Stopping a GLP-1: regain, what trials show and keeping results

Key takeaways

• In the STEP 1 extension, people regained 11.6 of the 17.3 percentage points they had lost within a year of stopping semaglutide.^[1]
• In SURMOUNT-4, switching from tirzepatide to placebo led to 14.0% regain in a year, while continuing led to a further 5.5% loss.^[3]
• A 2026 BMJ meta-analysis projected a return to baseline weight about 1.5 years after stopping semaglutide or tirzepatide.^[4]
• In everyday practice only about 33% to 50% of people are still on a GLP-1 at one year and 15% at two years.^[5]
• Exercise plus a GLP-1 kept off more weight (9.5 kg vs placebo) than either alone in a one-year maintenance trial.^[6]

In short: When people stop a GLP-1 medicine such as Wegovy or Zepbound, most regain a large part of the weight they lost, usually within one to two years, and the improvements in blood pressure and blood sugar tend to fade as well. In the STEP 1 extension, people regained about two thirds of their weight loss within a year of stopping semaglutide, and a 2026 BMJ review projected a return to starting weight about 1.5 years after stopping the newer medicines. That is not a personal failure: it reflects obesity as a chronic condition. If you are thinking about stopping, plan it with your prescriber, and build up nutrition, strength training and follow-up before and after.

This page explains what the research shows about stopping, why people stop, and what may help you keep results. It is general information, not a plan for you. Do not stop, skip or change the dose of a prescribed medicine without talking to the clinician who prescribed it.

What the trials show after stopping

STEP 1 extension (semaglutide)

In STEP 1, adults with overweight or obesity took weekly semaglutide 2.4 mg (the dose in Wegovy) or placebo for 68 weeks. In the extension, published in Diabetes, Obesity and Metabolism in 2022, a group of participants was followed for another year after treatment and the trial’s lifestyle support both stopped.

17.3% of starting weightLost by week 68 on semaglutide

11.6% of starting weightRegained in the year after stopping

5.6% of starting weightNet loss one year after stopping

STEP 1 extension: weight change before and after stopping semaglutide

Item	Value
Lost by week 68 on semaglutide	17.3% of starting weight
Regained in the year after stopping	11.6% of starting weight
Net loss one year after stopping	5.6% of starting weight

Placebo group: 2.0% lost, 1.9 points regained, 0.1% net. Heart and blood sugar improvements moved back toward baseline for most measures.

Source: Wilding JPH et al., Diabetes, Obesity and Metabolism 2022 (STEP 1 extension) (checked on October 6, 2026)

People on semaglutide had lost 17.3% of their weight on average by week 68. In the year after stopping, they regained 11.6 percentage points, leaving a net loss of 5.6% from where they started. The authors reported that the cardiometabolic improvements seen during treatment reverted toward baseline for most measures, and concluded that the results underline the chronic nature of obesity and suggest ongoing treatment is needed to maintain the improvements.

STEP 4 (semaglutide, randomized withdrawal)

STEP 4, published in JAMA in 2021, tested the question directly. After 20 weeks of semaglutide, 803 adults who had reached the maintenance dose were randomly assigned to keep taking it or to switch to placebo for another 48 weeks, with lifestyle support in both groups. Those who continued lost a further 7.9%; those switched to placebo regained 6.9%, a difference of 14.8 percentage points. Continuing was also linked to a smaller waist and lower systolic blood pressure.

SURMOUNT-4 (tirzepatide, randomized withdrawal)

SURMOUNT-4, published in JAMA in 2024, did the same for tirzepatide (the medicine in Zepbound). During a 36-week open-label lead-in, 670 adults lost an average of 20.9% of their weight. They were then randomly assigned to keep taking tirzepatide or switch to placebo for 52 weeks.

• Continued tirzepatide
• Switched to placebo

Kept at least 80% of the weight lost89.5%16.6%

Total weight lost from the very start (week 0 to 88)25.3%9.9%

SURMOUNT-4: one year after randomization at week 36

Item	Continued tirzepatide	Switched to placebo
Kept at least 80% of the weight lost	89.5%	16.6%
Total weight lost from the very start (week 0 to 88)	25.3%	9.9%

From week 36 to 88, weight changed by -5.5% with continued tirzepatide and +14.0% after switching to placebo.

Source: Aronne LJ et al., JAMA 2024 (SURMOUNT-4) (checked on October 6, 2026)

From week 36 to week 88, people who continued lost another 5.5%, while those switched to placebo regained 14.0%. Nearly 9 in 10 who continued (89.5%) kept at least 80% of the weight they had lost, compared with 16.6% of those on placebo. Notice that even the placebo group was still 9.9% below their starting weight at week 88: stopping usually does not erase every pound right away, but the trend is upward.

All the studies together

A systematic review and meta-analysis published in The BMJ in January 2026 pooled 37 studies with 9,341 participants. After weight-management medicines of any kind were stopped, weight came back at an average of 0.4 kg (about 0.9 pounds) a month, with a projected return to starting weight about 1.7 years later. With the newer medicines, semaglutide and tirzepatide, regain was faster, about 0.8 kg a month and 9.9 kg in the first year, with a projected return to baseline at 1.5 years. Cardiometabolic markers were projected to return to baseline within 1.4 years.

Semaglutide or tirzepatide stopped1.5 years

Any weight-management medicine stopped1.7 years

Behavioral weight-management program ended3.9 years

Projected years until weight returns to baseline after treatment ends

Item	Value
Semaglutide or tirzepatide stopped	1.5 years
Any weight-management medicine stopped	1.7 years
Behavioral weight-management program ended	3.9 years

37 studies, 9,341 participants. Projections from pooled data, not a forecast for one person. Regain was 0.3 kg a month faster after medicines than after behavioral programs.

Source: West S et al., BMJ 2026 (systematic review and meta-analysis) (checked on October 6, 2026)

The same review found that weight came back more slowly after behavioral programs ended (about 0.1 kg a month, back to baseline at about 3.9 years). That does not mean behavioral programs produce more weight loss; it means the skills people practice may keep working for a while after the program ends. It is one reason the habits below matter whether or not you stay on medicine.

Why weight comes back

GLP-1 medicines work while you take them: they reduce appetite and help you feel full sooner, as explained on our GLP-1 medications page. When the medicine stops, appetite usually returns toward where it was. The Wegovy label describes its use as reducing excess body weight and maintaining that reduction long term, together with a reduced-calorie diet and more physical activity; the trials above show the effect lasts only while the medicine is taken. Regain after stopping is the expected biology, not a lack of willpower.

Why people stop

In trials, 83% to 88% of participants were still taking the medicine at 66 to 68 weeks. In everyday practice, the 2025 joint advisory from four obesity and nutrition societies reports, only about 33% to 50% are still taking it at one year and 15% at two years. Stopping was associated with being 65 or older, a smaller weight response, and moderate or severe digestive side effects. Other common reasons include:

Manufacturer trials, at 66 to 68 weeks (83% to 88%)83%

Everyday practice, at 1 year (33% to 50%)33%

Everyday practice, at 2 years (about 15%)15%

Share of people still taking a GLP-1: trials vs everyday practice

Item	Value
Manufacturer trials, at 66 to 68 weeks (83% to 88%)	83%
Everyday practice, at 1 year (33% to 50%)	33%
Everyday practice, at 2 years (about 15%)	15%

Bars show the lower end of each reported range.

Source: Mozaffarian D et al., joint advisory (ACLM, ASN, OMA, TOS), Obesity Pillars 2025 (checked on October 6, 2026)

• Cost and coverage. As of October 6, 2026, manufacturer self-pay prices were $349 a month for Wegovy pens and $299 to $449 for Zepbound by dose. Losing coverage is a common trigger; see GLP-1 insurance coverage and the GLP-1 cost comparison tool before stopping for cost alone, because lower-cost options may exist.
• Side effects. Digestive effects are most common during dose increases. Your prescriber may be able to slow the increase or adjust the dose; see GLP-1 side effects.
• Pregnancy plans. The Wegovy label advises stopping at least 2 months before a planned pregnancy because semaglutide stays in the body a long time; the Zepbound label says to stop when a pregnancy is recognized.
• Surgery or procedures. The labels warn about aspiration of stomach contents during anesthesia or deep sedation, so tell the surgical team; whether to pause is their decision with your prescriber.
• Reaching a goal. Some people feel they are “done”. The trials suggest that, for most people, stopping at goal leads to regain, so this is a key conversation to have before deciding.

Talking to your prescriber

There is no FDA-labeled schedule for stopping or tapering GLP-1 medicines for weight, and trials have mostly tested continuing versus stopping, not gradual tapers. That makes the conversation with your prescriber important. Options to discuss may include continuing at the current dose, a lower maintenance dose, switching to another FDA-approved option such as a daily oral GLP-1, or stopping with a structured follow-up plan. Never switch to compounded or online “research” products to save money; read what the FDA says about compounded GLP-1s first.

Keeping results: what the evidence supports

Exercise, with or without medicine

A trial published in the New England Journal of Medicine in 2021 followed adults with obesity for a year after an 8-week low-calorie diet. Compared with placebo, people who exercised kept off 4.1 kg more, people on liraglutide (another GLP-1 medicine) 6.8 kg more, and people who did both 9.5 kg more. Only the combination improved blood sugar, insulin sensitivity and fitness, and it cut body-fat percentage by about twice as much as either alone. The joint advisory recommends strength training at least three times a week plus at least 150 minutes of moderate aerobic activity, and the NIH suggests 150 to 300 minutes or more a week to maintain weight loss. Start with our strength training guide and walking plan.

Protein and muscle

Part of the weight lost on a GLP-1 is lean mass, including muscle, and muscle helps you stay active and strong. The joint advisory proposes 1.2 to 1.6 grams of protein per kilogram of body weight a day during active weight reduction (or about 80 to 120 grams a day), and 1.2 to 1.7 g/kg during strength training. Your own target may differ, especially with kidney disease; ask your care team. See muscle loss on GLP-1s and the protein calculator.

Eating patterns and appetite

When appetite returns, structure helps: regular meals built on vegetables, fruit, whole grains, legumes, lean proteins, nuts and seeds, and less of the refined carbohydrates, sugary drinks and ultra-processed foods the advisory suggests minimizing. Our GLP-1 diet guide covers eating during treatment, and the keep it off hub covers long-term maintenance, including sleep, stress, holidays and plateaus.

Weigh in and follow up

The NIH suggests checking your weight at least once a week when maintaining weight loss. Catching a gain of a few pounds early is easier to address than a large one. Our weight tracker can help you see the trend.

Coverage and cost if you continue

For Medicare beneficiaries, the temporary Medicare GLP-1 Bridge (July 1, 2026 to December 31, 2027) offers Wegovy, Foundayo and Zepbound KwikPen for weight management at a $50 copay for Part D enrollees who meet set criteria (checked on CMS on 2026-10-06). Commercial plans vary; ask about prior authorization renewals before they lapse. Our Wegovy cost and Zepbound cost pages list dated prices and savings programs.

Questions to ask a professional

• What are the pros and cons of continuing, lowering the dose, switching or stopping in my case?
• If I stop, what follow-up schedule and restart threshold should we agree on?
• How much protein and strength training should I aim for before and after stopping?
• Which health markers should we recheck after stopping, and when?
• If cost is the problem, what lower-cost or covered options do I have?
• If I plan a pregnancy or surgery, when and how should I pause the medicine?

Frequently asked questions

What happens when you stop Ozempic or Wegovy?

Appetite usually returns and most people regain much of the weight. In the STEP 1 extension, people regained about two thirds of their weight loss within a year of stopping semaglutide, and blood pressure and blood sugar improvements moved back toward baseline.

How fast does weight come back after stopping?

A 2026 BMJ meta-analysis estimated about 0.8 kg (1.8 pounds) a month after stopping semaglutide or tirzepatide, with a projected return to starting weight at about 1.5 years. Individual experiences vary.

Can I stop my GLP-1 once I reach my goal weight?

You can discuss it, but the trials suggest that stopping at goal usually leads to regain. In STEP 4 and SURMOUNT-4, people who continued kept losing or maintained, while those switched to placebo regained. Make the plan with your prescriber.

Is there a way to taper off a GLP-1?

There is no FDA-labeled tapering schedule for weight management, and trials mostly compared continuing with stopping. A prescriber may discuss a lower maintenance dose or another option. Do not change the dose on your own.

Does exercise prevent regain after stopping?

It helps. In a one-year NEJM trial, exercise alone kept off 4.1 kg more than placebo after a diet, and exercise combined with liraglutide 9.5 kg more. Strength training also helps protect muscle.

Will my blood sugar and blood pressure go back up?

They tend to. In the STEP 1 extension most cardiometabolic improvements reverted toward baseline within a year, and the BMJ meta-analysis projected cardiometabolic markers back at baseline within 1.4 years. Ask your clinician to recheck them.

Should I stop my GLP-1 before getting pregnant?

The Wegovy label advises stopping at least 2 months before a planned pregnancy; the Zepbound label says to stop when a pregnancy is recognized. Plan this with your prescriber.

Why do so many people stop GLP-1 medicines?

Cost and coverage, side effects, a smaller response, pregnancy plans and the belief that treatment is finished are common reasons. The joint advisory reports that stopping is associated with age 65+, a smaller weight response and moderate or severe digestive side effects.

Can I restart if I regain?

Often yes, if it is still appropriate for you. Ask your prescriber how to restart and at what dose; do not restart leftover medicine at your old dose on your own.

References

1. Wilding JPH, Batterham RL, Davies M, et al.. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 2022. doi:10.1111/dom.14725 · PMID 35441470 (accessed October 7, 2026) Randomized trial
2. Rubino D, Abrahamsson N, Davies M, et al.. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance (STEP 4). JAMA, 2021. doi:10.1001/jama.2021.3224 · PMID 33755728 · NCT03548987 (accessed October 7, 2026) Randomized trial
3. Aronne LJ, Sattar N, Horn DB, et al.. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA, 2024. doi:10.1001/jama.2023.24945 · PMID 38078870 · NCT04660643 (accessed October 7, 2026) Randomized trial
4. West S, Scragg J, Aveyard P, et al.. Weight regain after cessation of medication for weight management: systematic review and meta-analysis. BMJ, 2026. doi:10.1136/bmj-2025-085304 · PMID 41500720 (accessed October 7, 2026) Meta-analysis
5. Mozaffarian D, Agarwal M, Aggarwal M, et al.. Nutritional priorities to support GLP-1 therapy for obesity: a joint advisory from ACLM, ASN, OMA and TOS. Obesity Pillars, 2025. doi:10.1016/j.obpill.2025.100181 · PMID 40673264 (accessed October 7, 2026) Guideline
6. Lundgren JR, Janus C, Jensen SBK, et al.. Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined. New England Journal of Medicine, 2021. doi:10.1056/NEJMoa2028198 · PMID 33951361 · NCT04122716 (accessed October 7, 2026) Randomized trial
7. Choosing a Safe & Successful Weight-loss Program. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). (accessed October 7, 2026) Government page
8. WEGOVY (semaglutide) injection and tablets: prescribing information. Novo Nordisk, via DailyMed, 2026. (accessed October 7, 2026) Drug label
9. ZEPBOUND (tirzepatide) injection: prescribing information. Eli Lilly and Company, via DailyMed, 2026. (accessed October 7, 2026) Drug label
10. Wegovy at NovoCare Pharmacy: self-pay prices. Novo Nordisk (NovoCare Pharmacy). (accessed October 7, 2026) Other
11. Zepbound coverage and savings. Eli Lilly and Company. (accessed October 6, 2026) Other
12. Medicare GLP-1 Bridge: Information for Part D Plans. Centers for Medicare & Medicaid Services. (accessed October 6, 2026) Government page

Facts checked on October 6, 2026

Educational information, not medical advice. Talk with a qualified healthcare professional about your own situation. In an emergency call 911.