Does weight regain happen faster after stopping weight loss medication, than after stopping a lifestyle intervention?

The media has been going crazy this past week over a recent article suggesting that weight regain is faster after stopping weight loss medications than after stopping a lifestyle intervention. Let’s talk about the data – then, let’s talk about my biggest concern here – why we are discussing regain after treatment in the first place??

The study, published in the British Medical Journal, looked at weight regain after stopping treatment in studies of weight management medications, compared to studies of lifestyle management programs. They found that weight regain after stopping weight management medications was about 0.4kg (just under 1lb) per month. This rate of weight regain was about 0.3kg (0.7lb) per month faster than weight regain after stopping a lifestyle program, independent of how much weight was lost with treatment. The weight regain was projected to return to baseline (before weight loss medication was started) at about 1.7 years, and the cardiovascular risk factor benefits (eg blood sugars, blood pressure) were projected to return to pre-treatment levels within 1.4 years after stopping medication.

I have a lot of concerns about this study. First of all, non randomized and observational studies were included. This means that the people in the medication vs lifestyle treatments were not the same. Some people have more success with lifestyle change than others, and those who take medication may have more difficulty with lifestyle change than those who don’t. Secondly, while the average study duration was 39 weeks, studies of just 8 weeks (with 4 weeks post treatment follow up) were eligible for inclusion in the analysis. This is way too short to say anything meaningful about weight management with any intervention.

My BIGGEST problem with this study is that it completely ignores the KEY POINT – weight management strategies are intended to be long term, and are not intended to be stopped. I can’t imagine a similar study on, say, treatment of high blood pressure. How fast does blood pressure bounce back up after stopping blood pressure medication, vs after stopping a low salt diet? Sounds ridiculous, doesn’t it. That’s because we wouldn’t stop treating the high blood pressure – we would continue treatment long term if it was working to control the blood pressure.

Similarly, in our Obesity Canada 2025 Pharmacotherapy Clinical Practice Guideline (disclosure, I am the lead author), we have a specific evidence-based recommendation to use weight management medication long term, when effective, to avoid weight regain and regression of health benefits. Same goes for lifestyle interventions.

All of that being said, the unfortunate reality is that in real life, many people end up stopping weight management medication. This is often due to cost, loss of insurance, or shortages (in prior years). Sometimes it’s because a person didn’t tolerate the medication well. Sometimes it’s because the time wasn’t taken with the health care professional before starting treatment to help the person understand the biology of weight, and that we are not curing obesity, but controlling it, with medication.

The answer to this conundrum is not to scare people away from weight management medication because they may regain weight faster after stopping treatment. Instead, we need to empower people to understand, before starting the treatment, that any obesity treatment is intended to be long term. We need to develop medications that are better tolerated than the currently available GLP1 medications, and there are lots of trials of new medications underway to address this. We need to find ways to make medication cheaper and more accessible. With the important and wide-ranging health benefits of newer obesity medications, insurance programs (public and private) need to be more engaged in supporting the cost of treatment. With new treaments like oral (in a pill) GLP1 medication and generics coming into some markets this year, I am optimistic that more people will be able to afford to take treatment longterm. Finally, authors point out that people who were in lifestyle change trials may have learned more practical coping skills to support healthy lifestyles over the long term. Oftentimes, people prescribed weight loss medication do not get lifestyle support, and giving this support through a comprehensive program is important to optimize success.

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