Weight regain after stopping GLP's

[lessthanhalf]

I came across this study and found it worth sharing

Trajectory of weight regain after cessation of GLP-1 receptor agonists: a systematic review and nonlinear meta-regression


https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00043-X/fulltext


According to it, individuals who shed pounds while on GLP's may, over the long haul, put back only 75% of what they had lost. That is a curious finding, and in the end it amounts to roughly a 5% weight reduction, which beats nothing at all. Still, my sense now is that a 20-30% loss is genuinely achievable if someone uses tirzepatide or retatrutide and remains on treatment. Perhaps even greater results could come from higher doses or from more experimental combinations.

Looking at the weight regain curve, it appears to flatten out eventually. Finding out the reason, and identifying what might be altered over the long term, would be a fascinating line of inquiry. The explanation offered in the articles, that food choices improve, does not strike me as convincing.

 

[OregonSunshine]

For the majority of individuals, I believe a maintenance dose will be the sole practical option for preventing the weight from coming back.

There are those who, for most of their lives, remained at a typical weight but put on pounds because of a temporary circumstance such as a medication or pregnancy. They may be able to take the GLP1 to shed that weight, then discontinue it and keep the weight off without help.

In my view, most people dealing with obesity have been doing so for much of their adult years, which means their brain is set up to demand far more food than their body actually requires.

 

[lessthanhalf]

I have made 2 attempts to share the graph as a jpg, but it only displays as blank. The journal article contains it if anyone wants to check. Uploading pdfs has worked fine for me in the past, so I am unsure why the image is causing an issue?

 

[AYarter]

Honestly, the drop-off from diet and exercise is even sharper. Just picture what that line would look like if insurers weren't cutting everyone off...

 

[PAPoots]

To me, the advantages of staying on it permanently easily justify the expense. It costs much less than supplements, plus drugs for blood pressure, cholesterol, and insulin. The only time it becomes pricier is if you get caught up buying other peptides. Still, you're adding healthy years. A single quad bypass or a handful of stents runs more than a lifetime of GLPs.

 

[trojanpeptide]

Here you go:

Conversely, some committed individuals stick with better habits once they stop GLP-1 RAs, and they either keep their weight steady or shed a few extra pounds. You can't simply be inactive, keep eating, and expect to shrink.

Edit: plus, certain folks run it in cycles—take 4 weeks off, allow the body to refeed, put back on roughly 10%, then turn to reta once more, repeatedly. Possibly less expensive that way.

 

[Chili777]

That's exactly why people keep freezers and vial cases around. I've got another 17 years to live, so I'm sitting at about half of what I need saved.

 

[AYarter]

Chili777 said:

That's exactly why people keep freezers and vial cases around. I've got another 17 years to live, so I'm sitting at about half of what I need saved.

I'm trying to stockpile tirz for my whole life... you know, just in case the world ends =P

 

[lessthanhalf]

PAPoots said:

To me, the advantages of staying on it permanently easily justify the expense. It costs much less than supplements, plus drugs for blood pressure, cholesterol, and insulin. The only time it becomes pricier is if you get caught up buying other peptides. Still, you're adding healthy years. A single quad bypass or a handful of stents runs more than a lifetime of GLPs.

When it comes to grey-market GLP's, the decision is obvious — I'm entirely on board with what was said above. Whether that holds up when paying full retail, though, is far less clear-cut.

Unfortunately, every cost effectiveness analysis I've come across so far reaches the same verdict: the price per QALY gained (quality of life year) is too high, and that will remain the case until costs drop substantially. Only when those analyses flip will countries such as Aus begin funding them more broadly — and even then, it won't make much difference in nations where the government doesn't cover medication expenses. I suspect these studies aren't fully capturing all the very long term medical cost savings, but the science on that front isn't settled yet.

 

[tubby]

What strikes me as interesting about research like this is that the regain percentage doesn't come nearer to 100%. If nothing else major shifts in someone's lifestyle, that's the figure I'd figure most folks would hit by 5 years out from quitting treatment.

 

[bbbilly]

i find it amusing whenever someone tells me the weight will come back once i quit. my usual comeback is

"right, unlike diet and exercise, which everyone knows is a one-and-done deal that keeps you lean and muscular for life... oh wait..."

that one tends to get a reaction

on a more serious side of things though. in the brief time i've been around here i've already come across multiple people talking about how they plan to increase, have just increased, or want to increase their dose while already being on high doses of at least 1 glp, sometimes more than 1. and they'll frequently mention having no appetite and no food noise, yet the scale isn't moving. so i've wondered what they're actually doing alongside the meds instead of just expecting the meds to handle everything. the med is doing precisely its job, suppressing hunger and silencing food noise. what's the end goal there? to be physically incapable of eating? because that seems to be what they're after rather than figuring out how to eat better or using exercise to create the caloric deficit that's required. (naturally, dietary restrictions/allergies and physical limitations come with their own considerations)

those who take nothing away from the meds will, i'm sure, regain all of it, while those who use them to understand why they eat the way they do and to get past those obstacles won't. for me, they helped me pinpoint the triggers behind my binge eating, so i can steer clear of them more easily and notice when a binge is starting so i can pull out of it (usually around 1/3 of the way in), because i'll have that moment of "man its getting kinda late why am i still up? oh im eating, normally im in bed by now" and then it hits me i'm doing it again, so i drop whatever i'm putting in my mouth, get out of the kitchen, and only come back once that episode has passed.

 

[anhydrous]

bbbilly said:

i find it amusing whenever someone tells me the weight will come back once i quit. my usual comeback is

"right, unlike diet and exercise, which everyone knows is a one-and-done deal that keeps you lean and muscular for life... oh wait..."

that one tends to get a reaction

on a more serious side of things though. in the brief time i've been around here i've already come across multiple people talking about how they plan to increase, have just increased, or want to increase their dose while already being on high doses of at least 1 glp, sometimes more than 1. and they'll frequently mention having no appetite and no food noise, yet the scale isn't moving. so i've wondered what they're actually doing alongside the meds instead of just expecting the meds to handle everything. the med is doing precisely its job, suppressing hunger and silencing food noise. what's the end goal there? to be physically incapable of eating? because that seems to be what they're after rather than figuring out how to eat better or using exercise to create the caloric deficit that's required. (naturally, dietary restrictions/allergies and physical limitations come with their own considerations)

those who take nothing away from the meds will, i'm sure, regain all of it, while those who use them to understand why they eat the way they do and to get past those obstacles won't. for me, they helped me pinpoint the triggers behind my binge eating, so i can steer clear of them more easily and notice when a binge is starting so i can pull out of it (usually around 1/3 of the way in), because i'll have that moment of "man its getting kinda late why am i still up? oh im eating, normally im in bed by now" and then it hits me i'm doing it again, so i drop whatever i'm putting in my mouth, get out of the kitchen, and only come back once that episode has passed.

I feel the same way. Once I reach a point that feels good to me, my intention is to keep using a maintenance dose for the long haul. That could mean continuing until a superior option becomes available — or possibly for life.

 

[Lovedog100]

When I moved from Ozempic over to Reta, getting to an effective dose took a few weeks — possibly a month. During that stretch, my weight went up. A weekly injection is something I can likely stick with far longer than a routine of exercising 5 days a week. As things stand, I'm doing both

 

[lessthanhalf]

If avoiding eating as much as your body signals you to requires relentless mental effort, then according to essentially all the evidence, almost everyone regains the weight sooner or later.

GLP medications address this issue substantially. Provided you continue taking them.

A decade ago I reached a normal bmi of 65kg and maintained it for close to 3 years, but in time I became depressed, stopped caring, and regained everything plus more, reaching 145kg. I did it once more in 2022 23, following a diet specifically crafted to keep hunger low and prevent binge eating triggers, and held it for a year, yet it demanded daily effort to consume less than my hunger told me I should, and that is exhausting. Fortunately I figured out that low dose ozempic was just barely affordable, and a year later found cheap pirate chinese peptides. After being on 15 mg of tirz and 5mg of reta I have gradually dropped another 13kg down to 66kg, without constantly forcing myself to eat less, still following an extremely strict no high calorific density/ highly rewarding foods diet but at least it seems like something I could sustain long term.

One problem with relying on GLP medications to train yourself into better dietary patterns is that you cannot possibly know how much of those better patterns come from the drugs, since they get people to eat healthier foods without any conscious effort anyway. So when you stop them, it is possible that those better patterns, which you believed were under conscious control, suddenly disappear, leaving you feeling bad and out of control of your eating and gaining weight, and putting an end to that whole yoyo pattern is what GLP drugs can offer. I had already trained myself into a very healthy eating pattern and lost 65 to 70 kg but it did not solve the problem of being nearly permanently hungry, but GLP medications did, or at least helped a lot.

 

[Grogu]

lessthanhalf said:

If avoiding eating as much as your body signals you to requires relentless mental effort, then according to essentially all the evidence, almost everyone regains the weight sooner or later.

GLP medications address this issue substantially. Provided you continue taking them.

A decade ago I reached a normal bmi of 65kg and maintained it for close to 3 years, but in time I became depressed, stopped caring, and regained everything plus more, reaching 145kg. I did it once more in 2022 23, following a diet specifically crafted to keep hunger low and prevent binge eating triggers, and held it for a year, yet it demanded daily effort to consume less than my hunger told me I should, and that is exhausting. Fortunately I figured out that low dose ozempic was just barely affordable, and a year later found cheap pirate chinese peptides. After being on 15 mg of tirz and 5mg of reta I have gradually dropped another 13kg down to 66kg, without constantly forcing myself to eat less, still following an extremely strict no high calorific density/ highly rewarding foods diet but at least it seems like something I could sustain long term.

One problem with relying on GLP medications to train yourself into better dietary patterns is that you cannot possibly know how much of those better patterns come from the drugs, since they get people to eat healthier foods without any conscious effort anyway. So when you stop them, it is possible that those better patterns, which you believed were under conscious control, suddenly disappear, leaving you feeling bad and out of control of your eating and gaining weight, and putting an end to that whole yoyo pattern is what GLP drugs can offer. I had already trained myself into a very healthy eating pattern and lost 65 to 70 kg but it did not solve the problem of being nearly permanently hungry, but GLP medications did, or at least helped a lot.

The crucial element in what you're saying is that hunger becomes permanent once GLP-1s are withdrawn. The medical community now classifies obesity as a disease, and if that's the case, then GLP-1s function as a treatment for it. What's actually going wrong is a disruption in the hormonal communication between the mind and gut, and behavioral changes alone are powerless to fix it. Conscious-level processes like willpower and habit building are separate from the hormonal dysregulation that fuels hunger, which acts at a much deeper level.

That's exactly why framing GLP medications as a way to "train yourself into better dietary patterns" doesn't hold up, and why weight comes back once treatment ends. There's no way to tell how much of any dietary improvement comes from the drug itself, because GLP-1s push people toward healthier eating automatically, without deliberate choice. Once the medication stops, those habits that seemed to have taken hold can disappear, and it isn't a matter of weak character; the signaling system underneath simply takes over again. What follows is the same old pattern: relapse, guilt, and regained weight.

To me, at least, the genuine "miracle" of these glp-1 medications is that they offer a way off the yo-yo cycle. While treatment continues, weight levels off and holds steady at the new number, and it looks like that can be maintained over the long term.

 

[Flexon]

Long-term success really comes down to changing how you live, and the food you choose matters more than anything else when it comes to losing weight. Moving your body is vital for overall wellbeing, yet it won't move the scale unless your meals keep you full. The answer is to eat foods that satisfy you. Without that fullness cue, you'll keep eating past what you need. GLP-1 may be useful for getting started on a healthier path, but it cannot be the sole adjustment.

 

[lessthanhalf]

Flexon said:

Long-term success really comes down to changing how you live, and the food you choose matters more than anything else when it comes to losing weight. Moving your body is vital for overall wellbeing, yet it won't move the scale unless your meals keep you full. The answer is to eat foods that satisfy you. Without that fullness cue, you'll keep eating past what you need. GLP-1 may be useful for getting started on a healthier path, but it cannot be the sole adjustment.

Diet and exercise can definitely lead to weight loss. But based on the evidence, for almost everyone it fails over the long haul — only roughly 5% of those who shed a large amount of weight through diet and exercise, or through GLP's and then quit the GLP's, manage to keep it off, or keep most of it off, long term. Thousands of studies exist on this. From my perspective, that makes it not an effective treatment. Back when nothing better was available, it was certainly preferable to doing nothing, and even medium-term gains of 5 to 10% can benefit metabolic health. With GLP medications, average long-term weight loss is realistically around 20 to 29% for tirz or reta.

I believe the scientific evidence is fairly strong that in people with severe obesity the appetite control system is quite broken, and that weight loss does not repair it. If the system governing eating isn't functioning properly, then consuming satiating food in health-appropriate amounts won't deliver the right signals to stop eating. On top of that, after substantial weight loss, metabolic adaptation to lower calorie intake means maintaining weight requires eating considerably fewer calories than someone of the same weight who never lost weight. Weight loss also raises hunger signalling. These 2 effects, independent of faulty appetite regulation, make keeping weight off extraordinarily difficult.

Between 2022 and 2023 I dropped about 70kg through diet and exercise, without glp's. To hold my weight steady I had to keep intake at roughly 1600 kcal/day, and even with a very carefully planned diet I felt hungry nearly all the time. Going by past experience, regaining the weight sooner or later was the most probable result. Luckily, after around a year of that, GLP medications became available as an alternative.

GLP drugs assist with weight loss and are just as effective at maintaining it long term as long as you continue taking them. Obviously eating a healthy diet and exercising is a good thing, but weight loss and the health benefits of these medications do not require this to work. The health benefits are undoubtedly greater when diet is good and exercise is happening, but GLP medications do improve food choices without any effort. And make exercise easier and safer after weight loss.

So when you compare lifestyle changes with GLP therapy, one performs OK short term with extremely low long term success rates, while the other is more effective in the short, medium and long term at causing and maintaining weight loss. It really is that simple, one works, the other does not.

 

[trojanpeptide]

On top of everything else, GLP1s appear to deliver additional advantages tied to living longer:

plus further ones beyond those, though the jury is still out when it comes to cancer:

still, concerns remain. Gallbladder problems rank as a big one, so toss in some TUDCA; it could well be a must!

And sure, I had help from AI, but honestly, I'd already read and watched plenty and knew all this

So then, what reason would I have to go ahead and fully stop for again?

 

[lessthanhalf]

A standout among the cancer trials is the 1 in which mortality was cut in half across multiple years among patients who were already diagnosed with bowel cancer. That is a remarkable finding, and it would make this a more potent therapy for that disease than nearly any other option, with the possible exception of surgical tumour removal. Naturally, it might simply be chance and prove impossible to reproduce. Considering how many cancers become more frequent because of obesity, and with early data strongly pointing to a lower likelihood of developing them while on glp's, this could turn out to be a major contributor in cancer. A great deal of research is currently underway.

 

[bbbilly]

it seems like everyone shares a similar outlook, just positioned at different extremes. nobody disputes that GLPs are useful, necessary, and work. my sense is that what we're really debating is how much someone leans on them, not whether they should be used as a tool at all. personally, even at 1.25mg/week of my tirz, i'm in a far better headspace to make good choices when it counts and to stop myself from sliding into a binge. i refuse to let the meds go to waste or undo the progress i'm after, and that refusal is what snaps me out of the cycle. even during the 6 months i was off it, i understood that feeling hungry didn't obligate me to eat, so i simply repeated the same meals daily no matter what my hunger said.

others appear to lean entirely on the medication to get where they want. just compare how many threads sit in the fitness/nutrition category versus any other non specialized section here. quit the meds and naturally the weight returns. the same holds if you quit tracking food and/or exercise, and i doubt anyone disputes that. my own take is that leaning too heavily on them is what keeps those statistics accurate, and from what i've seen i'd bet the folks posting "im not hungry at all but im not losing weight" are exactly why 95% weight regain after quitting persists.

so for people like me, the lens is diet and exercise first, meds second, whereas (granted, most likely folks who'd be outliers in the studies, judging only from the limited comments on forums like these without knowing the full effort they put into weight management) the other lens treats meds as the heavy lifter and the only thing that works.

again im unaware of any studies on this subject aswell, but i've noticed a common pattern among naturally thin people: "ya im hungry but i dont have time to eat right now so ill just eat later." it's less about hunger cues and more about mentally recognizing what those cues mean, and i'd be curious to see the outcome if they had a super effective GLP that only silenced the food noise entirely, while leaving appetite suppression and gastric emptying untouched. what those studies would look like.