One of the most common questions that I receive from the patients on GLP-1 weight-loss medication is: ‘When should I stop taking them?’

My answer often surprises them: I don’t recommend stopping at all.

The biggest mistake many GLP-1 users make is assuming that they’ll reach their goal weight and return to their ordinary lifestyles. But the number on the scale doesn’t mark the finish line.

Obesity and weight regulation don’t work that way.

I know that firsthand.

After losing 13lbs on GLP-1s, I stopped taking the medication for approximately two months and during that time, I gained all the weight back.

Then, when I restarted treatment I found that I needed a higher dose than before to achieve the same effect. The medication simply didn’t ‘hit the same’ as it had before. I cannot say why this occurs, studies of this phenomena have yet to be undertaken. But I have seen this effect both in myself and my patients.

As a board-certified plastic surgeon and physician who routinely prescribes GLP-1s to patients through my practice Physique26, I have seen this phenomenon repeated again and again.

The biggest mistake many GLP-1 users make is assuming that they’ll reach their goal weight and return to their ordinary lifestyles

This cycle of stopping and restarting can be frustrating, emotionally draining and ultimately more expensive than maintaining a lower dose.

That’s why I developed a different strategy at my practice.

We call it ‘microdosing.’

Once patients reach their desired weight, I gradually reduce them to the lowest dose that allows them to maintain their results.

The goal isn’t continued weight loss. The goal is weight stability. I’ve been microdosing for roughly 18 months and the number on my scale has remained the same.

This approach allows many patients to preserve the health benefits they’ve achieved from GLP-1s while minimizing medication exposure and cost.

Of course, there are exceptions.

Occasionally, I recommend stopping treatment if a patient is becoming excessively thin (one extreme user was down to barely 100lbs), losing too much muscle mass, experiencing negative side effects or chasing a goal weight that is no longer healthy nor even achievable.

As a physician, my responsibility is not to help patients become the thinnest version of themselves. My responsibility is to help them become the healthiest version of themselves.

But, as a doctor, I must also recognize that not everyone wants to use GLP-1s in a rational way.

Dr Sheila Nazarian is the founder of Nazarian Plastic Surgery and NazarianSkin

The recent trend toward ‘Ozempic skinny,’ for instance, has created unrealistic expectations. But being underweight is not healthier than being overweight.

Extreme weight loss can carry its own risks, including nutritional deficiencies and reduced bone density. Anecdotal evidence has also linked some GLP-1s to manifestations of eating disorders such as anorexia.

But even with all of these potential risks, I believe that when GLP-1s are prescribed responsibly and patients are treated appropriately, the drugs can be lifesavers and life-changing.

Emerging research suggests GLP-1s may reduce the risk of certain obesity-related cancers. Studies have also demonstrated significant cardiovascular benefits, including reductions in heart attack and stroke risk. Researchers are actively investigating potential protective effects against neurodegenerative diseases, such as Alzheimer’s disease, as well.

So, when patients ask me when they should stop their GLP-1 medication, my answer is often another question: ‘Why would you stop something that’s working?’

If a patient is at a healthy weight, feeling great, maintaining muscle mass, tolerating the medication well and experiencing meaningful health benefits, I generally prefer microdosing rather than discontinuing treatment altogether.

The future of weight management may not be about getting off these medications but learning how to use them intelligently for the long haul.

Living a sedentary life could be even more dangerous than smoking, and outdated exercise guidelines may be partly to blame.

Very low cardiovascular fitness quadruples the risk of death compared to a high-fitness lifestyle, while low muscular strength more than doubles it.

Smoking, meanwhile, raises the risk by about half that. Still, 28 million Americans smoke combustible cigarettes.

A sedentary lifestyle fundamentally damages the heart, weakens muscles, and disrupts how the body processes sugar and fat. Over time, this drives up one’s risk of heart disease, stroke, diabetes and certain cancers. 

For most healthy adults, the CDC and federal guidelines recommend 150 to 300 minutes of moderate-intensity exercise or 75 to 150 minutes of vigorous activity per week and muscle-strengthening activities at least two days a week

While only about 20 percent of American adults meet these activity recommendations, Dr Chris MacDonald, a behavioral scientist at the University of Cambridge and author of a new report on the harms of an inactive lifestyle, says they aren’t ambitious enough.

He said current exercise standards are built around a ‘bare minimum’ mindset designed to prevent deficiency, not to help people actually thrive.

Poor cardiovascular fitness quadruples death risk while smoking raises it by roughly half that amount. And 28 million Americans still smoke (stock)

In his report published in the journal Frontiers in Nutrition, MacDonald cited a study that tracked over 122,000 adults for more than eight years. It found that low muscular strength is linked to roughly a 200 percent higher risk of early death compared to high strength. 

Very low cardiovascular fitness is associated with about a 400 percent higher risk. 

Researchers behind that report looked at patients who underwent exercise treadmill testing and grouped them by fitness level: low, below average, above average, high and elite.

People in the elite fitness group had about 80 percent lower risk of death compared to those in the lowest fitness group.

Being unfit carried a risk of death comparable to or even greater than having coronary artery disease, smoking, or diabetes. In fact, the increased mortality risk associated with low fitness was several times larger than the risk tied to smoking.

Smoking, a separate study found, raises mortality by about 50 percent by comparison. The statistic that MacDonald cited came from a 2017 meta-analysis of 12 studies regarding the risk of sudden death due to smoking.

The report found that current smokers have more than three times the risk of sudden cardiac death compared to never-smokers. Former smokers still carry an elevated risk — about 38 percent higher than never-smokers — but quitting lowers it.

Each additional 10 cigarettes per day raises the risk of sudden cardiac death by about 58 percent, according to the report.

Over 122,000 adults were tracked for more than eight years in a 2018 study. The least fit had roughly five times the death risk of the most fit, which is a 400 percent higher risk 

The study’s authors noted that because 80 percent of sudden cardiac deaths are caused by heart rhythm disturbances, smoking’s link to arrhythmias through nicotine’s effects on the heart’s electrical system may help explain the connection.

MacDonald did not specify the health risks tied to vaping. The statistic he cited referred to traditional cigarettes.

The harms of a sedentary lifestyle are also well-documented. 

In one study of older adults, those who were physically inactive had more than double the mortality risk of their more active peers.

When physical inactivity is combined with other risk factors like smoking or obesity, the effects compound dramatically. 

Adults who are inactive, smoke, and are obese face a mortality risk more than 230 percent higher than those without these risk factors.

Low fitness is associated with a two- to 2.5-fold increase in mortality risk regardless of body weight. This relationship holds across decades of follow-up, with low fitness consistently linked to higher death rates in both men and women.

The CDC recommends 30 minutes of moderate exercise daily, five days a week plus strength training twice weekly. Only 20 percent of Americans meet these goals (stock)

Muscular strength matters just as much. Low muscular strength is independently associated with higher all-cause mortality, even after accounting for physical activity levels and cardiorespiratory fitness.

Referring to the UK’s single-payer National Health Service’s recommendation to aim for at least 20 minutes of moderate exercise a day, MacDonald said guidelines are framed around ‘minimums’ that ‘are not supported by the best available data nor do they explain the broader benefits.’

‘The UK and other governments should be ambitious and aspire to have the healthiest populations possible. Limiting recommendations to casual strolling and encouraging people to sit less, and reducing success to the number of daily steps is unambitious and inadequate,’ MacDonald said.

‘In my opinion, we should instead promote a culture that values strength, fitness, and purposeful movement across the lifespan, enabling people not merely to live longer, but to remain capable, independent, and vibrant throughout their lives.’

Millions of Britons are bracing for a major ‘pollen bomb’ to cause havoc across the UK this week, triggering severe allergy symptoms for hay fever sufferers. 

Forecasters expect temperatures to soar to 38C in parts of Britain on Wednesday and Thursday, which would eclipse the current UK June record of 35.6C and make it the hottest spell ever recorded during the month.

This could bring misery for the country’s 13million hay fever sufferers, with the Met Office forecasting ‘very high’ pollen levels as sizzling temperatures cause trees, grasses and weeds to release huge quantities of allergy-causing particles into the air.

Experts say the nature of this summer’s ‘stop-start’ weather has created the perfect conditions for a so-called ‘pollen bomb’.

Normally, tree and grass pollen are released at different times, but fluctuating conditions are believed to have caused both to overlap and release at the same time. 

This is expected to cause high concentrations of pollen in the air, increasing the likelihood of allergic reactions when the particles come into contact with the eyes, nose, throat and mouth.

NHS England has already confirmed visits to its website for hay fever advice have doubled due to the upcoming ‘heat dome’, with concerned allergy ridden Britons seeking advice on how to say safe.

Hay fever is an incurable allergic condition – typically treated by antihistamine medications – that can cause splitting headaches, extreme fatigue, sneezing, coughing, blocked or runny noses, itchy eyes and sore throats.

Millions of Britons are bracing for a major ‘pollen bomb’ set to sweep through the UK this week, triggering severe allergy symptoms for hay fever sufferers

Urging Britons to take care during the upcoming ‘pollen bomb’, Duncan Burton, chief nursing officer for England, warned people not to take too much medication – particularly if they plan to drive. 

He said: ‘While I’m sure most people are delighted to be enjoying the warmth and sunshine at this time of year particularly during the World Cup, the warm weather does bring an increase in the pollen count that can cause discomfort for hay fever sufferers.

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‘Most people will be able to manage their symptoms with medication that is available off the shelf from community pharmacies and supermarkets, and the NHS website has more advice on how to deal with the discomfort.

‘People should be careful not to double dose on medication which might make them drowsy particularly if planning to drive.’ 

NHS England said they have recorded 12,990 visits to their NHS hay fever page from June 14 to 17 – when temperatures began to escalate – compared to 5,632 visits the previous week, totalling a rise of 131 per cent. 

The health service says hay fever is worse between March and September, ‘especially when it’s warm, humid and windy’ as that is when pollen count is at its highest.

Tree pollen is usually released from late March until mid-May, followed by the grass pollen season which typically runs through to July. Weed pollen then continues until September.

However, experts say this year’s unusual weather patterns have disrupted this cycle. 

Alastair Culham, curator of the University of Reading’s herbarium, said this year ‘we’ve got both tree and grass pollen at very high levels at the same time’.

Culham, who is also a hay fever victim, said not all sufferers are allergic to both grass and tree pollen. 

But, he told The Times, for those who are, it can be particularly debilitating. ‘Certainly for me, this is the worst hay fever I’ve had in seven or eight years,’ he said.

This year’s unusual weather is thought to have been driven by the warm and dry spring being followed by a colder, wet spell in recent weeks. That caused a delay in trees flowering, but promoted lots of grass growth.

Temperatures could soar to 38C by  as Britain prepares for a record-breaking ‘heat dome’ 

Culham said ‘the problem isn’t just that these things have coincided, but the wet period we’ve had has allowed very lush grass growth, which means they’re producing that many more flowers and therefore that much more pollen’. 

A Met Office spokesman said: ‘Recent warm, dry conditions with light winds are ideal for pollen to be released and carried through the air, while a lack of rainfall means it isn’t being washed away, which can make symptoms feel particularly severe. 

‘For most hay fever sufferers, the worst conditions are warm, dry and breezy days. These allow pollen to be released easily and spread efficiently through the atmosphere. Calm, dry days can also lead to high levels locally, as pollen accumulates near the source.’

Previous studies have found that one in five hay fever sufferers have taken time off work because their symptoms were too severe.  

Unlike a common cold, which typically clears within a week or two, symptoms of the condition can last for months, according to the NHS. 

Fortunately, however, there are a range of remedies and treatments that can be easily implemented.

Official NHS guidance recommends applying a thin layer of petroleum jelly, such as Vaseline, around the nostrils to help trap pollen particles before they enter through the nose. Wearing wraparound sunglasses, a face mask or a wide hat can also help reduce exposure.

Going for a shower is also encouraged to wash pollen off, as is keeping windows and doors closed, vacuuming regularly and wiping down dusty surfaces.

The NHS says to avoid activities that increase contact with pollen, such as cutting or walking through grass or spending extended periods outdoors. Keeping fresh flowers indoors may also worsen symptoms.

Other triggers include cigarette smoke and drying clothes outside, which can allow pollen to collect on fabrics.

Pharmacists can provide advice on the most appropriate treatments, including antihistamines, nasal sprays and eye drops.