Do you really need to take weight-loss medication forever?

You can lose an average of 15% to 21% of your body weight on medications like semaglutide and tirzepatide, but you may regain more than half of that weight if you stop. Here’s why.
Published October 23, 2023

If you want to lose weight, you need an eating plan that's sustainable. Not for a week, not for a month...but for life. But what about prescription weight-loss medications?

If you’re using them correctly, then yes. Drugs like the GLP-1s Wegovy and Saxenda are FDA-approved for long-term use, which makes sense because they treat a long-term condition—obesity.

The thought of starting and staying on medication indefinitely, however, can cause some hesitation. So we talked to experts and patients to understand what forever means—and what really happens if you stop.

How do weight-management medications help people lose weight?

Generally, these medications all work by curbing appetite, but they do so slightly differently. Take GLP-1s, for example—the newest kind of weight-loss drugs.

“The process of eating, which releases nutrients, stimulates glucagon-like peptide-1, an appetite hormone we naturally have in our bodies, which decreases appetite and creates fullness. People with obesity tend to have less GLP compared to those with healthy weights,” says Dr. Shauna Levy, M.D., an obesity and medical weight-loss specialist and assistant professor at Tulane University School of Medicine in New Orleans.

The GLP-1 agonist medications add to the already existing GLP in the body to increase fullness and decrease hunger, as well as regulate blood sugar. As a result, “the medications dampen the hunger and reward cues in the brain,” Levy says. You’ll feel more full after eating less food and your cravings won’t be as severe, she explains. Ultimately, that means people consume fewer calories—as much as 35 percent less than they were before, which is what causes the weight loss.

Other weight-loss drugs approved for long-term use, like naltrexone/bupropion (Contrave) and phentermine/topiramate (Qsymia), suppress your appetite in different ways, like targeting nerves in the brain. Orlistat (Xenical, Alli), on the other hand, stops your body from absorbing as much of the fat you eat.

Research shows substantial results for these drugs, especially GLP-1s. A 2022 JAMA study on 338 adults who had overweight or obesity found that taking semaglutide and liraglutide, respectively, led to an average 15.8% and 6.4% loss in body weight over 68 weeks. That’s incredibly impactful: Losing 5% to 10% of your body weight is enough to improve blood pressure, cholesterol, and blood sugar.

How long do you have to take prescription weight-loss medications and what happens if you stop?

This will vary from person to person, but most likely? Long-term. Because treating any chronic disease requires more than a quick-fix medication. “Like diabetes and hypertension, obesity is not cured, it’s controlled,” says New York City-based endocrinologist and obesity medicine specialist Dr. Rocio Salas-Whalen, M.D.

“If the medication is working, then most likely you will take it for life,” adds Levy. And if you stop, your body will likely attempt to get back any lost body fat by revving appetite. “Hunger could increase to be even higher than it was before medication,” says Levy. In such instances, a person may eat more calories and regain weight.

In research published in the journal Diabetes, Obesity and Metabolism on nearly 2,000 adults with obesity, participants took weekly semaglutide injections in addition to making healthy lifestyle changes for 68 weeks, then stopped. One year later, participants gained back an average of two-thirds of the weight they lost.

That study comes as no surprise to Artemis B. a 40-year-old manager of airport operations who lost 20 pounds taking semaglutide. “Then, one day the drugstore called me to let me know the coupon I’d been using, which brought the cost down to $25 a month, was expiring and that it would start costing me $1,299 a month,” she says. After multiple attempts to get her insurance company to cover the drug (she’d been prescribed it for weight management but her insurer said the drug was too new to cover), she had to stop taking it.

“I thought it would be fine and that I could figure out how to continue losing weight without semaglutide,” she says. But over the next two months, she gained back all the weight she’d lost. “I was hungry all the time after stopping. Before medication, I was 232 pounds. Then I got down to 212, and today I’m 240,” she says. Still, she says she has no regrets. “I would go back on it if I could afford it. Hopefully my insurance will start covering it—I feel like I’m in a holding pattern until that happens."

Tell me more about…lifestyle changes

The term lifestyle changes is pretty vague, we agree, but it’s the accepted catch-all for diet, exercise, quality sleep, and anything else in your day-to-day world that can impact your weight. They play a key role in weight loss and management—something that’s often lost in all the swirl surrounding prescription weight-management medications. “We don’t recommend that someone take these medications and continue with unhealthy eating practices or lack of exercise,” Levy says. The good news is that both treatments—medication and lifestyle—support each other.

In the Diabetes, Obesity and Metabolism study mentioned above, the authors noted that stopping lifestyle changes may have contributed to the weight regain—meaning, rebound hunger wasn’t the singular culprit.

Whether you’re in the weight-loss or maintenance phase, the WeightWatchers program can help teach you these essential healthy habits. And if you do need to stop taking the medication for any reason, they may help protect against some of the potential weight regain.

Is it safe to take weight-management medication for the rest of your life?

These medications have undergone rigorous testing and review and the FDA has determined they are safe for long-term use. The GLP-1 agonists semaglutide and liraglutide, which seem new and therefore more risky, have been used for almost 20 years for people with type 2 diabetes and have been shown to be safe and well-tolerated, Levy says.

There are still situations where people shouldn’t take certain weight-management medications. If someone is pregnant or breastfeeding or has a personal or family history of medullary thyroid cancer, they should consider them off limits. And there are side effects to consider.

Nausea, vomiting, diarrhea, and abdominal pain are some of the more common side effects of weight-loss medications (for a full list of side effects, visit the drug manufacturer’s website). Nausea is most common and typically occurs when starting on the medication and increasing dosage, but Levy says that this is short-term and can be combated typically with lifestyle techniques and, for some people, anti-nausea medication. Once someone is on a stable dose, nausea typically improves.

While it’s rare for nausea to be severe, this means that the dose probably needs adjustment and it's important for that person to talk with their healthcare provider. Levy also mentions that, in studies, less than 5% of patients reported that they stopped taking the medication due to side effects.

Weighing risk versus benefit is key here, but both Levy and Salas-Whalen pointed out that untreated obesity carries risks and shouldn't be overlooked. It can raise your risk for conditions like type 2 diabetes, heart disease, osteoarthritis, sleep apnea, and cancer.

When you can’t face a forever thing

Levy says she often counsels patients who are reluctant to view weight-management medication as long-term treatment and talks them through the pros and cons. One issue that comes up is embarrassment. The internalized belief that obesity stems from a lack of willpower—not a complex web of biological, psychological, societal, environmental, and hormonal factors—can lead some to feel shame about going the medication route and hesitation to take them for years and years.

That’s how Nikki D., 46, owner of an online radio station in Indiana, feels. Her autoimmune disorder led to weight gain, and made it nearly impossible to lose—even after working with a dietitian and exercising as much as twice a day. At the suggestion of her endocrinologist, she started semaglutide in April 2022 and switched to tirzepatide after an insurance change, losing 41 pounds so far, and nearing her goal.

“My confidence is restored, and I don’t feel sluggish. I’m in love with me again,” she says. And yet? Even knowing the likelihood of weight regain, she has hesitations about staying on it. “There’s nothing negative about it, I just don’t like taking medicine.” Right now, she’s still taking the drug, but is working with her providers to determine the best way to discontinue it once she’s reached her goal, which is her prerogative.

So, what happens when you reach your goal weight?

After patients reach a healthy and stable weight, they stay on the highest dose they are tolerating in order to maintain their current weight. “You can and should be on [weight-loss] medications during your maintenance phase,” says Salas-Whalen. Maintenance mode can be just as challenging as losing weight in the first place, so having these meds by your side means you’re not left managing everything on your own. “I think of this as more of a relief than a burden,” Salas-Whalen says.

The bottom line

Similar to the treatments for other chronic conditions, medications to manage obesity are designed to be taken long-term, even after you reach your weight-loss goal. Research shows that stopping medication can cause you to regain much of the weight that was lost. To achieve real, lasting success, experts recommend pairing weight-loss medications with lifestyle changes such as exercising more and prioritizing healthier foods–healthy habits that the WeightWatchers weight loss program is specifically designed to help you stick with for life.