When patients stop taking GLP-1 weight-loss medications such as Wegovy or Ozempic, they may face a return of hunger, potential weight regain, and changes in blood sugar control, according to Dr. Laura Choi, a weight-loss surgeon and specialist.
GLP-1 receptor agonists, including semaglutide and tirzepatide, work by mimicking the glucagon-like peptide-1 hormone. They help the pancreas produce insulin, slow stomach emptying, and reduce hunger signals in the brain. This combination can make people feel full sooner and curb cravings.
Dr. Choi explained that discontinuing these medications can have several effects. “We have to remember that GLP-1 medications were originally designed for diabetic control,” Dr. Choi said. “When you remove that, diabetic symptoms and higher blood sugar levels return. If someone is diabetic or maybe pre-diabetic, then you may have a situation where your blood glucose goes high, and it’s difficult to control.” Symptoms of high blood sugar may include thirst, frequent urination, headaches, and fatigue.
On the positive side, side effects associated with the medications, such as nausea or constipation, usually resolve after stopping them.
However, the appetite-suppressing effect also fades. “We’re talking about a very complex balance of different types of interactions of neurotransmitters and centers in your brain that elicit hunger,” Dr. Choi said. “Because when you come down to it, it’s really about how a brain experiences hunger that affects our drive to go find food and eat it, which adds calories into our body. We’re always worried about weight regain, and it is closely tied to the hunger returning. That’s why we have to doubly rely on our lifestyle changes when it comes time to wean off, or you no longer have access to those medications.”
Research suggests that weight regain after stopping these medications can be significant. Dr. Choi cited data showing that, on average, 37% of the weight lost may return within a year after discontinuation. “That 37% is an average regain of the weight lost, so that’s also an optimistic way to look at it, because that means you’ve retained about 63% of your weight loss.” The amount and speed of regained weight vary by individual and can depend on factors such as previous cycles of weight loss and gain, as well as changes in eating or exercise habits.
A recent study in BMC Medicine reported that noticeable weight gain can start as soon as eight weeks after stopping a GLP-1 medication.
Addressing concerns about withdrawal, Dr. Choi said, “I think the word withdrawal, in general, could apply, but it’s more about losing the benefits. That’s a better description than withdrawal. I think losing the benefits of these medications — if you were enjoying those — can feel like withdrawal because then your sense of how you feel every day, or how you behave every day, can drastically revert to where they were pre-medicine.” She added that returning hunger and a heightened focus on food may be the body’s way of protecting itself after a period of reduced fat stores.
When asked whether these medications are intended for long-term use, Dr. Choi compared them to treatments for blood pressure or cholesterol that are often taken indefinitely. “The way these medications are understood to be helpful, it’s not expected that suddenly you’re not going to need it,” she said. “Most of the time, we don’t see all of your weight return, but some of it will, so we know that there will be lingering effects. But these medicines should also help you to modify your lifestyle. Still, those changes alone may not be able to sustain you at that lowest weight that you’ve been able to reach.”
Dr. Choi stressed the importance of medical guidance when starting or stopping these medications. “I think the No. 1 key is getting good clinical guidance when starting it, stopping it, weaning from it, whatever phase you’re in,” she said. She noted that without proper support, patients may discontinue medication prematurely or experience unnecessary side effects.
She encouraged patients to work closely with clinicians to manage their care plans and address issues such as cost and side effects. “Clinical guidance is going to help you get to the right place in the healthiest, safest manner,” Dr. Choi said.
