What happens when you stop a GLP-1 like Wegovy, Ozempic or Zepbound?

What happens to your weight when you stop?

In trials, most people regained much of the weight they had lost within a year of stopping. On average, they did not go all the way back to where they started.

The clearest test is a one-year follow-up of the main semaglutide trial (the STEP 1 extension). It followed 327 people for a year after treatment stopped: 228 had been on semaglutide 2.4 mg and the rest on a dummy injection.¹

So about two-thirds of the lost weight came back. For a 90 kg (198 lb) person, that means losing about 16 kg (35 lb), then regaining about 10 kg (22 lb).¹ About half the people (48%) were still at least 5% lighter than at the start.¹

Two more trials tested this differently. Everyone took the medicine first. Then, at random, some carried on and the rest were switched to a dummy injection without knowing. So the gap between the two groups shows what stopping does:

The kg figures are our arithmetic for one example person starting at 90 kg, using each trial's average percentages; real people varied a lot. In both trials about half the lost weight came back after switching. The trials also report regain of 6.9% (STEP 4) and 14.0% (SURMOUNT-4), but those are measured from the lower weight at the switch, so they look different.^2,3

Two 2026 reviews pooled many studies. A BMJ review of 37 studies (9,341 people) found weight came back at about 0.8 kg a month after semaglutide or tirzepatide.⁵ It projected a return to starting weight in about 1.5 years. That is an estimate: no study of these two drugs followed people for more than a year.⁵

A second review estimated that 60% of the lost weight returns in the first year. It predicted regain would level off at about 75%, not 100%.⁶ So the two reviews disagree: one projects a full return to starting weight, the other a partial one.^5,6 These are averages. In one tirzepatide analysis, 1 in 6 people regained less than a quarter of what they lost.⁴

What happens to blood sugar, blood pressure and cholesterol?

They tend to drift back towards where they were before treatment. The more weight comes back, the more they rise.

In STEP 1, blood pressure was back at its starting level a year after stopping. Average blood sugar (HbA1c, a 3-month sugar test) and cholesterol also rose again.¹

In the tirzepatide trial above (SURMOUNT-4), people who regained the most saw the biggest rises. Top (systolic) blood pressure went up by 7 to 10 points, depending on how much weight came back.⁴ People who kept most of the weight off kept some benefits, such as lower blood fats (triglycerides).⁴

The BMJ review projected that all these heart and sugar markers would be back at their starting levels within about 1.4 years.⁵

Why does the weight come back?

The medicine was holding your appetite down. When it wears off, hunger returns, and your body also pushes to regain lost weight.

Half of each semaglutide dose is still in the body after about a week. It stays in the blood for about 5 to 7 weeks after the last injection.¹³ As it goes, the feeling of fullness it gave goes too.

Losing weight by any route changes your hunger hormones. In one study of dieting, these changes and stronger hunger were still there a year later.⁸ The body acts as if it wants the weight back.

This is why experts now call obesity a long-term (chronic) condition, like high blood pressure. The WHO calls it "a chronic, relapsing disease requiring lifelong care".⁹ The Canadian guideline says stopping medication can lead to weight regain and the loss of health benefits.¹⁵ The STEP 1 authors said their results suggest ongoing treatment is needed to keep the benefits.¹

Regain is not a personal failure. The BMJ review found weight came back faster after medicines than after diet programs alone, whatever the amount first lost.⁵

Can you take a lower dose, or taper off?

One good trial says a lower tirzepatide dose keeps most of the weight off. For semaglutide, and for tapering to zero, the evidence is thin.

One trial (SURMOUNT-MAINTAIN) took 378 US adults who had lost weight on tirzepatide 10 or 15 mg. They were split into 3 groups for a year: full dose, 5 mg, or a dummy injection.¹⁰

Most people in this trial were white women.¹⁰ So results may differ for men, and for people of other ethnic backgrounds. Eli Lilly, which makes tirzepatide, paid for it.¹⁰ Staying on a medicine also means staying with its side effects. In the semaglutide trial above (STEP 4), 42% of people who continued semaglutide had stomach side effects, vs 26% on a dummy injection.²

For semaglutide, no finished trial has tested a lower maintenance dose or a slow taper. The first randomised taper trial, in China, had not started recruiting as of October 2026.¹¹ In real life, many people already use lower doses. In one Danish family practice, 40% of people still on semaglutide after a year took 1 mg or less.¹¹

The WHO's 2025 guideline names "maintenance and discontinuation" as areas where long-term data are limited.⁹ So a taper plan is your doctor's judgement, not a proven method.

What helps keep weight off?

Keeping up exercise and support with eating and habits help most. Nothing yet fully replaces the medicine.

A Danish trial gave 195 people who had just lost weight a year of supervised exercise, a GLP-1 medicine (liraglutide), both, or neither. Then all treatment stopped, and 109 of them were weighed again a year later.¹²

• Medicine plus exercise, against the medicine alone: about 2.5 kg less regain. That difference was small enough that it could have been chance.¹²
• Exercise alone, against the medicine alone: the medicine-only group regained about 6 kg more.¹²

So exercise during treatment looks helpful, but this one small trial can't prove how much it adds once you stop the medicine.

That exercise trial used liraglutide, an older daily GLP-1, and followed 109 people.¹² Protein and strength training to protect muscle are covered in Guide 8: Life on a GLP-1.

What does staying on it cost over years?

If you need it long term, the cost is long term too. No provincial plan covers these medicines for weight management, so unless private insurance pays, you pay. At the figures below, 5 years of Zepbound comes to about $19,500 at 5 mg and $27,300 at 10 mg, and 5 years of Wegovy about $25,262. What you pay at the pharmacy can differ.

These are examples, not a price list. A pen or 4-week supply holds 4 weekly doses, so a year is 13 of them.^16,17

Medicine only. What you pay at the pharmacy can differ, and clinics or programs may charge for their own services.

Coverage can change over time. Private plans that cover these medicines often require prior authorization and set rules such as BMI thresholds.²⁵ Canada's Drug Agency suggested that if public plans ever paid for Wegovy (for people with heart disease), renewal after the first year should need at least a 5% drop in weight or BMI.¹⁷ Prescription medicines can count toward the Medical Expense Tax Credit.²²

In one Danish practice, 38% had stopped semaglutide within a year, for all reasons.¹¹ Before you start, ask whether you could afford it for years, not months. Guide 7 explains how services charge.

When is stopping the right call?

Stopping is a reasonable choice in several situations. A medicine that harms you, isn't working, or can't be paid for is not worth staying on. These are the common reasons.

• Side effects you can't live with, or a serious one such as pancreatitis. Guide 5 lists the warning signs.
• Planning a pregnancy. The makers recommend stopping semaglutide at least 2 months, and tirzepatide at least 1 month, before a planned pregnancy.¹⁵ Semaglutide stays in the body a long time.¹³ The tirzepatide label warns it may harm an unborn baby.¹⁴
• An operation or sedation. These medicines slow the stomach. Rarely, people have breathed in stomach contents during anesthesia.¹³ The labels say to tell your surgeon you take one. They say there isn't enough data to know if pausing it helps.^13,14
• It isn't working. See what the Canadian guideline says, below.
• Cost, if paying for it is straining your budget, or your coverage ends.
• It was never the right medicine for you, for example taken to lose a few kilos before a holiday, or bought without a proper prescription. See Guide 4.

What the Canadian guideline says

Canada has no national rule that forces you to stop. The 2025 Canadian obesity guideline sets out the main points:¹⁵ For a 90 kg (198 lb) person, 5% is 4.5 kg, about 10 lb.

Whether to carry on is about whether the medicine is helping you. Falling short is not a personal failure, and your doctor can talk through other options.

How do you stop safely?

With your doctor, and with a plan for what comes next. Your weight, blood sugar and blood pressure will need watching for months.

Talk to the person who prescribed it before you stop. The Canadian guideline warns that stopping can lead to weight regain and the loss of health benefits, so a plan for what comes next matters.¹⁵

If you have diabetes, stopping can push your HbA1c (a blood test of your average sugar over about 3 months) up.⁷ Your doctor may need to add or change another sugar medicine. Don't just stop and wait to see.

Keep the habits you built: regular exercise and the eating patterns that worked. They give you the best chance of holding on to some of the loss.¹²

What if you miss doses or can't get supply?

A short gap is usually fine. After a longer gap, ask your doctor before restarting, because you may need to restart on a lower dose.

Semaglutide (Canadian Ozempic and Wegovy labels): take a missed dose within 5 days. After that, skip it and take the next one on your usual day. If more than 2 doses in a row are missed, the Wegovy label says you may need to restart on the lower dose steps.¹⁹

Tirzepatide (Canadian Zepbound label): take a missed dose within 4 days. After that, skip it and take the next one on your usual day.²⁰ Ask your doctor what dose to restart on after a long gap.

Questions people ask