A groundbreaking study published in the British Medical Journal (BMJ) has delivered a crucial reality check for millions using the new generation of weight-loss injections. The research indicates that stopping medications like semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound) leads to a rapid regain of the lost weight, with individuals typically returning to their original weight within just 1.5 years. This rebound effect is even faster than what is observed after discontinuing older weight-loss agents or following diet and exercise programs.
The Harsh Reality of Discontinuation
The BMJ analysis, which reviewed 37 studies involving over 9,000 participants, found a consistent pattern across all weight-loss therapies. On average, people began regaining weight at a rate of 0.4 kg per month after stopping treatment, completely reversing their weight loss achievements approximately 1.7 years later. Strikingly, there was no difference in weight between those who had discontinued the drugs and those who never took them after about 1.4 years.
The data for the newer, highly effective GLP-1 drugs like semaglutide and tirzepatide, though extrapolated due to limited long-term discontinuation data, painted a starker picture. The projected weight regain rate for these drugs was 0.8 kg per month, meaning patients could expect to regain all lost weight in about 1.5 years post-discontinuation.
Not a Short-Term Fix: A Chronic Condition Management
Leading endocrinologist Dr. Ambrish Mithal, Chairman of Endocrinology and Diabetes at Max Healthcare, emphasizes that these findings underscore a fundamental truth. "Just like medicines for hypertension or diabetes, these weight-loss drugs work only as long as you continue to take them," he explains. The question of stopping has become prominent only with this new generation of drugs because of their dramatic efficacy, leading to significant weight loss that cannot be sustained indefinitely without the medication.
Dr. Mithal outlines key principles for managing patients on these drugs:
1. Long-Term Maintenance, Not Complete Cessation: For severely obese individuals or those with diabetes and co-morbidities, going completely off the medicine is not a viable solution. The strategy involves gradually tapering the dose to a long-term maintenance level once significant weight loss is achieved, especially if excessive weight or muscle loss occurs. This must be combined with sustained diet and exercise.
2. Realistic Weight Goals: The target should not be an unrealistic "ideal" body weight, particularly for those who started with morbid obesity. Weight loss eventually plateaus. "The important thing is, even if you do not achieve the ideal weight, your health is much better with whatever weight you have lost," says Dr. Mithal.
3. Special Population Challenges: Decisions are particularly challenging for moderately obese younger patients and women using the drugs for conditions like PCOS to aid conception. The medicine cannot be continued during pregnancy or lactation, creating a complex clinical dilemma.
Heart Health Benefits Also Fade
The study's implications extend beyond the scale. It found that the cardiometabolic benefits gained during active treatment also weakened after stopping the drugs. Improvements in key health markers—including HbA1c (average blood sugar), cholesterol, triglycerides, and blood pressure—returned to their original baseline levels roughly 1.4 years after discontinuation.
For instance, active treatment decreased systolic blood pressure by an average of 5.8 mm Hg. After stopping, it began rising by 0.5 mm Hg per month. Similar reversal trends were noted for diastolic blood pressure, cholesterol, and triglycerides.
This contrasts with weight loss achieved through structured behavioural management programs, where research suggests the health benefits can persist for at least five years, possibly because patients retain practical coping skills.
The study serves as a critical guide for doctors and patients, framing obesity treatment with these powerful new drugs as a long-term management strategy rather than a short-term cure. It highlights the necessity of medical supervision, dose adjustment, and managing expectations for sustainable health outcomes.
