Do patients on Ozempic (semaglutide) maintain weight loss after discontinuing the medication?

Weight Regain After Discontinuing Ozempic (Semaglutide)

Patients who discontinue Ozempic (semaglutide) typically regain approximately two-thirds of their lost weight within one year after stopping the medication. 1

Evidence on Weight Regain After Discontinuation

The weight management effects of semaglutide are not maintained after discontinuation, as demonstrated by high-quality clinical evidence:

• The STEP 1 trial extension showed that after discontinuing semaglutide 2.4 mg weekly, patients regained 11.6 percentage points of their body weight within one year, resulting in a net weight loss of only 5.6% from baseline (compared to 17.3% weight loss while on treatment) 1

• Cardiometabolic improvements seen during active treatment with semaglutide largely reverted toward baseline values after discontinuation 1

• In the STEP 4 randomized clinical trial, patients who were switched from semaglutide to placebo after a 20-week run-in period experienced a 6.9% weight regain over the following 48 weeks, while those who continued semaglutide lost an additional 7.9% of body weight 2

Mechanisms of Weight Regain

Weight regain after discontinuing semaglutide occurs because:

1. Obesity is a chronic disease requiring ongoing treatment
2. The appetite-suppressing and metabolic effects of GLP-1 receptor agonists are only present while the medication is active in the body
3. Without continued treatment, physiological mechanisms that defend against weight loss become active again

Clinical Implications

• Guidelines recognize that "weight management pharmacotherapy indicated for chronic therapy should be continued beyond reaching weight loss goals to maintain the health benefits" 3
• "Sudden discontinuation of weight management pharmacotherapy often results in weight gain and worsening of cardiometabolic risk factors" 3

Strategies for Patients Discontinuing Semaglutide

For patients who must discontinue semaglutide:

1. Gradual dose reduction: Consider tapering the medication rather than abrupt discontinuation
2. Intensive lifestyle intervention: Structured diet and physical activity programs
3. Alternative medications: Consider transitioning to another weight management medication if appropriate
4. Regular monitoring: Schedule frequent follow-up visits to assess weight and adjust strategies

Special Considerations

• Individual responses vary - a case report showed one patient maintained weight loss for 6 months after discontinuation with strength training and diet modification 4
• Patients with post-bariatric surgery weight regain have shown benefit from semaglutide treatment, suggesting it may help those with weight regain after other interventions 5

Conclusion

The evidence clearly demonstrates that weight regain is the expected outcome after discontinuing semaglutide, confirming that obesity is a chronic condition requiring ongoing treatment. Patients should be counseled about this likelihood before starting treatment and should understand that long-term or indefinite use may be necessary to maintain weight loss benefits.