There’s No Easy Way to Stop Taking Ozempic


主要成分为司美格鲁肽的GLP-1类减肥药正流行，可是一旦停用也会面临体重反弹的风险，一直用药也不现实。如何停药更科学？


如果没有保险，包括Wegovy在内的减肥药每月要花费大约1,000美元。

如果你不得不停止使用减肥药，会发生什么情况？ 6park.com
What happens if you have to go off weight-loss drugs? 6park.com
   
对于数百万正在使用Wegovy、Zepbound或诺和泰(Ozempic)等药物的美国人来说，这是一个越来越令人担忧的问题。雇主健康计划正在收紧要求或者缩小覆盖范围。而且制药商为新上市药物提供的折扣券也到期了，这样一来，如果没有保险，用药者每月就必须支付大约1,000美元。 6park.com
It’s a growing concern for the millions of Americans taking medications including Wegovy, Zepbound or Ozempic. Employer-health plans are tightening requirements or dropping coverage. And manufacturers’ discount coupons for initial supplies of medication expire, leaving people having to cough up roughly $1,000 a month without insurance.  6park.com
   
对患者来说，这是一个难题。许多医生表示，他们必须无限期地使用胰高血糖素样多肽-1(GLP-1)类药物，否则就面临体重反弹的风险。但是，对很多人来说，永远使用这类药物不是一个现实的选择。 6park.com
For patients, this presents a conundrum. They have to stay indefinitely on the drugs, known as GLP-1s, or risk gaining back the weight, according to many doctors. But for lots of people, taking the medication forever isn’t a realistic option.  6park.com
    
面对这种困境，有些人正在尝试改用不同的GLP-1类药物，看看他们的保险能否覆盖这种药物。还有些人正在研究比较老的减肥疗法或者在配置药房寻找较便宜的替代品。 6park.com
Faced with this predicament, some are trying to switch to a different GLP-1 to see if their insurance will cover it. Others are looking into older anti-obesity treatments or finding cheaper versions at compounding pharmacies.  6park.com
   
所有替代选择都不完美。比较老的药物效果不佳，比较便宜的复方药，医生又担心其安全性和质量。 6park.com
No option is perfect. Older drugs don’t work as well, and doctors worry about safety and quality with cheaper compound versions.  6park.com
   
41岁的克里斯蒂娜·海沃斯(Christine Hayworth) 来自加利福尼亚州长滩，她在使用GLP-1类药物一年后大约减重60磅（约27公斤）。但是到了去年秋天，她的制药商储值卡到期了，于是她停止了用药。 6park.com
Christine Hayworth, a 41-year-old in Long Beach, Calif., lost about 60 pounds in a year on GLP-1 medication. But in the fall, she stopped taking it when her manufacturer savings card expired.  6park.com
    
在停药一个半月后，她的体重反弹了8至10磅（约3.6-4.5公斤）。她说，最终她从获得了对Wegovy的保险批准，重新减掉了这些体重。 6park.com
In the month and a half when she was off the drugs, she regained 8 to 10 pounds. Ultimately she got insurance approval for Wegovy, and relost the weight, she says. 6park.com
    
“我当时陷入了恐慌，在那段时间里，我感觉自己的体重在呈螺旋式上升，”她说。“我成功减掉那么多。现在如果都长回去该怎么办？” 6park.com
“I went into a panic, and during that time it was like my body was spiraling,” she says. “I had all this success. Now what if I just go backwards?”

获得保险批准

Wegovy及诺和泰的制造商诺和诺德公司(Novo Nordisk)资助了2022年的一项研究，这项被广泛引用的研究发现，患者在停止使用司美格鲁肽（semaglutide，这些药物的主要成分）一年后，体重反弹了三分之二。Wegovy被批准用于治疗肥胖症。诺和泰被批准用于治疗二型糖尿病，但很多人用它来减重，属于超说明书用药。 6park.com
A commonly cited 2022 study funded by Novo Nordisk, the manufacturer of Wegovy and Ozempic, found that patients regained two-thirds of their lost weight a year after they stopped taking semaglutide, the main component in the medications. Wegovy is approved for obesity treatment. Ozempic is approved for Type 2 diabetes, but many people take it off-label for weight loss. 6park.com
   
人们通常在开始使用GLP-1类药物六到九个月后减重效果达到最大化，然后进入停滞期，波士顿布莱根妇女医院(Brigham and Women’s Hospital)体重管理和健康中心联合主任卡罗琳·阿珀维安(Caroline Apovian)说道。 6park.com
People typically reach peak weight loss and plateau six to nine months after starting to take GLP-1 medications, says Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston.


Wegovy的流行引发了人们对保险覆盖范围和成本的担忧。

医生表示，随着健康计划越来越关注成本，患者越来越难获得这类药物的保险覆盖。他们指出，保险覆盖问题主要影响的是以减肥为目的的服药者，而不是为了治疗二型糖尿病的患者。 6park.com
Doctors say it has become harder for patients to be covered for these drugs as health plans grow more concerned about costs. The coverage issues mainly affect people taking the drugs for weight loss, not for managing Type 2 diabetes, doctors say. 6park.com
   
远程医疗减重诊所Mochi的首席执行官迈拉·艾哈迈德(Myra Ahmad)博士表示，回想2022年的时候，大约有60%的预授权获得了保险公司的批准。现在这个比例下降到25%-30%。 6park.com
Back in 2022, about 60% of prior authorizations got approved by insurers, says Dr. Myra Ahmad, chief executive of Mochi, a telehealth obesity clinic. Now the rate is down to 25% to 30%, she says.  6park.com
  6park.com
她说，体重反弹刚开始很平缓，然后会变得更加剧烈。 6park.com
Weight regain is gradual at first, then comes back more forcefully, she says.  6park.com
    
如果你无法获得一种药物，你可以让你的医生尝试向保险公司申请批准另一种药物。比如说，如果你用过Wegovy，可以尝试获得Zepbound的保险覆盖。 6park.com
If you lose access to one drug, you can have your doctor try to get your insurance to approve a different one. So if you’ve been on Wegovy, for instance, you could try getting coverage for Zepbound. 6park.com
    
还有一些比较老的减肥药物，但它们的效果没那么好，而且可能有更多的副作用，比如芬特明(phentermine)、Contrave和Qsymia，也有超说明书用药，例如将糖尿病治疗药物二甲双胍(gumetformin)用来减重。 6park.com
There are also older anti-obesity medications, but they aren’t as effective and might have more side effects, such as phentermine, Contrave and Qsymia, as well as drugs that are taken off-label for weight loss, such as the diabetes medication metformin. 6park.com
   
患者往往需要使用多种药物，并努力改变饮食和健康习惯，洛杉矶西达赛奈体重管理和代谢健康中心(Cedars-Sinai Center for Weight Management and Metabolic Health)的肥胖医学主任阿曼达·贝拉斯克斯(Amanda Velazquez)博士这样说道。 6park.com
Often, patients have to go on multiple medications as well as trying to change their diet and exercise habits, says Dr. Amanda Velazquez, director of obesity medicine at Cedars-Sinai Center for Weight Management and Metabolic Health in Los Angeles. 6park.com
   
阿珀维安说，高蛋白饮食、远离过度加工食品以及在锻炼中增加阻力训练也对减重有帮助。 6park.com
Eating a high-protein diet, staying away from ultra-processed foods and adding resistance training to your workouts also helps, says Apovian. 6park.com
    
阿珀维安说，还有一种可能性是减重手术，从长期来看，这可以让患者减去最多达35%的体重。她说，对于需要减掉20%以上体重的人来说，这是一个不错的选择。 6park.com
Another possibility is bariatric surgery, which can result in patients’ losing up to 35% of their body weight in the long term, says Apovian. This is a good option for people who need to lose more than 20% of their body weight, she says.

停药策略

医生表示，需要进行更多研究才能确定（有停药需求的）患者的最佳停药方式。斯坦福生活方式和体重管理诊所(Stanford Lifestyle and Weight Management Clinic)的医务主任丹·阿扎古里(Dan Azagury)指出，如果可能的话，停用GLP-1类药物的最佳方法是非常循序渐进地减少使用剂量。 6park.com
Doctors say more research is needed to determine the best way to go off the drugs for patients who need to. If possible, the best way to go off GLP-1s is to reduce your dosage very gradually over time, says Dr. Dan Azagury, medical director of Stanford Lifestyle and Weight Management Clinic. 6park.com
   
“如果你突然停药，你的体重几乎铁定会反弹，”他说。“如果你一下子就把药停了，真的很难对抗这种感觉。” 6park.com
“If you do it abruptly, it’s practically guaranteed you’re going to regain weight,” he says. “Sometimes the hunger comes back really significantly, and it’s really hard to fight that if you stop it overnight.” 6park.com
   
他还建议大幅增加锻炼，争取每周进行六天的高强度锻炼。 6park.com
He also recommends significantly increasing your exercise routine and to aim for intense exercise six days a week.  6park.com
   
旧金山地区肥胖远程医疗初创公司Enara Health的首席医疗官莉迪亚·亚历山大(Lydia Alexander)博士指出，如果你的身体已经在一段时间内（可能至少是一年或更长时间）保持健康体重，那么也许可以在某个时点停药。她补充说，即使可以停药，对于那些患有多年肥胖症的人来说，停药的过程可能要比最近才长胖的人困难得多。 6park.com
If your body has been at a healthy weight for some period—likely at least a year or more—it might be possible to go off the drugs at some point, says Dr. Lydia Alexander, chief medical officer of Enara Health, a San Francisco-area obesity telehealth startup. Even then, going off the drugs will probably be much harder for someone who has had obesity for years compared with someone who gained weight more recently, she adds. 6park.com
   
53岁的肯·柴纳维尔(Ken Chinavare)是底特律地区的一名飞机机械师。他在通过Wegovy减重30多磅（约13.6公斤）并对自己的体重感到满意后，于去年停药。在过去的一年中，他减掉的体重几乎全部反弹回来了。现在他正在考虑是否要重新使用GLP-1类药物。 6park.com
Ken Chinavare, a 53-year-old airplane mechanic in the Detroit area, stopped taking Wegovy last year after he had shed more than 30 pounds on the medication and was comfortable with his weight. Over the past year, he has regained most of the weight. Now he is thinking about whether to go back on a GLP-1.  6park.com
   
“这种反弹给我造成了心理上的打击”，他说。“真让人沮丧，在使用Wegovy的时候，我感觉自己正常了，脑子里不会一直惦记着食物。” 6park.com
“The regain has taken a psychological toll,” he says. “It’s disheartening. While on Wegovy, I felt normal. I didn’t have constant food noise in my head.”