Weight regain after stopping GLP (glucagon-like peptide) use is a common issue among patients. A recent study published in the journal Diabetes Care, titled “Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension,” found that patients who discontinued use of the GLP semaglutide experienced significant weight regain and worsening of cardiometabolic markers (Graph 1). This weight regain issue has become a major concern among patients who are looking to lose weight and those who are self-medicating with GLPs.

The study followed patients who had participated in a previous trial of semaglutide for weight loss and found that those who discontinued the medication experienced a mean weight regain of 5.4 kg (12 lbs) over a period of 26 weeks (graph 1). Additionally, markers of cardiometabolic health such as glucose and blood pressure also worsened.

This highlights the importance of addressing the behavioral factors that contribute to weight regain after stopping GLP use. Many patients rely on the GLP medication alone to achieve weight loss without making necessary changes to their diet or exercise habits, and do not get the necessary feedback from their healthcare providers when it comes to reducing medications. When the medication is discontinued, these habits do not sustain the weight loss and patients revert to their old ways, leading to weight regain.

Graph 1:

So what actually happens when you suddenly stop taking GLP-1s?

When someone suddenly stops the medications, it can be like a dam breaking. The feelings of fullness and suppressed appetite that the medication provided are gone, leaving the individual with a raging hunger and an intense craving for food. It can feel like a constant battle to resist the urge to eat, and it can be incredibly difficult to overcome. This is not just a minor inconvenience, it can be a major problem that can make it difficult to maintain a healthy weight and blood sugar levels. It is interesting to note that patients who lost between <5-15% of body weight had the greatest increase in weight gain (graph 2) when they stopped using GLP-1s.

Graph 2:

If you’re taking GLP-1 receptor agonists for weight loss, it’s critical to understand the importance of titrating the medication down in order to minimize side effects such as food cravings. Suddenly stopping these medications can cause a flood of hunger and cravings that can be difficult to resist, making it harder to maintain a healthy weight and blood sugar levels.

But unfortunately, the current healthcare system is not always set up to support real-time titration of medications. Long wait times for follow-up appointments and overworked healthcare providers can make it hard for patients to get the support they need. It’s a battle that can feel impossible to win.

The solution to this problem is clear: we need a comprehensive and personalized approach to weight loss and weight management that addresses both the behavioral factors and real-time medication titrations that contribute to weight regain. This is where programs like Zone.health come in. Zone.health is a digital health program that uses a combination of behavioral change tools, medication, and technology such as continuous glucose monitoring (CGM) and fitness tracking devices to provide patients with real-time data on their glucose levels and physical activity.

The program’s mobile app allows patients to monitor their progress, set goals, and receive personalized guidance and support throughout their weight loss journey. The app also includes evidence-based techniques such as nudge therapy, mindfulness, and goal setting to address the psychological and emotional factors that can impact weight loss. By providing patients with the necessary tools and support to address behavioral factors and real-time data on their glucose levels and physical activity, the Zone.health program can make the weight loss much more permanent. The ‘clinic-in-the-cloud’ care team helps titrate medication so that patients slowly reduce dosing as the weight target loss nears.

It is important for patients to understand that self-medicating or just getting a prescription for GLPs alone is not the solution and can lead to more weight gain. Programs like Zone.health that address the behavioral factors and use technology, continuous management and medication together can help prevent weight regain and improve overall health outcomes.