a week that gets the heart rate up and makes you pant. And it may differ from one person to the next. For people with severe obesity and low initial fitness level, a brisk walk may be sufficient, whereas people with higher fitness level may have to practice running or cycling, e.g., interval spinning," Simon Birk Kjær Jensen explains.

In fact, the study shows that the exercise groups experienced better quality of life.

"From our data, it is clear that those who followed an exercise regime with or without treatment with obesity drugs felt less tired and more energetic. They also experienced better mental health. It simply led to improved quality of life," Signe Sørensen Torekov says. "The same did not apply to those who only received medical treatment. In fact, they felt more tired and less energetic."

Prescription exercise

According to the researchers responsible for the new study, there is therefore reason to consider adding exercise recommendations to prescriptions for weight loss drugs to increase people's chances of maintaining weight loss and the beneficial effects post treatment.

"We now have an effective drug for obesity, and we need it, because a lot of people are suffering from obesity. But according to our data, it is super important to combine medical treatment with regular physical exercise, because of the beneficial effects hereof, e.g., better quality of life and muscle mass maintenance," Simon Birk Kjær Jensen says.

"The study almost makes me want to advise against medical treatment without increased physical exercise, especially if you do not want to be taking the drugs for the rest of your life. We need to stop thinking that people who weigh less also exercise more, because that is simply not the case. It requires structure, support and habit building. The good news is that post-treatment weight loss maintenance is possible, but only when combined with exercise," says Signe Sørensen Torekov.