After Oprah Winfrey confirmed she’s taking a weight-loss drug as part of her regimen to stay healthy, questions began about how exactly she’s using the medication.
Winfrey didn’t specify which treatment she’s been prescribed in her exclusive interview with People, published on Dec. 13.
The possibilities include Wegovy and Zepbound, which are approved for weight loss for people with obesity or complications from being overweight. Many patients have also been using Type 2 diabetes drugs Ozempic and Mounjaro off-label because weight loss is one of their side effects.
All of the medications mimic a hormone known as GLP-1, which the body releases when a person eats food. Zepbound and Mounjaro also target a second hormone.
'I now use it as I feel I need it'
The headline of Winfrey’s interview with People described her approach to the medication as using it as a “maintenance tool” after decades of fluctuating weight.
“I now use it as I feel I need it, as a tool to manage not yo-yoing,” she told the magazine.
Winfrey also said she took the medication before Thanksgiving “because I knew I was going to have two solid weeks of eating.” Instead of gaining 8 pounds like she did last year, she only gained half a pound, she revealed, noting the drug “quiets the food noise.”
It’s unclear whether the talk show host intends to take the medication long-term to prevent weight regain or if she plans to only use it intermittently. TODAY.com has reached out to Winfrey for comment.
Dr. Christopher McGowan, a gastroenterologist and obesity medicine specialist who runs a weight loss clinic in Cary, North Carolina, says his take on her comments is that she’s using the drug for long-term maintenance.
“The way I interpret that quote is that she presumably has used this medication for some period of time to help her lose weight, and she’s planning to stay on it for maintenance, which is exactly how these medications are intended to be used,” McGowan tells TODAY.com.
“She’s an individual who has, as she admits, yo-yo dieted for many, many years. The last thing that she should do is use the medication to lose weight and then stop that medication. She’s inevitably going to regain the weight.”
Below, McGowan answers questions about the dos and don'ts of taking weight-loss medications.
Why do people need to stay on these weight-loss medications?
If you look at the FDA indication for Wegovy and Zepbound, they are for chronic weight maintenance. That’s a key description because they are for patients with obesity and pre-obesity who need to lose weight, but they also help patients preserve that weight loss.
Some individuals may think they can use a weight-loss medication, lose the weight and then discontinue it, but research shows that the average weight gain within a year of stopping the medication is two-thirds of the weight that was initially lost. Most patients will return to their baseline weight if they stop the medications, as that is the nature of obesity, a chronic, progressive and relapsing condition.
What happens when people lose the expected 15% to 20% of their body weight with these drugs?
Each patient will reach a point at which their weight loss plateaus, and then that would be what we consider the maintenance phase.
At that point, the patient should plan to stay on the medication indefinitely. They may stay on the highest dose or go back down one or two doses. That medication is in the background helping them to control the weight.
If they were to stop the medication, the weight would naturally begin to creep back.
If "maintenance" means someone wants to use a weight-loss medication intermittently, what’s your take?
The GLP-1 medications are absolutely not designed to be used on an as-needed basis. These are generally not to be used intermittently. They are designed for chronic long-term treatments.
So no, I would not recommend that for anybody. It’s really not a sustainable strategy. Someone who starts a medication for weight should plan to continue that medication long-term, and this again speaks to the nature of obesity. There is no cure for obesity. There are only treatments.
Can you go on and off these drugs without consequence?
The medications completely exit the body after three and four weeks. After that period, we need to restart the medication at its lowest dose to limit side effects.
For most of these medications, it takes a four-to-six-month titration process to get back up to the highest dose. So it's very problematic if someone discontinues the medication, whether they’re forced to because of supply limitations or whether they choose to.
Can doctors prescribe these medications for weight maintenance?
We have to treat each patient as an individual, so there may be circumstances where that’s an appropriate decision.
We do use anti-obesity medications for patients who have met their goal through other interventions, such as bariatric surgery, but still need additional assistance. Over time, weight recurrence can occur, and they need another level of support.
Medications can be a valuable tool in that scenario, even if they haven’t been specifically studied for that indication.
Someone who’s lost weight on their own or through other means, has a lower BMI and wants to start an anti-obesity medication for maintenance may not qualify under the FDA indications, which means their insurance is unlikely to cover them.
But yes, there is a bit more nuance to this than these strict FDA indications. As an obesity specialist, we can use them off-label when needed.
This interview has been condensed and edited for clarity.
