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For years, weight loss has largely been presented as a simple equation: eat less, move more and watch the numbers on the scale fall.
But for people who repeatedly lose weight only to regain it, the reality can be considerably more complicated.
Where fat is stored, how the body responds to weight loss and the biological mechanisms governing hunger and satiety can all influence a person’s ability to maintain a healthier weight. Increasingly, this has shifted the conversation away from weight as a matter of appearance and towards its relationship with metabolic health.
One area attracting particular attention is visceral fat, the fat stored deep within the abdomen around internal organs.
Unlike the fat that sits directly beneath the skin, visceral fat is metabolically active. It has been associated with a range of health problems, including insulin resistance, cardiovascular disease and type 2 diabetes.
This is one reason abdominal obesity can be a more meaningful health concern than the number on the weighing scale alone.
Dr Foo Wing Jian of Premier Clinic said conversations around weight management should therefore look beyond aesthetics and consider a person’s overall health.
The challenge, however, is that losing weight is not always as straightforward as simply making better choices.
When a person loses weight, the body can respond by increasing hunger and altering energy expenditure. These biological responses can make maintaining weight loss difficult, particularly for people who have struggled with obesity for years.
This helps explain why some people can follow a diet successfully for several months, only to find themselves gradually returning to their previous weight.
For some people, lifestyle changes remain an important foundation for weight management. A balanced diet, regular physical activity, adequate sleep and other behavioural changes can improve health regardless of whether a person is taking medication.
But for those who are unable to achieve or maintain sufficient weight loss through lifestyle changes alone, medical weight management has increasingly become another option.
Rather than treating weight as an isolated problem, the approach can involve assessing factors such as body composition, metabolic health and an individual’s medical history before determining what intervention may be appropriate.
That can include nutritional support, exercise, behavioural changes and in selected cases, medication.
The rise of medical weight management
The growing interest in weight-loss medication reflects a broader change in how obesity is understood.
Obesity is a chronic condition with biological, environmental and behavioural factors. For some patients, medication can help address mechanisms that make appetite regulation and sustained weight loss difficult.
One of the drugs that has attracted considerable attention is tirzepatide, marketed as Mounjaro.
Tirzepatide works on two hormonal pathways, GIP and GLP-1, which are involved in appetite regulation, food intake and glucose metabolism. By influencing these pathways, the medication can help reduce appetite and food intake while improving blood sugar control.
Clinical trials have shown substantial weight loss among people taking tirzepatide, helping propel the drug into the centre of the wider conversation about medical weight management.
But its effectiveness has also raised another question that is less frequently discussed: what happens when people stop taking it?
That question matters because obesity is not necessarily resolved simply because a person reaches a lower weight.
The Surmount-4 trial offered an illustration of what can happen after treatment withdrawal. Participants who had initially lost weight with tirzepatide and were subsequently switched to placebo regained a substantial proportion of the weight they had lost. Over the following year, those who stopped treatment regained an average of about 14% of their body weight, while those who continued tirzepatide lost additional weight.
The findings do not mean everyone who stops tirzepatide will regain weight to the same extent. They do, however, reinforce the idea that maintaining weight loss can be a continuing process rather than a finish line.
For patients, this raises a practical question that if a medication is helping control a chronic condition, how long should treatment continue?
That leads to a second, more difficult question.
What happens if you take it for years?
Mounjaro was first approved in 2022 in the USt by the U.S. Food and Drug Administration. That means there is already considerable clinical evidence surrounding tirzepatide, but there has not been enough time to establish what continuous use looks like over several decades.
There are known risks associated with the medication but there are also questions that simply cannot yet be answered because the drug has not existed long enough.
Among the established safety concerns are gastrointestinal side effects such as nausea, vomiting, diarrhoea, constipation and abdominal discomfort. Tirzepatide also delays gastric emptying and more serious gastrointestinal reactions have been reported.
Pancreatitis is another recognised concern. Gallbladder problems, including gallstones and inflammation of the gallbladder, have also been reported. In people losing significant amounts of weight, however, it is important to recognise that rapid weight loss itself can increase the risk of gallstones, so not every gallbladder problem can automatically be attributed to the medication.
There is also the question of thyroid cancer, although this needs careful explanation.
Tirzepatide carries a boxed warning in the US because the drug caused thyroid C-cell tumours in rats. It remains unknown whether this translates to humans. Because of this uncertainty, tirzepatide is contraindicated in people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. That is very different from saying Mounjaro causes thyroid cancer.
The same caution should apply to claims circulating online about so-called permanent gastroparesis, organ damage, blindness or other dramatic long-term effects. Individual reports can be important signals for researchers and regulators, but they do not by themselves establish that a medication caused a particular condition.
For patients considering treatment, the more useful question is therefore not whether Mounjaro is simply “safe” or “unsafe”.
It is whether the potential benefits outweigh the known risks for that particular person, and how treatment should be monitored over time.
That conversation is especially important because medical weight management may increasingly involve long-term treatment rather than a short course designed to produce a certain number on the scale.
Beyond the number
The growing role of medications such as Mounjaro does not make diet and exercise irrelevant. Instead, it highlights how limited the traditional weight-loss conversation has been.
For someone with significant visceral fat, elevated metabolic risk or repeated difficulty maintaining weight loss, the goal may not simply be to become thinner.
It may be to improve blood sugar, blood pressure, cardiovascular health, mobility and overall quality of life. That also means success cannot necessarily be measured by the weighing scale alone.
The emerging approach to weight management is more complicated, but perhaps more realistic: understand why weight is increasing, identify the health risks associated with it and determine what combination of lifestyle changes and medical interventions can be sustained over time.
Mounjaro may be part of that conversation but it is not the end of it.
As more people use newer weight-loss medications for longer periods, researchers will continue to learn about their benefits, risks and limitations.
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