As a board-certified obesity medicine physician, I prescribe GLP-1 medications like Wegovy (semaglutide) and Zepbound (tirzepatide) regularly. They’re effective—patients may lose 15-20% of their body weight, reverse prediabetes, improve blood pressure, and feel better than they have in years.
But here’s something you should know: if you stop the medication, the weight typically comes back.
The data consistently shows what happens. And understanding this reality helps set realistic expectations about what these medications can and can’t do.
The Data on Weight Regain Is Clear
The research on what happens when people stop GLP-1 medications is sobering. In the STEP 1 trial, participants who discontinued semaglutide after losing an average of 17.3% of their body weight regained most of it within one year. Specifically, they regained about 11.6 percentage points, leaving them with only 5.6% net weight loss from their starting weight. That’s approximately two-thirds of the lost weight regained in just one year.
The SURMOUNT-4 trial with tirzepatide showed even more dramatic results. Patients who achieved 20.9% weight loss over 36 weeks were then randomly assigned to either continue the medication or switch to placebo. Those who stopped the medication regained 14% of their body weight over the next year, while those who continued lost an additional 5.5%.
It’s Not Just About the Number on the Scale
What makes this weight regain particularly concerning is what happens to your health markers. The cardiometabolic benefits you gained during treatment—improved blood pressure, better cholesterol, normalized blood sugar, reduced waist circumference—largely reverse when you regain the weight.
Participants who regained 25% or more of their initial weight loss experienced significant worsening of blood pressure, lipids, and glycemic parameters compared to those who maintained their weight loss. In other words, you don’t just regain the weight—you regain the health risks that came with it.
Lifestyle Changes Are What Make It Sustainable
Here’s the key insight from all this data: without lifestyle changes, weight loss from medication alone isn’t sustainable.
GLP-1 medications are powerful tools. They reduce appetite, make you feel full sooner, increase availability of healthy hormones and help you eat less without the constant battle against hunger. But they don’t automatically change your relationship with food, your activity level, or the environmental factors that contributed to weight gain in the first place.
The medication creates an opportunity—a window where eating less feels manageable instead of miserable. What you do during that window matters enormously.
Patients who use the medication as a tool to build sustainable habits—decreasing consumption of ultraprocessed food, using NEAT [link to NEAT information page].to their advantage, and decreasing all-round stress—are better positioned for long-term success, whether they stay on medication or eventually stop.
Those who rely solely on the medication without addressing the underlying lifestyle factors tend to struggle more with regain, even while still taking it, and face dramatic regain if they ever stop.
How I Use These Medications in Practice
I use GLP-1 medications as a tool to kickstart weight loss and help bridge patients while we work on lifestyle changes together. The medication makes the early phase easier—it’s hard to build new habits when you’re constantly hungry and fighting cravings. With appetite suppression on your side, you can actually focus on learning new patterns.
For some patients, this bridge period might be six months to a year—they lose weight with medication support, build sustainable habits, and eventually transition off while maintaining their results through lifestyle alone.
For others, it takes longer. Maybe a few years. Maybe a lifetime. And that’s okay too. There’s no shame in needing ongoing medical support to manage a chronic medical condition.
The important thing is understanding that the medication isn’t doing the work for you—it’s making the work easier while you do it. And just don’t be surprised if building truly sustainable lifestyle changes takes a long time. For many people, it does.
What About Bariatric Surgery?
Let’s talk about the option nobody wants to consider but that’s worth discussing honestly: weight loss surgery, particularly sleeve gastrectomy.
I know—nobody dreams of having surgery. But here’s what makes bariatric surgery different from medication: the changes are permanent.
Having bariatric surgery is like taking a weight loss pill every single day without having to remember it, refill it, or worry about insurance coverage or medication shortages. But it’s not purely mechanical—bariatric procedures also create significant metabolic and hormonal changes that affect appetite regulation, insulin sensitivity, and fat metabolism in ways we’re still working to fully understand.
Modern bariatric surgery is safe, effective, and produces durable weight loss for most patients. For those with significant obesity, it often produces better long-term results than medication alone.
I’m not saying everyone should have surgery. But if you’re looking at the prospect of being on medication indefinitely, or if you’ve tried multiple approaches without sustainable success, surgery deserves serious consideration. You can learn more about different surgical options [here – link to bariatric surgery information page].
What This Means for You
The research on weight regain after stopping GLP-1 medications tells us something important: these medications are effective while you’re taking them, but they’re not a cure. Most people will regain significant weight if they stop without having made meaningful lifestyle changes.
This doesn’t mean the medications don’t work—they absolutely do. It means they work best when combined with real changes to how you eat, move, and live.
At Synergy Health, we prescribe these medications, but we do it as part of a comprehensive approach that includes supervised exercise in our on-site fitness facility and nutritional counseling. We’re not just handing you a prescription and hoping for the best—we’re working with you to build the lifestyle foundation that makes long-term success possible.
Whether that takes months, years, or becomes a lifelong partnership with ongoing medication support depends on your individual situation. There’s no one-size-fits-all timeline. What matters is understanding that sustainable weight loss requires more than medication alone—it requires building a life that supports your health goals.
Dr. Essam
Board-Certified in Internal Medicine & Obesity Medicine
Synergy Medical | Lewisville, Texas
Synergy Weight Loss and Primary Care is my answer to a healthcare system that too often prioritizes metrics over meaningful care—where patients become data points and diseases become diagnosis codes.