What happens when you stop taking weight-loss drugs?

GLP-1 drugs like Wegovy, Ozempic, or Zepbound have helped many patients lose significant amounts of weight, but people often have to stay on them indefinitely or risk regaining the weight they lost.

According to a 2022 study from Novo Nordisk, which manufactures Wegovy and Ozempic, patients who stopped taking semaglutide, the main ingredient in both drugs, regained two-thirds of the weight they lost after a year.

"The regain has taken a psychological toll," said Ken Chinavare, a 53-year-old airplane mechanic who regained most of the 30 pounds he shed while on weight-loss medications. "It's disheartening. While on Wegovy, I felt normal. I didn't have constant food noise in my head."

However, it's currently unclear whether all patients will regain the weight they lost if they stop taking weight-loss drugs.  

In a recent study by Epic Research, researchers analyzed almost 40,000 patient records from 236 health systems. Patients in the study were either using liraglutide, the active ingredient in Novo Nordisk's Victoza or Saxenda, or semaglutide, found in Ozempic and Wegovy.

Although around 20% of patients on either drug regained all or more of the weight they originally lost in 12 months after stopping the medications, over 50% of patients either maintained their weight loss or continued to lose weight.

What options do patients have if they can't stay on weight-loss drugs?

Currently, many health insurers are either enacting more stringent requirements or dropping coverage of weight-loss drugs altogether due to high costs. Patients are also facing difficulty paying for expensive weight-loss drugs when manufacturer coupons for the drugs expire.

With access to new weight-loss drugs becoming more difficult, some patients are turning to older anti-obesity drugs, such as Contrave or Qsymia. However, these drugs are often not as effective and may have more side effects.

So far, doctors say more research is needed to determine the best way for people to stop taking weight-loss drugs, with a more gradual approach likely being beneficial in the long run.

"If you do it abruptly, it's practically guaranteed you're going to regain weight," said Dan Azagury, medical director of the Stanford Lifestyle and Weight Management Clinic. "Sometimes the hunger comes back really significantly, and it's really hard to fight that if you stop it overnight."

According to Lydia Alexander, CMO of the obesity telehealth startup Enara Health, it's likely easier to stop taking weight-loss drugs if your body has been at a healthy weight for least a year or more. However, she noted that people who have had obesity for years will likely have a harder time going off these drugs than people who have gained weight more recently.

For people who want to try to keep off their weight after going off GLP-1, Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women's Hospital, recommends eating a high-protein diet, staying away from ultra-processed foods, and including resistance training in workouts.

Azagury also made a similar recommendation, saying people should significantly increase their exercise routine and try to include intense exercise at least six days a week.

Another potential option is bariatric surgery, which can help patients lose up to 35% of their body weight in the long term. According to Apovian, bariatric surgery may be a good option for patients who need to lose over 20% of their body weight. (Reddy, Wall Street Journal, 2/22; Carbajal, Becker's Hospital Review, 2/22; Reed, Axios, 1/24; Bartelt et al., Epic Research, 1/23)

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