Stopping weight-loss injections: What happens to your weight and appetite?

Almost everyone who starts or is considering weight loss treatment with medication wonders what happens afterwards. This is a valid question, as there are now studies that have specifically investigated the course of events following the end of treatment. This article explains what was observed, how it can be explained and what implications this has for treatment planning.

Key points at a glance

• Following the end of treatment, weight increased significantly again on average in the studies. In the extension of the STEP-1 study, approximately two-thirds of the weight previously lost had been regained within a year, after both the medication and the lifestyle programme had been discontinued.
• On average, however, the participants were still below their starting weight at the end of this extension period. The statement ‘back to where they started’ does not reflect the data.
• These results describe group averages, not individual predictions. The outcomes for individual participants varied considerably.
• Whether, when and how treatment is discontinued is a matter for medical care and should not be decided independently.

Can weight increase again after stopping treatment?

Yes, and that is the norm, not the exception. In controlled trials, weight increased significantly on average after treatment ended, whilst it was better maintained with continued treatment.

The reason lies in the way they work. These medicines amplify the body’s own signals for satiety and suppress the appetite. As soon as the active ingredient is no longer administered, this amplification ceases. From a technical perspective, it is also assumed that, following weight loss, the body reacts by making adjustments that promote weight regain. This also applies to weight loss achieved without medication and is not specific to these active ingredients.

What the STEP-1 and SURMOUNT-4 studies actually investigated

In the extension of the STEP-1 study, weight trends were monitored after treatment with a GLP-1 receptor agonist and the accompanying lifestyle programme had been discontinued. Within one year, participants regained, on average, around two-thirds of the weight they had previously lost. Specifically, a weight loss of around 17 per cent over 68 weeks was followed by a regain of around 12 percentage points. On average, participants therefore remained around 6 per cent below their baseline weight. Improvements in cardiometabolic parameters also largely reversed.

It should be noted that this extension only involved a selected group of the original study participants – just over 300 people from some of the centres – and that the analyses were designed to be exploratory. There was no group that continued the treatment in this study.

SURMOUNT-4 was structured differently. Around 670 participants initially received an active substance that acts on the GLP-1 and GIP receptors in an open-label setting for 36 weeks. Afterwards, one subgroup was switched to placebo for 52 weeks, whilst the other subgroup continued the treatment. In the placebo group, weight increased by an average of around 14 per cent during this period, whilst in the continuation group it decreased by a further 5 per cent on average. This design is meaningful because both groups had previously received the same treatment and differed only in terms of whether they continued with it.

Important for context: Both studies describe mean values. Within the groups, there were participants who gained hardly any weight, and others who gained more. Statements such as ‘Anyone who stops will put all the weight back on’ misrepresent the data.

Why regaining your appetite is not a personal failure

This is the point that most often goes wrong in public debate. When hunger and appetite return after weaning, this is often interpreted as a lack of discipline, both by outsiders and frequently by those affected themselves.

In fact, it makes more sense to view this as a biological pattern. Appetite regulation is a hormonally controlled system. It is therefore not a question of someone losing control, but rather that a medicine which interferes with this system simply ceases to do so once it is discontinued. The extent to which this is reflected in patients’ experiences has so far been studied less thoroughly than changes in body weight.

This classification is not merely a question of fairness. It is relevant in practical terms because self-reproach can make it difficult to address the situation in practice. If you realise that the subject of food is weighing heavily on you, that should also be included.

What factors are taken into account when deciding to discontinue treatment

Obesity is medically recognised as a chronic condition. It does not follow from this that a particular medicine must necessarily be taken indefinitely. It does, however, follow that discontinuing treatment is a medical decision and not a matter of when a desired weight appears to have been reached.

Several factors are taken into account in this decision: the course of the condition to date and the changes achieved, tolerability, existing comorbidities and how you have responded to treatment, your daily routine and how stable your dietary and exercise habits have become, as well as practical aspects such as costs or a planned pregnancy.

Sometimes, discontinuing treatment is medically necessary, for example in the event of side effects or if the desired effect does not materialise. In all cases, it is crucial that the decision is made in consultation with the treating practice. Anyone who stops treatment on their own initiative not only loses the benefit of monitoring their weight progression. Blood pressure, blood sugar and other readings may also change, and in the case of existing comorbidities, this may necessitate an adjustment to the rest of the treatment.

What is included in a maintenance plan

When a course of treatment is to be brought to an end, the transition is actually the critical part. It makes sense to prepare for it rather than simply letting it happen.

This means that dietary and exercise habits should not be established only after treatment has ended, but should be developed during treatment. It also involves monitoring muscle mass, as any significant weight loss results in a loss of lean body mass as well. An adequate protein intake and strength training are therefore considered useful complementary measures, even though robust studies specifically for this class of active substances are as yet lacking.

This includes agreed follow-up appointments after treatment has ended. They make it possible to spot any changes early on and discuss them, rather than only getting back in touch months later. Which strategy is appropriate in each individual case depends on the course of the condition, any underlying conditions and the patient’s personal circumstances, and can only be determined under medical supervision. Find doctors offering weight-loss consultations near you

Frequently Asked Questions

Do you need to taper off the treatment?

The treating practice will decide whether and how to phase out treatment, based on the patient’s progress. There is no universally applicable plan that could be derived from a guidebook. Bring up the subject before you make any changes.

Is everyone really putting on weight again?

No. The studies describe average values, and individual outcomes varied significantly. On average, however, the weight regain was substantial, which is why it would be unrealistic to regard it as an exceptional case.

Is it possible to maintain your weight without medication?

This is possible; however, according to the available data, the average outcome is poorer than with continued treatment. Stable dietary and exercise habits, maintained muscle mass and ongoing medical supervision have a beneficial effect.

Classification

The question of discontinuing treatment is not an afterthought, but should be addressed at the very start of treatment planning. Anyone who realises from the outset that the period following treatment is the more difficult part will approach the treatment differently from someone who expects a short course of treatment.

A surgery offering suitable consultation hours is the right point of contact for this planning and for ongoing care. View doctors offering weight-loss consultations by region