What Happens When You Stop Taking Weight-Loss Medications?

There are many reasons why someone would want to stop taking weight-loss medications. Whether it's the cost, side effects or you've simply lost the weight you were looking to lose, questions emerge when deciding to stop taking GLP-1 medications, such as Wegovy, Ozempic, and others. Will I regain the weight? Will my hunger return?

We spoke with Dr. Laura Choi, a weight-loss surgeon and weight-loss specialist, about what someone can expect when they stop taking weight-loss medication.

What happens to the body when you stop taking weight-loss medications

GLP-1 receptor agonists are a class of weight-loss medications designed to imitate their namesake hormone, glucagon-like peptide-1. These medicines, including semaglutide or tirzepatide, encourage the pancreas to produce insulin and slow down stomach emptying. This helps people feel full faster and for longer. The drugs also affect the brain by curbing the body's hunger signals, or what people who take these medications refer to as "food noise," the constant cravings or thoughts about food.

So what happens when someone stops?

Your blood sugar rises

"We have to remember that GLP-1 medications were originally designed for diabetic control," Dr. Choi says. "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 glucose levels can include excessive thirst, frequent urination, headache and fatigue, and they can lead to dehydration, dizziness and nausea or vomiting. Someone may be more at risk for yeast infections or other fungal infections.

Any side effects will lessen or disappear

Some people can experience side effects while taking GLP-1 medications. Side effects, such as nausea, vomiting, diarrhea or constipation, usually occur when a person first starts medication or increases their dosage. Many of these side effects can be easily managed by actions such as drinking enough water, eating slowly and increasing fiber intake.

Any side effects someone experiences when taking a weight-loss medication will resolve once they are no longer taking it.

Your hunger, including cravings, return

While taking weight-loss medication, a person's appetite can radically shift. Someone who may have always had food on the brain and could eat large amounts of food may become indifferent to food altogether and only be able to handle smaller portions.

But after lowering a dose or stopping these medications altogether, the dreaded "food noise," or constant thoughts about food, usually returns. Dr. Choi says this is rooted in how the drugs work, affecting the amount of hunger a person's brain actually senses.

"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 says. "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."

Do you gain weight after stopping GLP-1 medications? And how quickly?

Dr. Choi says that there's still a lot of data collection and investigation being done to better understand how stopping these medications affects the body. But how much weight can someone expect to regain? Dr. Choi says the best data available come from studies showing the results of subjects who had been off the medications for a full year.

"The data-driven studies demonstrate about 37% of lost weight is regained in a year, but that can be very variable," Dr. Choi says. "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."

How much weight someone will regain after stopping weight-loss medications — and the speed at which it comes back — will vary from individual to individual. Dr. Choi notes that an important factor in each person's response is the number of weight-loss cycles they've experienced throughout their lifetime.

"The more loss-and-gain and loss-and-gain cycles that you've gone through in your past experience, the more your body may be prone to rebound weight quicker," Dr. Choi says. "Some people will say things like, 'Oh, when I started regaining weight, it seemed like I just smell food, and I gained more weight.' That's an exaggeration, of course, but it can certainly feel that way given the pace of how quickly some people can regain weight."

In addition, as with weight loss, many variables affect weight gain, some of which we can control, some of which we can't.

"It also depends on whether you've completely changed your eating pattern or exercise habits when your hunger level changes," Dr. Choi says. "Or maybe something happened that caused extreme stress, like losing a job and losing insurance. These other things that happen in their lives can also change their bodies more drastically, so that they can be losing more or regaining more weight faster."

A recent study in BMC Medicine found that significant weight gain can begin as early as eight weeks after stopping a weight-loss medication.

Is there such a thing as 'withdrawal' from weight-loss medication?

"I think the word withdrawal, in general, could apply, but it's more about losing the benefits," Dr. Choi says. "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."

Dr. Choi emphasizes that thinking about or reverting to how your body used to function before taking one of these medicines can feel demoralizing or like a step back, especially if it brought positive changes to your life.

"What people refer to as 'withdrawal' may be that returning to your hunger levels pre-medication feels worse than how it used to feel because the body adjusts as it loses fat volume," Dr. Choi says. "The way your body used to work with the amount of fat it used to have functions differently now that your body has lost some of that fat mass. Your body is going to be a little bit more protective of itself because we all need to have some level of fat on our bodies."

This flared-up reaction towards hunger and calorie retention is the body's self-protection instincts kicking in. When the body is at a lower weight, and you are no longer on the medication, your brain and body prioritize storing fat and see the decrease in calories as a sign of distress, which can mean you may still gain weight even if you continue habits you began while on medication, such as eating smaller portions.

Are weight-loss medications meant to be taken long-term?

There are many medications that, once prescribed, are intended to be taken indefinitely — such as those used to manage blood pressure or cholesterol. Should we think the same for weight-loss medications?

"The way these medications are understood to be helpful, it's not expected that suddenly you're not going to need it," Dr. Choi says. "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 sees long-term benefits in how these medicines can alter body function, enabling individuals to make lasting lifestyle changes, such as modifying their eating habits and exercise routines.

"If you feel less hunger, of course, it becomes easier to cut your portions or to try to focus on different food groups to maximize your meals and snacks," Dr. Choi says. "And I always emphasize that patients have to hydrate well to limit hunger and optimize the satiety part of the medications' benefit. So there can be permanent changes in how you eat, how you shop, how active you are physically that these medicines can unlock — but sometimes they aren't enough on their own."

What you can do if you need to pause or stop a weight-loss medication?

Dr. Choi suggests that people interested in lowering or stopping their dosage should follow the same approach as those starting a weight-loss medication — work with a doctor.

"I think the No. 1 key is getting good clinical guidance when starting it, stopping it, weaning from it, whatever phase you're in," Dr. Choi says. "Getting good clinical guidance is really important in maximizing the benefits and minimizing the negative aspects."

It's easier than ever to get these medicines through telehealth platforms, and there is no shortage of "advice" for how to approach taking these medicines online. Without proper medical advice, Dr. Choi says it may be easier to become frustrated or experience side effects that lead to discontinuing the medicine before understanding if it will truly work for you.

"I do hear of a lot of patients who say, 'Oh, I tried it for a few months, it didn't work,' but they didn't ramp up to the proper dose, or they went up in dosage too quickly before their body got acclimated, and they had side effects," Dr. Choi said. "A lot of times I'll rehash a patient's experience and realize they didn't get enough guidance or have enough understanding of what you're supposed to get out of the medicine before deciding it didn't work."

Dr. Choi says that weight-loss doctors can provide customized recommendations for modifying food choices, portions, and water and fiber intake, as well as other strategies, to protect against discomfort that may prevent someone from getting the most out of these medicines.

"When you have a clinician who's going to be patient enough to listen and really understand what you're dealing with, then you may not have to stop the medication," Dr. Choi says. "If you don't get good guidance, you're not going to see the optimal effects — and then if you don't get good guidance when you lose access or want to adapt your dose, that can really worsen the rebound weight gain and all the negative aspects of coming off those medicines."

Dr. Choi emphasizes that most obesity medicine physicians are willing to work with patients to understand their desires regarding their care plan, including cost-effectiveness.

"Clinical guidance is going to help you get to the right place in the healthiest, safest manner," she says.