Stopping a GLP-1 Medication: Weight, Appetite and Next Steps
If you have ever wondered what happens when you stop taking a GLP-1 medication, you are in good company. It is one of the most common questions out there, and it is hard to answer in a headline. Two large trials set out to find out, and what they showed is worth understanding before you make any decision.
What the two trials did
Neither trial was designed to tell anyone to stay on a medication forever. Both were built to answer a narrower question: how much of the weight loss stays off when treatment ends, compared with when it continues? Both involved people who had already lost weight on the medication.
| SURMOUNT-4 (tirzepatide) | STEP 1 extension (semaglutide) | |
|---|---|---|
| Starting point | People who had lost weight on tirzepatide for about 36 weeks | People who had completed 68 weeks of semaglutide with lifestyle support |
| What changed | Randomly assigned to keep taking tirzepatide or switch to placebo for 52 weeks | Treatment stopped, and participants were followed for another year |
| If treatment continued | An average of 5.5% more weight lost | Not applicable in this phase |
| If treatment stopped | Weight regained: about 14% of body weight on average | About two-thirds of the weight lost came back within a year |
What happened to the weight
In SURMOUNT-4, people who kept taking tirzepatide kept losing, about 5.5% more on average. People switched to placebo regained an average of about 14% of their body weight. In the STEP 1 extension, participants who had lost an average of about 17% on semaglutide regained roughly 11.6 percentage points of it in the year after stopping, which left them with a net loss of about 5.6% compared with where they began.
It was not only about the scale
The extension study also found that many of the health improvements that came with the weight loss, such as improvements in blood pressure and blood fat and sugar measures, largely reversed as the weight came back. In SURMOUNT-4, greater regain went hand in hand with a worsening of waist size, blood pressure, cholesterol and blood sugar measures. That does not mean the medication is the only way to improve those numbers, but it shows how closely they tracked the weight in these trials.
How to read these results kindly
- These are averages. Some people regained more and some less. The trials cannot tell you what would happen to you.
- The trial setting is not everyday life. Participants had regular visits and lifestyle support, and stopping was a study design, not a personal choice made for cost, side effects or other reasons.
- Regain is not failure. Researchers describe obesity as a chronic condition, and regaining weight after stopping a treatment is common with many treatments. It is not a sign of weak willpower.
- It does not mean everyone must stay on forever. It means the benefit depends, in part, on continuing, and that stopping deserves a plan.
If you are thinking about stopping
People stop for many reasons: cost, side effects, a change in insurance, reaching a goal, or pregnancy plans. If that is you, the research suggests it helps to plan rather than stop abruptly and hope. Here are good questions to bring to your prescriber:
- What happened in the trials, and what might that mean for me?
- Is there a way to taper or step down, and what would I watch for?
- What should I be doing with food, strength training and sleep to protect what I have gained?
- How and when should we check my blood pressure, blood sugar and cholesterol?
- What are the other options if cost or side effects are the problem?
We cover the food side in our guide to building a balanced plate when your appetite is small and how much protein you actually need. For the background on these medications and the first big trials, see why researchers are so interested in GLP-1 medications.
Putting it together
Stopping a GLP-1 medication usually means regaining a good share of the weight, and some of the health gains can slip with it. That is a reason to talk with your prescriber before you change anything, and it is not a reason to feel stuck. Plan the exit as carefully as you planned the start, and know that you have support along the way.
Sources
- Aronne LJ, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA. 2024. Summary: American College of Cardiology
- Wilding JPH, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022. PMC9542252
This article describes research and is not medical advice. It does not recommend any medication or provider, or tell anyone to start, stop or change a treatment. See our Medical Disclaimer.
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