Table of contents
After semaglutide or tirzepatide is stopped, body weight starts to rise in most people, and a large part of the weight lost returns within a year. In the STEP 1 trial extension, participants who stopped taking semaglutide 2.4 mg regained, within a year, on average two thirds of what they had lost, and their blood pressure and blood sugar returned to values close to those before treatment (1). In the SURMOUNT-4 trial, people who switched to placebo after 36 weeks of tirzepatide gained on average 14% over the following year, relative to their weight when they stopped the medicine (2). Obesity is a chronic disease, and the effect of both medicines on appetite gradually wears off after they are stopped. However, weight does not return to the same extent in everyone. Decisions about stopping the medicine, lowering the dose and planning for the time without it are made by the doctor together with the patient.
In brief
- A year after stopping semaglutide, participants in the STEP 1 trial extension had regained on average two thirds of the weight they had lost. After tirzepatide was stopped in the SURMOUNT-4 trial, only one in six people maintained at least 80% of their earlier weight loss.
- After the medicine is stopped, blood pressure and blood sugar readings usually get worse as body weight rises, so they need to be monitored just like body weight.
- Trial participants whose tirzepatide dose was reduced to 5 mg maintained a smaller weight loss than those on the full dose, but a greater one than those on placebo. Less frequent injections and gradual tapering have been little studied, and neither is part of the licensed dosing instructions. The doctor decides on every change of dose.
- It helps to prepare for stopping while you are still on treatment: develop a way of eating that you can keep up without the medicine, do strength training and agree with the doctor how much weight gain should bring you back for an appointment.
Does weight come back after you stop obesity medication?
In most people, yes. In three trials in which participants stopped taking the medicine, their body weight rose after stopping. In two of them, some people continued taking the medicine, and their weight kept going down (1, 2, 3).
| Trial | Treatment before stopping | What happened next | Result |
|---|---|---|---|
| STEP 1, extension (228 people after semaglutide) | semaglutide 2.4 mg for 68 weeks, average weight loss of 17.3% | the medicine and the monthly advice on diet and physical activity stopped, a year of follow-up | after a year, body weight 11.6 percentage points higher, that is, 5.6% below the starting weight |
| STEP 4 (803 people) | semaglutide for 20 weeks, 10.6% loss | randomly assigned to the medicine or placebo for 48 weeks, with advice on diet and physical activity in both groups | a further 7.9% loss on the medicine, a 6.9% gain on placebo |
| SURMOUNT-4 (670 people) | tirzepatide 10 or 15 mg for 36 weeks, 20.9% loss | randomly assigned to the medicine or placebo for 52 weeks, with advice on diet and physical activity in both groups | a further 5.5% loss on the medicine, a 14% gain on placebo, that is, still 9.9% below the pre-treatment weight |
In STEP 4 and SURMOUNT-4, the change was calculated from weight on the day of randomisation, and in STEP 1 from weight before treatment. In the official product information for Mounjaro, the SURMOUNT-4 results were calculated using a different statistical method: -6.7% on the medicine and +14.8% on placebo (6).
In the STEP 1 extension, the average body weight of people treated with semaglutide fell from 105.6 to 87.5 kg, and a year after stopping the medicine it was 99 kg (1). In STEP 4 and SURMOUNT-4, people on placebo gained weight even though, unlike in STEP 1, they received advice on diet and physical activity throughout. In SURMOUNT-4, 89.5% of people who continued taking tirzepatide and 16.6% of people on placebo maintained at least 80% of their earlier weight loss (2).
How quickly does weight come back after stopping semaglutide or tirzepatide?
Body weight starts to rise in the first months after stopping. According to a 2026 BMJ review of 37 studies, weight after stopping semaglutide or tirzepatide rose on average by 0.8 kg a month (data from 10 groups, 1,776 people), that is, by about 10 kg in the first year (4). The authors calculated that at this rate body weight would return to the starting level after about a year and a half. This is a projection, however, because studies of these two medicines followed participants for no more than a year after stopping. In the STEP 1 extension, weight rose throughout the year of follow-up, more slowly towards the end (1).
The medicine does not leave the body on the day of the last injection. Semaglutide is still present in the blood for about 7 weeks after the last 2.4 mg dose, and the half-life of tirzepatide, meaning the time after which half of the medicine is left in the blood, is about 5 days (5, 6). The effect of both medicines therefore wears off gradually over the following weeks.
Does everyone regain the same amount of weight after stopping the medicine?
No. The trials report averages, and individual participants regained very different amounts of weight. A year after stopping semaglutide, almost half of the STEP 1 extension participants (48.2%) still weighed at least 5% less than before treatment. At the end of treatment, this figure was 86.4%. The people who had lost the most weight maintained the largest weight loss: in those who had lost at least 20% of their body weight, weight after a year without the medicine was on average 12.1% below the starting weight (1).
An analysis of the SURMOUNT-4 trial looked at 308 people who switched to placebo after losing at least 10% of their body weight. Of these, 54 regained less than a quarter of the weight they had lost, and 74 regained at least three quarters (7). It is not yet known how to identify in advance who will maintain their weight without the medicine (4).
What happens to blood pressure and blood sugar after stopping the medicine?
Higher blood pressure and higher blood sugar usually return along with the weight. The more weight comes back, the more these results worsen.
The average systolic blood pressure of people treated with semaglutide in the STEP 1 extension fell from 129 to 121 mm Hg, and a year after stopping the medicine it was 131 mm Hg. Glycated haemoglobin (HbA1c), which shows the average blood sugar level over recent months, fell from 5.7% to 5.2% and went back up to 5.6%. Among participants who had prediabetes before treatment, 93.6% had normal blood sugar at the end of treatment, and 43.3% a year after stopping. In the placebo group, the figure after the same period was 34% (1).
After tirzepatide was stopped, systolic blood pressure in the SURMOUNT-4 analysis rose on average by 6.8-10.4 mm Hg, depending on how much weight came back. Blood pressure rose even in people who regained less than a quarter of the weight they had lost (7). Based on studies of various obesity medicines, the authors of the BMJ review estimate that blood pressure, blood sugar and cholesterol return to pre-treatment values within about 1.4 years of stopping. This is a projection from a model, and there were too few data on these results for semaglutide and tirzepatide (4). People with high blood pressure, prediabetes or diabetes should measure their blood pressure regularly after stopping the medicine and, at a time agreed with the doctor, repeat the tests that had abnormal results before treatment. We describe these tests in our article on tests before obesity treatment.
Why do appetite and weight come back after stopping the medicine?
After the medicine is stopped, its effect on appetite gradually wears off. Hunger may return, and in most trial participants body weight rose again.
Semaglutide and tirzepatide act on the areas of the brain that regulate appetite. They reduce the feeling of hunger and strengthen the feeling of satiety and fullness. When a person eats less and loses weight, the body activates compensatory mechanisms that can increase hunger and appetite and weaken the feeling of satiety. The same mechanisms are behind the yo-yo effect after dieting without medication. After stopping the medicine, constant thoughts about food may also come back.
According to the BMJ review, weight rose faster after stopping medication than after the end of weight loss programmes without medication, even with the same earlier weight loss. The comparison was based on results from different studies (4). The authors suggest that when hunger is lower, the patient eats less without effort and is less likely to consciously watch their diet and physical activity. After stopping the medicine, they have to rely on habits they may not have developed during treatment.
When might a doctor recommend stopping obesity medication?
Obesity medication is taken for as long as it is needed, works and is well tolerated. The Polish Society for the Treatment of Obesity (PTLO) does not recommend treatment shorter than 6 months, considers at least 12 months to be optimal and notes that some patients need long-term treatment (8).
According to PTLO, stopping treatment too early may make it harder to maintain the results, and the doctor should discuss the planned length of treatment with the patient in detail. The doctor considers stopping the medicine in several situations.
- The medicine is not working. PTLO considers treatment effective if body weight has fallen by at least 5% after 3 months on the therapeutic dose. If it has not, the doctor first looks for the cause, such as missed doses or difficulties with the diet, and then considers changing the medicine (8). Liraglutide (Saxenda) is stopped if body weight has not fallen by at least 5% after 12 weeks on 3 mg a day (9). A weight stall after earlier weight loss is a different situation, which we describe in our article on what to do when your weight stalls on medication.
- Side effects are troublesome, or a complication has occurred that requires the medicine to be stopped. We write about them in our article on side effects of obesity medication.
- The patient is planning a pregnancy. Semaglutide is stopped at least 2 months before a planned pregnancy, and tirzepatide at least a month before (5, 6).
- The patient wants to end treatment because they have reached their goal, find the injections hard to tolerate or can no longer afford the medicine. It helps to discuss this decision with the doctor and prepare a plan for the first months without the medicine.
The BMJ review cites data from the USA and Denmark showing that, outside clinical trials, roughly half of people with obesity stop treatment with a GLP-1 receptor agonist within the first year (4).
Can you maintain your weight on a lower dose or less frequent injections?
For tirzepatide, a lower dose has been tested in a randomised trial and helped to maintain part of the weight loss. Little is known about less frequent injections and gradual tapering. The doctor decides on every change of dose and of the interval between injections.
What did the SURMOUNT-MAINTAIN trial of a lower tirzepatide dose show?
In the SURMOUNT-MAINTAIN trial, 378 adults in the USA who had taken tirzepatide for 60 weeks at the highest dose they tolerated well (10 or 15 mg) were randomly assigned for a year to one of three groups: the same dose, a reduction to 5 mg or placebo. According to the authors' statistical model, 112 weeks after the start of treatment body weight was on average 21.9% below the starting weight in the full-dose group, 16.6% below in the 5 mg group and 9.9% below in the placebo group. From week 84, people who had regained more than half of the weight they had lost could receive rescue treatment with tirzepatide. It was given to 8% of people in the full-dose group, 25% in the 5 mg group and 67% in the placebo group (10).
The 5 mg dose is one of the recommended maintenance doses of tirzepatide, but the licensed dosing instructions do not include stepping down to it from a higher dose to maintain weight (6). The authors of the trial also point out that people respond differently to a dose reduction.
Can you lower the semaglutide dose to maintain your weight?
The maintenance dose of semaglutide injections is 2.4 mg once a week, and 7.2 mg in some adults. A lower dose can be used temporarily if severe gastrointestinal symptoms occur and when restarting treatment after a break (5). Long-term treatment with a lower dose of semaglutide is therefore outside the licensed use of the medicine.
Do less frequent injections or tapering the medicine help maintain weight?
Wegovy and Mounjaro are given once a week, so an injection every two weeks is outside their licensed use (5, 6). Doctors at a single clinic in the USA described injections every two weeks in a retrospective analysis of 30 patients, without a comparison group (11). Such a small case series cannot show whether this regimen is effective and safe.
The licensed dosing instructions do not include gradual tapering either (5, 6). It is not known whether weight returns more slowly after the dose is reduced gradually than after the medicine is stopped abruptly (12). A randomised trial planned in Canada is to test this: some participants will gradually reduce their semaglutide dose over 16 weeks, and others will stop it straight away (13).
Can you lower the dose of obesity medication yourself or take smaller doses from your pen?
No. The Mounjaro KwikPen contains four doses to be given in consecutive weeks, and in the leaflet for the Wegovy FlexTouch pen the manufacturer states that the dose should not be set by counting the clicks you hear (5, 6). Anyone who measures out smaller amounts themselves, so-called microdoses, is going against the manufacturer's instructions and does not know how much medicine they are actually injecting. The pen must also not be shared with other people, even if the needle is changed. Any change of dose needs to be discussed with the doctor.
How should you prepare for stopping obesity medication?
It is best to start preparing while the medicine is still working and hunger is lower. The plan covers eating, physical activity and the checks of weight, blood pressure and blood sugar agreed with the doctor for the first months without the medicine.
While you are still on treatment, work out a way of eating that will let you maintain your weight without the medicine, for example with a dietitian. Read more in our article on what to eat on obesity medication.
PTLO recommends strength training at least twice a week, with exercises for all muscle groups. This kind of training helps preserve muscle while losing weight (8). In a Danish trial, after 8 weeks on a low-calorie diet, adults with obesity spent a year doing supervised exercise, taking liraglutide, combining the two or receiving placebo. A year after this stage ended, people who had only exercised had maintained their weight, while people on liraglutide alone had gained 6 kg more than them. People who had combined the medicine with exercise had on average a 5 kg greater weight loss at that point than people on liraglutide alone (14). The trial concerned liraglutide, not semaglutide or tirzepatide, but it suggests that physical activity introduced during treatment helps to maintain weight after treatment ends too.
If eating has been a way of coping with stress, or if you have episodes of binge eating, it helps to work on this with a psychologist before the medicine is stopped.
In observational studies, people who weighed themselves regularly were more likely to maintain a lower body weight. However, PTLO notes that weighing can cause stress for some patients, so how often to weigh yourself is decided individually (8).
Even a good plan does not guarantee that your weight will stay the same. The authors of the BMJ review found no evidence that advice on diet and physical activity given after stopping the medicine slows weight gain (4). This is why the plan should include a follow-up date and a weight gain threshold, agreed with the doctor, at which the patient comes in earlier.
When should you go back to the doctor after stopping obesity medication?
Contact your doctor before your scheduled follow-up appointment if:
- Your body weight is rising and has passed the threshold agreed before stopping
- Constant thoughts about food or binge eating have come back
- Your blood pressure measured at home is clearly higher than before you stopped the medicine
- Your blood sugar readings are rising, if you have diabetes
- You have new symptoms, such as persistent nausea or abdominal pain
Severe, persistent abdominal pain spreading to the back may be a symptom of pancreatitis and needs urgent medical help, including in the first weeks after the last injection, when the medicine is still in the blood (5, 6).
How is the medicine stopped in the Nasz Gabinet obesity treatment programme?
In the Nasz Gabinet obesity treatment programme, the doctor reviews the data from the app every month: weight recorded once a week and body measurements taken once a month. If continuing the medicine is indicated, the doctor issues an e-prescription. The decision to stop the medicine is made together with the patient in a video consultation. The programme also includes video consultations with a psychologist. The programme lasts 6 months, and the patient buys the medicine at a pharmacy.
Frequently asked questions
Do you gain weight after stopping Ozempic?
Ozempic is a type 2 diabetes medicine containing semaglutide at doses of up to 2 mg a week. A different product with the same active substance, Wegovy, is licensed for treating obesity (5, 15). The STEP 1 and STEP 4 trials concerned semaglutide 2.4 mg in people with obesity or overweight without diabetes. A review of randomised trials found that in people with type 2 diabetes, body weight rose on average by 2 kg and HbA1c by 0.65 percentage points after GLP-1 receptor agonists were stopped (16). A diabetes medicine should not be stopped without involving the doctor who treats your diabetes.
Do you have to take obesity medication for life?
Not everyone does. According to PTLO, some patients need long-term treatment. In most trial participants, the effect lasted as long as they were taking the medicine, but some kept a lower body weight after stopping too. The doctor assesses this individually and also takes into account coexisting conditions, such as high blood pressure or prediabetes.
Are there withdrawal symptoms after stopping obesity medication?
No withdrawal symptoms are described in the official product information for Wegovy and Mounjaro (5, 6). The main effect of stopping is the return of appetite and weight. If nausea, diarrhoea or abdominal pain appear or do not go away after stopping, discuss this with the doctor.
Can you go back to obesity medication after a break?
Yes, if the doctor decides that the medicine is still indicated. With semaglutide (Wegovy), after several missed doses the doctor considers restarting treatment at a lower dose.
Sources
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- 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;331(1):38-48. PMID 38078870, DOI
- Rubino D, Abrahamsson N, Davies M et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-1425. PMID 33755728, DOI
- West S, Scragg J, Aveyard P et al. Weight regain after cessation of medication for weight management: systematic review and meta-analysis. BMJ. 2026;392:e085304. PMID 41500720, DOI
- Charakterystyka Produktu Leczniczego Wegovy (semaglutyd), roztwór do wstrzykiwań (summary of product characteristics, solution for injection). European Medicines Agency. ema.europa.eu
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Not sure what to do next about your obesity medication?
In the obesity treatment programme, the doctor reviews your results from the app every month and plans further treatment together with you. Video consultations with a doctor and a psychologist are part of the programme.
