Will you gain weight after stopping a GLP-1?

The news around GLP-1s tends to read like a highlight reel. The weight-loss medications have proven to be incredibly effective at helping people lose weight, and they seem to offer many other health benefits as well, like improving heart health and reducing addictive behaviors.

But there’s a catch, sort of. You have to keep taking GLP-1s for those benefits to stick. This isn't exactly breaking news: Back in 2022, a study found that people taking a GLP-1 regained two-thirds of their weight loss after stopping it. But lately headlines are broadcasting a new finding — that people who quit GLP-1s regain the weight even faster than people who used other methods to lose weight, like diet and exercise. So, how are you supposed to maintain your hard-won results? Here’s what the experts say.

GLP-1 receptor agonists mimic GLP-1 (short for glucagon-like peptide-1), a gut hormone that your body naturally releases when you eat. This hormone helps bring down blood sugar after you eat by stimulating insulin secretion, slows stomach emptying to keep you feeling full, and can even activate receptors in your brain to curb appetite. This combination of effects can lead to significant weight loss — to the tune of 15% to 21% of your starting body weight, on average, according to studies.

There are different reasons people stop taking GLP-1s. Changing insurance coverage can be to blame for some. “I have patients who have been doing extremely well on the medications and all of a sudden, insurance decides to not cover the medication anymore for whatever reason,” says Dr. Juliana Simonetti, M.D., a board-certified internist at University of Utah Health and co-director of its Comprehensive Weight Management Program. As a result, people have to stop taking the GLP-1 because the cost gets too high. “In the beginning of the year, this is always more pronounced, because each insurance changes what they're doing for coverage.” 

Gastrointestinal side effects can also make it tough to stick with GLP-1s, says Dr. Robert Kushner, M.D., professor of medicine and medical education at Northwestern University Feinberg School of Medicine in Chicago. Nausea, diarrhea, constipation, and vomiting are among those that can occur during the first four to five months of use, which is when people escalate their doses, he says. 

Data backs this up, with one study finding that side effects and cost were two of the top contributors of patients who stopped taking GLP-1s for overweight or obesity within the first year of starting. 

Even if cost or side effects aren’t an issue, personal preference may come into play. “Most people don’t want to take medication for the rest of their life, regardless of the medical problem,” says Kushner. It’s especially common for people on weight-loss medications, since they reach their goal weight and assume they can keep it off themselves.

Unfortunately, maintaining weight loss isn’t as easy as people may think it is. Just this year, a new study made headlines about how people quickly regain weight after stopping their GLP-1s. They regained an average of 22 pounds in the first year — with a projected estimate that they'd return to their original, pre-GLP-1 weight after 18 months. That averaged out to regaining almost 2 pounds per month, which was faster than the weight regain across all weight-loss medications (just under than 1 pound per month) and after weight loss via a behavioral weight-management program that focused on diet and exercise (0.2 pounds per month).

Experts have known for years that stopping GLP-1s results in weight gain. If anything, this study simply “affirms what we have been seeing directly in patient care — that is, people rapidly regain weight once they stop obesity medications,” says Kushner.

The research on regaining weight tracks with the way the medical community now views obesity: as a chronic disease. You need to keep taking medications to manage other chronic conditions, like an autoimmune disease or high blood pressure. “If you're treating diabetes with medications and it’s well-controlled, but you stop the medication, your A1C tends to go back up,” Simonetti says. Similarly, you have to keep taking GLP-1s to treat obesity.

But people don’t always think of obesity as a chronic condition. Instead, Kushner says, people often think of losing weight as a personal responsibility and under their control; that if they just have more discipline and resolve, they can successfully lose weight. Along that same vein, people think that if they can get a “jump start” on weight loss from a GLP-1, “they believe that they can take it from there and discontinue medication,” he says.

But for most people, that’s just not the case. “To think of this as a quick fix — that there is this medication that'll lead to weight loss and then it's done — I think is a misunderstanding of the problem as a whole,” says Simonetti. 

There are two big reasons people regain weight after halting GLP-1s. For one, its effects go away soon after you stop taking it. They “work by reducing hunger and cravings and increasing fullness,” says Kushner. “Once the medication is stopped, appetite returns to pre-medication levels, and with that change, an increase in caloric intake.” It can feel impossible to keep up with the lower calorie intake you might have maintained on a GLP-1 once your appetite and the food noise (a.k.a. food-related thoughts in the brain) return.

The other reason is something called metabolic adaptation, which is a physiological mechanism that encourages the body to hang onto weight. “As humans, we have evolved to protect against energy deprivation — so we are made to hold onto calories,” says Simonetti. When you lose weight, your metabolism falls and you burn fewer calories during the day — your body, thanks to evolution, wants you to put on weight. That makes your new, lower weight that much harder to maintain without medication, since you’re essentially working against your body’s built-in, biological mechanisms.

We’ll start with the good news: There are some people who won’t regain weight. But there’s not a whole lot of evidence to indicate who’s more likely to regain weight and who isn’t. “There's not any one specific factor that we know of, or that has been studied, to say, ‘These are the patients who are being extremely successful at maintaining weight loss versus not being successful’,” says Simonetti.

That said, adopting lifestyle strategies while taking a GLP-1 might help to reduce the risk of regain. If you change your behavior as well, you might have better luck at avoiding regain. “Engaging in robust physical activity, following a calorie-restricted diet, and consuming low energy-dense foods have been shown to predict longer-term success,” says Kushner. Strength training is especially important here, since it helps you hold on to more muscle as you lose weight, which can help keep your metabolism higher.

This is where the Weight Watchers GLP-1 Success program comes in. It encourages people to prioritize healthy food and physical activity — especially weight training — while taking the medication. And it also helps you lose more weight: After 12 months, Weight Watchers Med+ members taking a GLP-1 who engaged regularly with the GLP-1 Success Program lost 29.1% more weight, on average, than those who did not.*

Let’s say you want to stop taking GLP-1 but you also don’t want to undo your progress. Here’s some options that may help.

• Taper your GLP-1: One option is to taper your GLP-1s instead of just going cold turkey. Back in 2024, research presented at the European Congress on Obesity found that people who gradually reduced their GLP-1s dose to zero over the course of nine weeks were able to maintain a stable body weight in the first 26 weeks post-GLP-1s.

• Try a different medication: If you want to keep taking a weight-loss medication but the cost or side effects make GLP-1s a no-go, there are other options out there such as Qsymia and Contrave — and your clinician may be able to recommend and prescribe a different weight-loss medication. 

• Keep your focus on diet and exercise: When you stop taking the meds, it becomes critical to double-down on healthy behaviors. This includes “making dietary modifications, increasing physical activity, doing resistance training, and making sure you get enough sleep,” says Simonetti. Kushner, for his part, recommends having a daily gameplan in place for meals and snacks, and setting up an exercise routine that you can be consistent with. A program like Weight Watchers can offer support, coaching, and a clear plan. One study found that people who stopped taking tirzepatide regained the least amount of weight if they stuck to regular “lifestyle consultations,” which are check-ins to get support while sticking with healthy habits. 

• Track your stats: If you don’t know your weight, you can’t tell if you’re regaining. So, start with a baseline. According to the BMJ study, “the average weight regain was 1.76 pounds per month after stopping semaglutide or tirzepatide,” says Kushner. “That can be used as a useful guide to alert one to take action.” Don’t stop with weight, though. Use Weight Watchers AI Body Scanner to see how your body composition is likely changing. It tells you more than just weight can, so you can see if you’re gaining muscle while maintaining fat loss. (The AI Body Scanner is not available in some locations.) If you feel concerned about changes in your weight or body composition, get in touch with your clinician to create a plan. 

If you do regain weight, give yourself a break. You can do everything “right” and still regain weight, says Simonetti. “The physiology is still there.” After all, most people start with diet and exercise before moving to a weight-loss medication like a GLP-1; so relying solely on healthy behaviors may only take you so far.

Depending on the reasons you stopped, there could be the option of restarting your GLP-1. (In fact, 36% of people with overweight or obesity actually went back on GLP-1s after quitting because they regained weight.) It happens a lot in practice, says Simonetti. If that’s the case, just be prepared to redo the gradual dosage increase to minimize side effects.

That’s why staying in regular contact with your clinician even once you’ve stopped a GLP-1 is important. They can help you monitor what’s going on, give recommendations for lifestyle changes or medications, and help you keep your weight regain in perspective.

GLP-1s are meant to be a long-term weight-loss medication — meaning if you stop taking it, you’ll likely regain some or all weight you’ve lost. It’s understandable: As with any chronic condition, like diabetes or high cholesterol, you have to keep taking medication to maintain its benefits. But lots of people end up stopping GLP-1s, often due to side effects or cost or thinking that they can maintain on their own without medication. There’s no way to completely avoid regaining weight, but making lifestyle changes that you can stick to long-term can go a long way.