If I stop weight loss medication, will the weight come back?

In discussing weight management medication in my practice, two of the most common questions I get asked are:

How long do I need to take this weight loss medication for?

and

If I stop the medication, will the weight come back?

Clinical trials of weight loss medications often follow participants for a few weeks to months after medication is stopped, consistently showing that weight starts to go back up. Now, we have longer term data, looking at what happens to people who have been on obesity medication for over a year, one full year after weight management medication is stopped.

The data, published in Diabetes, Obesity, and Metabolism, is an extension of the STEP1 study of semaglutide 2.4mg weekly (Wegovy) for weight management. In this extension study, 327 participants were followed for a year after all interventions (semaglutide or placebo, and lifestyle intervention for all participants) were stopped.

During the STEP1 trial, after 68 weeks of treatment, average weight loss was -17.3% with semaglutide, and -2.0% with placebo. One year after the study was completed, people who had been in the semaglutide group had regained +11.6% weight. Thus, they were still -5.6% down in weight compared to before the study started, but the trajectory (per the figure in the paper) is still going up. So, if these people were followed for say another year, it’s likely that the trend of weight regain would continue. (though we would need longer term data to know this for sure)

Along with weight regain after stopping semaglutide, it doesn’t come as a surprise that most of the health benefits were lost as well, including benefits to blood pressure, blood sugar, and inflammation (hsCRP).

People who had been in the placebo (with lifestyle change) group regained all of their (very little) weight lost (they were -0.1% down from baseline at the end of the 1 year post-study follow up). This reminds us that lifestyle changes need to be permanent in order to work long term.

That weight is regained after stopping treatment should not come as a surprise. Think of it this way: if we control elevated blood pressure (hypertension) for a year with medication, what would we expect to happen when we stop the treatment? Naturally, blood pressure would go back up. If we treat type 2 diabetes with a medication for a year and then stop it, what then? Same thing – sugars go back up. Hypertension and type 2 diabetes are both chronic disease that need long term treatment, so it doesn’t make sense to stop the treatment and expect the underlying medical condition to go away. Medications for these health issues do not cure what they are treating – they help to control it. (Note: With intensive, ongoing lifestyle strategies, blood pressure and blood sugars can be improved or even controlled. But again, these lifestyle changes need to be permanent to work long term, which can be really tough to stick to over the long term.)

Similarly, obesity is a long term medical condition, which we can help to control with long term medication. Our natural human biology drives weight regain after weight loss, and without the ongoing effect of weight loss medication to defend against that biology, weight almost always goes back up. Medication doesn’t cure obesity, nor should we expect it to.

BOTTOM LINE: Weight is regained if weight management medication is stopped. Treatment is intended to be long term, just like medical treatment for other chronic medical conditions.

Disclaimer: I am an investigator in the STEP clinical trial program. All studies are conducted by Novo Nordisk, the makers of semaglutide. I receive honoraria as a continuing medical education speaker and consultant from Novo Nordisk.

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