Since the first GLP-1 agonist was approved for obesity treatment in 2014, science and society have marveled at the medication’s power and potency. We know GLP-1s effectively treat obesity, diabetes, sleep apnea, and more with general tolerability and/or manageable side effects. What remains less clear is the answer to this question: “Will I need to be on a GLP-1 forever to maintain weight loss?”
Though research is unfolding in real time, we’ve rounded up expert advice and findings from existing studies to paint a picture of patient outcomes after discontinuing or tapering off GLP-1s. Here’s what we know.
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Obesity is a chronic disease that requires ongoing care.
The medical community’s understanding of and approach to obesity has experienced a seismic shift in the last few decades, challenging the conventional view of obesity as a risk factor for other conditions that could be easily corrected — with the right diet, more exercise, and copious willpower. Now, thanks in part to a Lancet Commission report, leading experts understand that obesity is a chronic disease requiring long-term treatment, not unlike diabetes or heart disease.
Multiple factors — genetic, environmental, psychological, nutritional, and metabolic in nature — conspire against weight loss. GLP-1 drugs seem to break down these obstacles — until you stop taking them.
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What happens when you stop taking a GLP-1?
When most people stop taking GLP-1s, they rapidly regain the weight they’ve lost, according to research. One study presented at Obesity Week, the annual gathering of international obesity experts, looked at 18,000 people who had lost at least 5% of their body weight while taking a GLP-1. Michael Weintraub, MD, a clinical assistant professor at NYU Langone Health, presented the research’s findings: Three months after stopping medication, participants had gained back an average of 4.5% of their body weight; at nine months, 6.7%; and at 12 months, 7.5% of their body weight. Those who lost the most weight while taking a GLP-1 gained the most back when they stopped taking it.
As weight loss is reversed, so too are many of its accompanying health benefits, like reduced blood glucose, cholesterol, triglycerides, and blood pressure — all risk factors for heart disease. One review of the research found that 15 months after people stopped taking the medications, these risk factors had nearly returned to pre-GLP-1 levels.
Ceasing use of GLP-1s for even three or six months was associated with an increased risk of major cardiac events compared to staying on the medication continuously, Ziyad Al-Aly, MD, reported at Obesity Week.
For these reasons, current recommendations advise patients not to discontinue use of GLP-1s until putting into practice an effective weight maintenance plan.
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How is weight loss maintained after GLP-1 use?
On a quest to find a middle ground between “forever” and cessation, some patients are experimenting with lower or less frequent doses of GLP-1s. Others are switching to an older obesity medication that is less powerful yet easier to tolerate. The research supporting these strategies is still sparse but promising.
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Taper your GLP-1.
Without evidence-based recommendations, people are charting their own maintenance paths. Many are reducing their doses, whether for financial reasons (to stretch out their medication) or because they’ve reached their weight goals or their weight loss has plateaued.
Mitch Biermann, MD, PhD, an obesity physician at Scripps Clinic in San Diego, launched a study on tapering because his patients were already doing it on their own. “I saw it working for them and started to suggest it to other people,” he told a group of doctors at Obesity Week. He asked 30 patients who had lost an average of 30 pounds on a GLP-1 to reduce the frequency of the GLP-1 injection from weekly to every other week. Four people started to regain weight and resumed the weekly dose, but the remaining 26 maintained their weight loss at nine months and even saw about a 1% further reduction in weight.
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Switch to a first-generation obesity drug.
Some older obesity drugs lack the horsepower of GLP-1s but have proved effective in maintaining weight loss after GLP-1 cessation. Examples include phentermine-topiramate (Qsymia) and bupropion/naltrexone (Contrave). Switching from a GLP-1 to an older obesity drug may make sense for some people because these drugs tend to have fewer side effects, including a less dramatic suppression of appetite, and they cost less — making them a more sustainable long-term option.
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You can stop taking a GLP-1 — with a plan.
Though most people experience a weight reversal, Weintraub’s study found that about 42% of people taking GLP-1s were able to maintain their weight loss a year after stopping the medication. “I have patients who have been able to stop the medication and do really, really well,” Ariana Chao, PhD, an associate professor at the Johns Hopkins University School of Nursing, said in an Embody webinar titled, “GLP-1s and Beyond: Weight Loss Medications and Treatments Today.”
This transition, it seems, succeeds in the presence of a very structured lifestyle approach to weight management. “It’s hard work and it’s challenging,” Chao said. “[My patients] check in with me really frequently to help maintain their weight loss.”
Patients may require a dietary plan crafted with a dietitian, behavioral support from a therapist, and consistent daily exercise. Fitness experts recommend at least 200 minutes of moderate to intense aerobic exercise a week (for example, 40 minutes, five days a week) to prevent regaining weight. While these lifestyle recommendations are not new, their importance is amplified if you plan to stop taking a GLP-1.
