Coming Off a Weight Loss Drug? Here’s What You Need to Know

Injectable weight loss drugs have exploded in popularity in recent years, due to their transformative results in treating obesity and type 2 diabetes. Semaglutide and tirzepatide, known by their brand names Ozempic, Wegovy, Mounjaro, and ZepBound, mimic the gut hormone GLP-1 (glucagon-like peptide 1) to regulate blood sugar and curb appetite. They are incredibly effective, for as long as you keep taking them.

However, access to anti-obesity medications over the long term can be hampered by high costs, lack of insurance coverage, supply chain disruptions due to extremely high demand, and unwanted side effects such as nausea, vomiting, diarrhea, and constipation.

Many major health insurance companies don’t cover obesity medications or only cover them for a limited period (e.g., three to six months). Furthermore, in clinical trials, up to 10 percent of participants quit taking the drugs because of the side effects. Outside of a clinical study, where physicians are readily available to offer follow-up support in managing side effects, the number of people who stop taking the medications is probably higher, says Dr. Christopher McGowan, founder of True You Weight Loss.  

For patients paying out of pocket, weight loss medications can come with an ongoing cost of $15,000 per year.

So, despite their efficacy, many people will be forced to transition off weight loss medications at some point in their obesity treatment journey, which can bring a challenging set of symptoms, side effects, and even the relapse of chronic conditions like type 2 diabetes, hypertension, and high cholesterol.

What Happens When You Stop Taking GLP-1 Medications?

It’s crucial to know what to expect when quitting weight loss medication, so you can mentally prepare and begin implementing strategies to manage the transition.  Once you stop taking a GLP-1 medication, your appetite and excess blood glucose will return. In fact, research shows that people who stopped taking Ozempic regained two-thirds of the weight they lost on the drug within one year, while their cardiometabolic indicators (blood pressure, cholesterol, and blood sugar) also worsened.

Obesity medications have a long half-life of five to seven days, so stopping them is completely safe, Dr. McGowan says, but it’s still best to talk to your doctor so you know what to expect.

Once you stop taking a GLP-1 medication, the hunger hormone ghrelin increases and your metabolism slows. This tricks your body into thinking you’re starving, so your natural weight-gaining mechanisms will kick into overdrive to regain the weight you’ve lost.

Here’s what to expect when transitioning off obesity medications:

1. Increased hunger: Semaglutide and tirzepatide both slow digestion and alter brain chemistry to decrease hunger and lessen the pleasure you get from food. Once you stop taking them, though, your hunger cues return, leading you to eat more to feel satisfied.
   
   
2. Blood sugar hike: Because weight loss medications help stimulate the pancreas to release insulin, quitting them is likely to raiseglucose levels in your bloodstream. Increased caloric intake and rapid weight gain can also lead to insulin resistance, which makes blood sugar much more difficult to control.

• Weight gain: No surprise here – weight gain after quitting GLP-1 medications is well documented, while increased appetite and raised blood sugar contribute to weight gain as well.

• Food cravings: Anti-obesity drugs help quiet “food noise” -- excessive thoughts about food and cravings that can lead to unhealthy diet choices and overeating. When you stop taking these medications, a preoccupation with food, anxiety over decisions about what to eat, and intense cravings may return.
  
  
• Depressed mood: Weight gain can affect your mental health. When you regain weight quickly after quitting a GLP-1 medication, you may experience decreased energy and fatigue, changes in the way your clothes fit, and even some unwanted attention or comments from the people in your life. These factors can lead to poor self-esteem and feelings of depression.
  
  
• Return of metabolic disease: Because obesity and type 2 diabetes are so closely connected to other types of metabolic disease – including high cholesterol and hypertension – it’s very common to see these conditions worsen when you quit weight loss medications.  

Managing Ozempic Withdrawal

The transition period after stopping weight loss medications, sometimes called “Ozempic withdrawal,” can be challenging. Here are some strategies to help you cope:

Focus on diet and nutrition

Maintaining a healthy diet can help you avoid rapid weight regain and the return of any related health problems.

A healthy diet full of plants and fiber is critical to maintaining weight loss over the long-term and can also help stabilize blood sugar and energy levels, while promoting regularity and digestive health. Swap in high-fiber plant protein where you can, and load your diet full of fruits, vegetables, legumes, and whole grains.

Protein, especially from plant sources like beans, lentils, tofu, and quinoa, is also a critical component for keeping weight off for good. Protein helps your body build and maintain lean muscle mass, altering your metabolism to burn more calories during daily activities and even while at rest.

If you need expert help, engaging the support of a registered dietitian is recommended. They can offer proven strategies, guidance, and accountability to help prevent weight regain once you stop taking a GLP-1 weight loss medication.

Keep a food journal

Keeping a food journal is a standard part of most nutrition counseling programs because it’s a powerful tool in helping identify foods that work best for your body and goals. Tracking what helps you stay full, satisfies cravings without spiking blood sugar, boosts your mood and energy, and also tastes good can help you make sustainable diet changes for the long term.

Commit to increasing your physical activity

Studies show two hours of cardio exercise every week (any activity that raises your heart rate counts) builds a strong cardiovascular system, which will help your body maintain weight loss after stopping a weight loss drug. Regular strength training is also important to promote lean muscle and enhance the benefits of adding more protein to your diet. Dr. McGowan recommends starting with 150 minutes of cardio every week combined with two to three days of full-body strength training to maintain a healthy weight.

Get your ZZZs

When it comes to maintaining a healthy weight, diet and exercise are the two most discussed factors, but don’t overlook the importance of good sleep. Getting seven to eight hours of rest each night helps you function at your best, provides sufficient energy for regular exercise, decreases cravings and poor food choices, and promotes focus and cognition, keeping you sharp and committed to your health goals.

Consult with an obesity medicine physician

There’s no one better equipped to help you prevent weight regain than a doctor who’s board-certified in obesity medicine. While you may not be able to afford or tolerate GLP-1 medications, there are dozens of other weight loss drugs out there to consider – and a trained physician can help you understand your options. In addition, an obesity medicine physician can get to know you, your history of obesity, and what strategies you’ve tried – so they can design a weight loss program that’s designed to fit your needs.

Consider non-surgical weight loss options

If diet, exercise, and/or weight loss medications have not worked for you, it might be time to consider the non-surgical procedures offered at True You Weight Loss. Endoscopic sleeve gastroplasty and gastric balloons are both safe, effective, and minimally invasive procedures that can help you reach your long-term weight loss goals without the complications of major surgery.

If you’d like to learn more about bariatric endoscopy and the weight loss procedures offered by True You Weight Loss, please contact us to request a consultation.