5.4 Week 8 onwards: Further monitoring and support

At the week 8 consultation, the framework in Table 3 can be used again with a discussion about whether the person wants to try the next dose increase or stay at the same dose for longer. Depending on side-effects and tolerability, they might prefer to down-titrate the dose or prolong the time between dose increases.

It is worth noting that GLP-1 clinical trials typically had weekly support for 12 weeks to handle adverse effects and were titrated to the appropriate dose for that person, as well as providing advice and support on diet and physical activity, then less frequently until the end of treatment.

Be aware that weight loss itself can be associated with stigma and judgement from others who may be curious (even ‘nosey’) and questioning.

Abrupt discontinuation of GLP-1s (a ‘hard stop’) was used in clinical trials and weight regain in most people is well documented in these circumstances. There is ongoing debate in the scientific community about whether GLP-1s should be stopped abruptly or tapered, and about the use of ‘maintenance’ doses to sustain weight loss alongside exercise and modified diet. Keep an eye out for future changes in practice.

Finding ways to enhance social support for changed behaviours may be a crucial part of preventing medium to long-term weight regain. Family members and friends have been shown to be key; less is known about work colleagues and other people in the person’s network. Asking about this and simply listing or mapping points of contact and people can be helpful in identifying opportunities.

It is worth noting that while family members and friends may be supportive of the person’s efforts to lose or maintain weight, they may also intentionally or unintentionally undermine efforts. Difficulty in changing behaviours such as unhealthy eating within the family can be a major barrier for some people. Trying to accommodate different family members’ food preferences has been shown to lessen people’s efforts to eat healthily.