Maintaining Weight Loss After Stopping Semaglutide or Tirzepatide

If you have reached your weight loss goal with the assistance of a GLP-1 medication, congratulations! Obtaining a healthy weight reduces the long term risk of diabetes, many cancers, dementia, heart disease, and stroke. We hope you are enjoying more energy, increased mobility, and becoming a healthier version of yourself.  We share your enthusiasm! 

If you’re at your goal weight, you may be wondering if it’s time to stop the medication. First and foremost, there are no published guidelines on how or when to stop GLP-1 agents (i.e. Semaglutide and Tirzepatide) when used for weight loss. These medications were originally developed to treat diabetes, which is most commonly a lifelong condition. There is published data that shows that patients who lose weight with GLP-1 medications will, on average, slowly regain much of the weight that was lost. However, there are ways to limit and slow weight regain from occurring. Here are some effective strategies to sustain weight loss after stopping Semaglutide or Tirzepatide.

Understand the Mechanism

Both Semaglutide and Tirzepatide work by mimicking a family of hormones called “incretins”, which the body normally produces to regulate blood sugar and appetite. Understanding that these medications aid in weight loss primarily through appetite reduction can help patients prepare for stopping the medications by focusing on adopting other habits that naturally manage hunger and satiety.

Gradual Transition

Abruptly stopping any medication can lead to unexpected changes in your body. We recommend you check in with your provider before stopping the medication. A gradual transition off the medication can help your body adjust to the change and potentially reduce the risk of rebound weight gain. Stopping cold turkey is a tough adjustment for your body. There is no particular danger in stopping the medications abruptly, but hunger can return more quickly than desired. Keep in mind that these medications are started slowly and it’s usually best to do the same when transitioning off of them. Some patients may find a lower maintenance dose works best for them. Others may be comfortable stopping altogether after slowly tapering down the dose and then resuming the medication if problematic weight gain recurs. Your journey will be your own and we are here to help you along the way. 

Calories in vs Calories Out

As we have discussed previously, body weight is a formula of calories in vs calories expended.  We have control over both of these variables – calories ingested and calories expended. To manage calories in, we recommend monitoring your daily intake by tracking all of your food and other caloric intake. Apps such as myfitnesspal have made this process much easier. Before stopping your weight loss medication, it is very important to track your daily calories ingested. If you can stay at this daily calorie number, you will greatly reduce the risk of regaining weight.

Sustainable Eating Habits

• Mindful Eating: Focus on eating slowly and without distractions, which can help you recognize your body’s satiety cues and avoid overeating.
• Balanced Diet: Incorporate a diet rich in vegetables, fruits, and lean proteins. Avoiding refined carbohydrates and sweets is critical. If consuming grains, aim for whole grains and in small quantities. These foods are not only nutritious but also filling, which can help manage hunger.
• Portion Control: Learn to control portion sizes. Using smaller plates and measuring servings can prevent inadvertent calorie overload.

Calorie Expenditure

Managing calories expended is a bit more complicated.  The easiest way to look at calories expended per day is your calories burned with exercise and also calories used for maintaining your body. Calories used while inactive is called the basal metabolic rate (BMR).  Your BMR can be affected by age, menopausal state for women, air temperature, and muscle mass, among other factors. The only calorie expenditure you have direct control over is exercise to increase calories used. Any type of exercise helps – walking, resistance training with weights or band, aerobic activity. Resistance training has the added benefit of increasing muscle mass, which will increase your BMR. Unfortunately it’s very easy to stumble into eating more calories than you use by exercise.  As the saying goes: “it’s hard to outrun a bad diet.” So being attentive to your diet and calories ingested is much more important than focusing on the calories expended to maintain body weight. 

Regular Physical Activity

Exercise is crucial in maintaining weight loss. Aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity each week, as recommended by the CDC, alongside muscle-strengthening exercises on two or more days a week. This helps burn calories and build muscle, which can keep your metabolism active. Resistance training is also frequently overlooked by many. Even lifting light weights or using resistance bands while watching TV can accomplish a lot for burning calories and maintaining lean body mass.

Behavioral Strategies

• Setting Realistic Goals: Set achievable goals that foster motivation and provide a sense of accomplishment.
• Keeping a Food Diary: Writing down what you eat can increase awareness of calorie intake and eating patterns.
• Stress Management: Stress can lead to overeating. It can also disrupt sleep, which is also associated with overeating and increased tendency to store fat. Techniques such as yoga, meditation, and deep breathing can help manage stress.

Medical Follow-Up

Regular follow-ups with your primary healthcare provider are important. We are happy to discuss maintenance weight loss medication management with you.  We also recommend that you check in with your primary doctor to monitor thyroid, kidney and liver function, blood sugar levels, blood pressure, and cholesterol. Your body is changing with weight loss and any medication you are taking may need to be adjusted.

Social Support

Engage with friends or support groups, whether online or in person. Sharing experiences and tips can provide motivation, accountability, and innovative strategies to keep the weight off.

By implementing these techniques, you can increase your chances of maintaining weight loss after discontinuing Semaglutide or Tirzepatide. Remember, the goal is to transition to a sustainable and healthy lifestyle that supports your long-term health and well-being. If a lower dose or occasional dosing of medical weight loss treatment is helpful, we are here to support you.

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