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Stopping a GLP-1: why weight may return and how to prepare for the aftermath
Stopping treatment with GLP-1s does not mean a lack of willpower. Appetite and the biological signals that promote weight regain may reappear once the effect of the medication wears off. This is consistent with the chronic and recurrent nature of obesity.
What the STEP extension has shown 1
After 68 weeks of semaglutide 2,4 mg and lifestyle intervention, a subgroup of participants was monitored for one year without treatment. On average, they regained around two-thirds of the weight they had previously lost. Several cardiometabolic improvements also reverted to their baseline levels. Whilst this group-level result does not precisely predict an individual’s course, it refutes the idea of a universal ‘quick fix’.
Why your appetite may increase
The medication had helped to reduce hunger and increase feelings of fullness. Once stopped, this effect wears off, whilst the body often resists weight loss after slimming. A strategy based solely on ‘eating even less’ becomes difficult to maintain.
Prepare to stop before the last pen
- Clarify the reason: Planning a pregnancy, side effects, cost, lack of access, unsatisfactory results or medical advice. Each situation calls for a different response.
- Plan your follow-up: Appointments, weight checks at reasonable intervals, waist circumference, blood glucose levels where indicated, blood pressure and symptoms.
- Stabilise meals: Protein, vegetables, high-fibre foods and regular portions. Avoid waiting until you are extremely hungry.
- Keep the following in mind: Two sessions a week and a realistic daily activity.
- Set an alert threshold: Rapid weight regain, compulsive eating, or a deterioration in blood sugar levels or sleep should prompt you to contact your healthcare team.
Do not portray the recovery as a moral failure
A partial relapse may occur despite serious efforts. The aim is therefore to intervene early, rather than waiting until the condition has fully returned. Your doctor may discuss continuing treatment, a different dose, an alternative treatment strategy or more intensive support. None of these decisions should be made on the spur of the moment via social media.
