Stopping GLP-1 medication usually leads to weight regain. One year after stopping semaglutide 2.4 mg, people in the STEP 1 extension had regained about two-thirds of the weight they lost, and their blood pressure and blood sugar gains largely faded.[1] In SURMOUNT-4, people switched from tirzepatide to placebo regained 14% of their body weight in a year.[3]
This guide covers semaglutide (Ozempic, Wegovy; see our semaglutide profile) and tirzepatide (Mounjaro, Zepbound; see the tirzepatide profile). For how these drugs work, visit the GLP-1 basics hub.
What the trials show about weight regain
Three trials tested what happens when people stop treatment.
| Trial | Before stopping | After stopping (placebo) | If treatment continued |
|---|---|---|---|
| STEP 1 extension (semaglutide 2.4 mg) | −17.3% over 68 weeks | Regained 11.6 points in 1 year; net −5.6% at week 120 | Not studied[1] |
| STEP 4 (semaglutide 2.4 mg) | −10.6% over 20 weeks | +6.9% over 48 weeks | −7.9% more[2] |
| SURMOUNT-4 (tirzepatide 10 or 15 mg) | −20.9% over 36 weeks | +14.0% over 52 weeks | −5.5% more[3] |
STEP 1 extension
After 68 weeks of semaglutide 2.4 mg, both the drug and the lifestyle program were stopped. A subset of 327 participants was followed for another year.[1] People on semaglutide had lost 17.3% of their weight. By week 120 they had regained 11.6 percentage points, leaving a net loss of 5.6%.[1] Weight was still rising at the final visit, so it is not known where it would have settled.[1] Regain was also faster than in STEP 4, which the authors linked to the larger weight loss before stopping in STEP 1.[1]
People who lost the most weight tended to regain the most, but they still kept a larger net loss than those who had lost less.[1]
STEP 4
STEP 4 gave everyone semaglutide for 20 weeks, then randomly switched some to placebo. Over the next 48 weeks, people who continued lost a further 7.9%, while those switched to placebo gained 6.9%. The difference was 14.8 percentage points.[2] Waist size, systolic blood pressure and physical functioning scores were also better with continued treatment.[2] Stomach side effects were more common with continued semaglutide (49.1% vs 26.1%), but few people in either group stopped because of them.[2]
SURMOUNT-4
SURMOUNT-4 used the same design with tirzepatide. After a 36-week lead-in with an average loss of 20.9%, people switched to placebo regained 14.0%. Those who stayed on tirzepatide lost another 5.5%.[3] At week 88, 89.5% of people on tirzepatide had kept at least 80% of their earlier loss, compared with 16.6% on placebo.[3]
Blood pressure, blood sugar and other markers
Weight is not the only thing that changes after stopping.
- STEP 1 extension: improvements in blood pressure, blood sugar, cholesterol and other markers moved back toward baseline by week 120 for most measures.[1]
- Prediabetes: among people with prediabetes at the start, 93.6% on semaglutide had normal blood sugar at week 68. A year after stopping, that fell to 43.3%, versus 34.0% in the placebo group.[1]
- STEP 4: gains in waist size, systolic blood pressure, fasting glucose, insulin and cholesterol were kept with continued semaglutide but got worse after the switch to placebo.[4]
The STEP 1 extension authors concluded that ongoing treatment is needed to maintain improvements in weight and health,[1] and the STEP 1 and 4 analysis found that cardiometabolic benefits were not maintained after stopping.[4]
Why weight comes back
Obesity is a chronic condition. The STEP 1 extension authors note that weight loss sets off compensatory changes in the body that push weight back up, and that regain after stopping is driven by both physical and behavioral factors.[1]
Timing also plays a role. Semaglutide has a half-life of about 1 week and stays in the bloodstream for about 5 to 7 weeks after the last 2.4 mg injection.[8] Tirzepatide’s half-life is about 5 to 6 days.[9] As drug levels fall over those weeks, the appetite-lowering effect is expected to fade with them.
How long do people actually stay on GLP-1 drugs?
Outside of trials, stopping is common.
| Study | Population | Finding |
|---|---|---|
| Rodriguez et al. 2025 (JAMA Netw Open) | 125,474 US adults starting liraglutide, semaglutide or tirzepatide | Stopped within 1 year: 64.8% without type 2 diabetes, 46.5% with it[5] |
| Gasoyan et al. 2025 (Obesity) | 288 people who stopped within a year | Cost or insurance 47.6%, side effects 14.6%, shortages 11.8%, too little weight loss 1.7%[6] |
| Gasoyan et al. 2026 (Diabetes Obes Metab) | 7,938 people who stopped after 3 to 12 months | 19.6% restarted the same drug within a year; 35.2% got another obesity treatment[7] |
In the Rodriguez study, people who lost more weight were less likely to stop, and moderate or severe stomach side effects made stopping more likely. Among those who stopped, 36.3% without diabetes and 47.3% with diabetes restarted within a year.[5]
The 2026 Gasoyan study found that average weight change in the year after stopping was small (+0.5% in people treated for obesity), but varied widely from person to person.[7] These people had stopped earlier and lost less weight (8.4% on average) than trial participants, so the results are not directly comparable to STEP 1 or SURMOUNT-4.[7]
Stopping safely: what to discuss with your prescriber
- No tapering schedule exists. The Wegovy and Zepbound labels do not describe one, and no trial has tested tapering. Some people move to a lower maintenance dose instead; see semaglutide maintenance dose and tirzepatide maintenance dose.
- Diabetes medicines may need adjusting. If you take a GLP-1 for type 2 diabetes, stopping can raise blood sugar. Your clinician may change other medicines.
- Pregnancy planning. The Wegovy label says to stop at least 2 months before a planned pregnancy because of semaglutide’s long half-life.[8]
- Restarting. If 2 or more weekly Wegovy doses are missed in a row, the label says to restart at a lower dose to reduce stomach side effects.[8] For Zepbound, a dose missed by more than 4 days should be skipped.[9]
- A plan for eating and activity. Our GLP-1 diet guide covers protein and meal planning.
If you are thinking of stopping because the drug is not working, read not losing weight on a GLP-1 first. If side effects are the reason, see managing GLP-1 nausea. For how the two main drugs compare, see semaglutide vs tirzepatide.
