Weight regain after stopping Wegovy or Zepbound: what the trials found
Quick answer. In trials, people who stopped these medicines regained much of the weight. A year after stopping semaglutide, people had regained about two thirds of what they lost. After switching to placebo, people who had lost 20.9% on tirzepatide gained 14.0% of their body weight back in a year. Newer trials tested stepping down to a lower tirzepatide dose and switching to a pill. The Atlas found no published trial of stopping slowly versus all at once.
What the stopping trials showed
Three large trials gave people a medicine for months, then split them into a group that kept taking it and a group that stopped. This is the cleanest way to see what stopping does. All three enrolled adults without diabetes.
| Trial | Who and for how long | What happened | What to know |
|---|---|---|---|
| STEP 1 extension (semaglutide 2.4 mg) | 327 adults followed for a year after 68 weeks of treatment and lifestyle support ended | On treatment, weight fell 17.3% on average. In the year off, people regained 11.6 percentage points of it, which left a net loss of 5.6%. The placebo group ended 0.1% down. | A subset of the main trial, and every analysis was exploratory. Lifestyle support stopped at the same time as the drug. Sponsor: Novo Nordisk. |
| STEP 4 (semaglutide 2.4 mg) | 803 adults who finished a 20-week run-in (average loss 10.6%), then took semaglutide or placebo for 48 weeks | From week 20 to week 68, weight changed by 7.9% down with continued semaglutide and 6.9% up with placebo. | Both groups kept lifestyle support. Sponsor: Novo Nordisk. |
| SURMOUNT-4 (tirzepatide 10 or 15 mg) | 670 adults who finished 36 weeks of treatment (average loss 20.9%), then took tirzepatide or placebo for 52 weeks | From week 36 to week 88, weight changed by 5.5% down with continued tirzepatide and 14.0% up with placebo. At week 88, 89.5% of the continued group had kept at least 80% of their lead-in loss, against 16.6% of the placebo group. | Over all 88 weeks the placebo group was still 9.9% below its starting weight, against 25.3% below for the continued group. Sponsor: Eli Lilly. |
The 14.0% in SURMOUNT-4 is the placebo group's average weight change measured from its week 36 weight. It is not 14% of the weight that had been lost.
How much comes back, and how fast
Two reviews pooled many studies of people who stopped weight medicines. They agree on direction, but they measure different things, and neither can say what any one person will do.
The BMJ review's authors suggest caution about short-term use of these medicines without a more comprehensive approach to weight management. They found no evidence that support offered after stopping, or more behavioral support during treatment, changed how fast weight returned. How long they take to work, and plateaus covers the curves before treatment stops.
| Review | What it pooled | Main result | Caveats |
|---|---|---|---|
| BMJ, West and colleagues, 2026 | 37 studies and 9,341 people, covering older and newer weight medicines | After stopping, people regained an average of 0.4 kg a month (95% CI 0.3 to 0.5). For semaglutide and tirzepatide the estimate was 0.8 kg a month (0.7 to 0.9), after an average loss of 14.7 kg on treatment, and a projected return to starting weight in 1.5 years (1.0 to 1.9). Regain was faster than after behavioral weight programs, by about 0.3 kg a month. | Follow-up averaged 32 weeks. The newer medicines had only eight studies with at most 12 months of follow-up, so the return-to-baseline time is a projection beyond the data. The comparison with behavioral programs is indirect. |
| EClinicalMedicine, Tzang and colleagues, 2025 | 18 randomized trials and 3,771 people on GLP-1 medicines | In people with obesity, weight rose 5.63 kg (95% CI 3.52 to 7.73) after stopping and HbA1c rose 0.25 percentage points, with waist, systolic blood pressure and fasting blood sugar also getting worse. Regain was larger with follow-up past 26 weeks (7.31 kg versus 2.51 kg). | Results differed a great deal between trials. The review included people with diabetes in other analyses. It rated all included trials low risk of bias, while the BMJ review rated 18 of 35 randomized trials high risk, so the two reviews do not judge trials alike. The authors reported no funding. |
What happens to blood pressure and blood sugar
In the STEP 1 extension, the improvements seen on treatment moved back toward where people started for most measures. The BMJ review projected that fasting blood sugar, systolic blood pressure, cholesterol and triglycerides would return to baseline within a year of stopping, and HbA1c and diastolic blood pressure within 1.4 years. Its headline is that all of the markers it tracked were projected to return to baseline within 1.4 years.
A 2026 analysis of SURMOUNT-4 looked at 308 people who had lost at least 10% on tirzepatide and were then switched to placebo. 254 of them (82.5%) regained at least a quarter of what they had lost. The more weight came back, the more their measures worsened.
| Share of lost weight regained | People | Waist | Systolic blood pressure | HbA1c |
|---|---|---|---|---|
| Under 25% | 54 | up 0.8 cm | up 6.8 mm Hg | up 0.14 points |
| 25% to under 50% | 77 | up 5.4 cm | up 7.3 mm Hg | up 0.15 points |
| 50% to under 75% | 103 | up 10.1 cm | up 9.6 mm Hg | up 0.27 points |
| 75% or more | 74 | up 14.7 cm | up 10.4 mm Hg | up 0.35 points |
This was a post hoc analysis, so the groups were not randomized by how much weight they regained. Sponsor: Eli Lilly.
Stepping down or switching: what newer trials tested
Two 2026 trials asked whether something short of full treatment can keep weight off. They report arms of a trial, not advice. Whether to change a dose or a medicine is for you and a prescriber to decide. The switching page covers what labels and studies say about moving from one GLP-1 medicine to another.
| Trial | What was compared | Result | What to know |
|---|---|---|---|
| SURMOUNT-MAINTAIN (tirzepatide) | After 60 weeks of open-label tirzepatide, 378 adults were assigned to keep the highest dose they tolerated (10 or 15 mg), drop to 5 mg, or switch to placebo for 52 weeks | Change in body weight from the start, at week 112: 21.9% down on the continued dose, 16.6% down on 5 mg and 9.9% down on placebo. Rescue tirzepatide for large regain was used by 8%, 25% and 67% of the three groups. | The Atlas read the published abstract, not the full paper. The authors wrote that 5 mg might be a valuable alternative to stopping, though responses may vary. Sponsor: Eli Lilly. |
| ATTAIN-MAINTAIN (orforglipron) | Adults who had finished SURMOUNT-5 on weekly tirzepatide (205) or semaglutide (171) were assigned to the daily pill orforglipron or placebo for 52 weeks | Among those whose weight had leveled off, the pill group kept 74.7% of their weight reduction after tirzepatide versus 49.2% on placebo, and 79.3% after semaglutide versus 37.6% on placebo. | No group kept taking the injection, so the trial cannot say how the pill compares with staying on the shot. It lasted one year. Sponsor: Eli Lilly. |
Is stopping slowly better than stopping at once?
The Atlas found no published trial that answers this. One is registered: the REST trial (NCT07294950), run by Mount Sinai Hospital in Canada, plans to compare a gradual semaglutide dose reduction with stopping at once in 98 adults. It is recruiting and has no results.
The authors of the EClinicalMedicine review say treatment guidelines should address stopping and long-term maintenance, not only starting and dose increases. That is a call for guidance, not a finding about tapering.
What people report
In online communities, people who have stopped describe appetite returning within weeks, food noise coming back and the scale moving up. The themes people commonly describe are going down in dose instead of stopping outright, switching to a pill, and wishing they had built eating habits while the medicine was working.
None of this was measured, and people who regain weight may be less likely to post. It is here because it is a common story. It does not show what works. The eating after stopping page covers food and habits.
Why people stop
Cost, insurance changes, side effects, pregnancy and reaching a goal all come up. The BMJ review notes that real-world data show about half of people stop within 12 months. The paying for GLP-1 medicines page covers costs, and the Medicare page covers a program that is set to run through the end of 2027.
Quick answers
- Does weight come back after stopping Wegovy or Zepbound?
- On average, yes. In the STEP 1 extension, people regained about two thirds of the weight they had lost within a year of stopping semaglutide. In SURMOUNT-4, people switched to placebo gained 14.0% of their week 36 body weight back over 52 weeks.
- How fast does the weight come back?
- The BMJ review estimated 0.4 kg a month on average across weight medicines and 0.8 kg a month for semaglutide and tirzepatide, with a projected return to starting weight in about 1.5 years for the newer medicines. That return time is a projection, not something the trials observed.
- Do blood pressure and blood sugar improvements last after stopping?
- On average they moved back toward baseline. The BMJ review projected that all the markers it tracked would return to baseline within 1.4 years after stopping, some sooner.
- Has taking a lower dose been tested?
- Yes, once in a published trial. In SURMOUNT-MAINTAIN, people who dropped to tirzepatide 5 mg were 16.6% below their starting weight at week 112, compared with 21.9% for those who kept the highest dose they tolerated and 9.9% for placebo. The microdosing page explains why that does not test starting on a small dose.
- Can a pill keep weight off after injections?
- ATTAIN-MAINTAIN tested the pill orforglipron against placebo in people who had lost weight on tirzepatide or semaglutide shots. The pill group kept more of the weight reduction over 52 weeks. The trial had no group that stayed on the shot, and the maker sponsored it.
- Is it better to taper off than stop at once?
- That has not been shown. The Atlas found no published trial comparing the two.
- Does a certain way of eating or exercising prevent regain?
- The trials above were not designed to test that. See the eating after stopping page for what experts and communities say.
Questions to ask
- If I stop, what is the plan for the first three months?
- Is a lower dose, or a different medicine, an option for me?
- How often should we check my weight, blood pressure and blood sugar after I stop?
- Do any of my other medicines need to change as my weight changes?
- Who should I call if my appetite or weight changes quickly?
What is still unknown
- No published trial compares stopping slowly with stopping at once.
- The trials followed people for a year or less after stopping. Whether weight levels off below the starting weight or returns to it over longer periods is not shown.
- For the newer medicines, the BMJ review had only eight studies with at most 12 months of follow-up, so its return-to-baseline time is a projection.
- STEP 1, STEP 4 and SURMOUNT-4 enrolled adults without diabetes, so their results may not apply to people with diabetes.
- Most of the stopping trials were run or sponsored by the makers of the medicines tested.
- The Atlas read the SURMOUNT-MAINTAIN abstract, not the full paper, and the ATTAIN-MAINTAIN results are from a single one-year trial.
Sources
- Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension Wilding JPH, et al. Diabetes Obes Metab. 2022;24(8):1553-1564. PMID 35441470. Funding: Novo Nordisk. Journal article
- Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance (STEP 4) Rubino D, et al. JAMA. 2021;325(14):1414-1425. PMID 33755728. Funding: Novo Nordisk (trial sponsor per ClinicalTrials.gov). Journal article
- Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity (SURMOUNT-4) Aronne LJ, et al. JAMA. 2024;331(1):38-48. PMID 38078870. Funding: Eli Lilly. Journal article
- Cardiometabolic parameter change by weight regain on tirzepatide withdrawal: a post hoc analysis of SURMOUNT-4 Horn DB, et al. JAMA Intern Med. 2026;186(2):157-167. PMID 41284285. Funding: Eli Lilly (sponsor of SURMOUNT-4). Journal article
- Tirzepatide for maintenance of bodyweight reduction in people with obesity in the USA (SURMOUNT-MAINTAIN) Horn DB, et al. Lancet. 2026;407(10545):2305-2318. PMID 42119587. Funding: Eli Lilly. Journal article
- Orforglipron for maintenance of body weight reduction (ATTAIN-MAINTAIN) Aronne LJ, et al. Nat Med. 2026;32(7):2679-2687. PMID 42120723. Funding: Eli Lilly (trial sponsor per ClinicalTrials.gov). Journal article
- Weight regain after cessation of medication for weight management: systematic review and meta-analysis West S, et al. BMJ. 2026;392:e085304. PMID 41500720. Funding: Not stated in the abstract. Journal article
- Metabolic rebound after GLP-1 receptor agonist discontinuation: a systematic review and meta-analysis Tzang CC, et al. EClinicalMedicine. 2025;90:103680. PMID 41399474. Funding: None reported. Journal article
- Impact of semaglutide withdrawal on cardiometabolic profile: gradual dose reduction versus immediate cessation (REST, NCT07294950) ClinicalTrials.gov record NCT07294950. Sponsor: Mount Sinai Hospital, Canada. Status when the Atlas looked: recruiting, no posted results. Trial registry