What happens when you stop Wegovy or Zepbound, and what are the US rules?
What three stopping trials found, what happens to blood pressure and blood sugar, the US stopping thresholds (label, NIH and insurers), and the money reasons people lose access.
Written for the United States. Other country versions are coming.
Most people regain much of the weight. A year after stopping Wegovy, people in one trial had regained about two-thirds of what they lost. In a Zepbound trial, people switched to a dummy injection regained 14% of their weight in a year. The US has no single stopping rule: labels, NIH and insurers differ.
Key takeaways
- A year after stopping Wegovy 2.4 mg, people in the STEP 1 extension had regained about two-thirds of their lost weight, ending 5.6% below where they started.2
- In SURMOUNT-4, people switched from Zepbound to a dummy injection regained 14.0% of their weight over 52 weeks, while those who continued lost another 5.5%.5
- NIH guidance says a clinician will probably advise stopping if you have not lost 5% after 12 weeks on the full dose; the Saxenda label uses 4% at 16 weeks.1,7
- The Wegovy and Zepbound labels set no fixed stopping percentage, but insurers can: one 2026 health-plan policy needs at least 5% loss to renew.4,6,8
- Medicare’s GLP‑1 Bridge, which pays for weight-loss use, runs only from July 1, 2026, to December 31, 2027.9
On this page
What happens to your weight when you stop?
Most of it tends to come back. The NIH’s diabetes and obesity institute says, “You probably will regain some weight after you stop taking weight management medication.”1
- GLP‑1 medicines are prescription-only in the US. Talk to your prescriber before stopping, pausing or changing one.
- Label facts here come from the current US prescribing information (the “label”) for each brand.
- This post describes trials and US rules. It is not a plan for your treatment, and trial averages are not a promise about you.
- Every risk of these medicines is in our side-effects guide, and stopping is covered in our stopping guide.
Three trials looked at this. In the STEP 1 extension, everyone stopped and was followed for a year. In STEP 4 and SURMOUNT-4, people who had lost weight on the medicine were split at random: some carried on, others switched to a dummy injection (placebo).2,3,5
327 adults followed for a year after stopping, with no medicine and no more lifestyle program. Novo Nordisk paid for the trial.2
Weight, % below starting weight
People regained about two-thirds of the weight they had lost.2
803 adults who had lost 10.6% over 20 weeks on semaglutide, then followed for 48 more weeks. Novo Nordisk paid for the trial.3
Weight change from week 20 to week 68
670 adults who had lost 20.9% over 36 weeks on tirzepatide, then followed for 52 more weeks. Eli Lilly paid for the trial.4,5
Weight change from week 36 to week 88
Over the whole 88 weeks: 25.3% below starting weight for those who kept taking it, against 9.9% for those switched to the dummy.5
A worked example. In the STEP 1 extension, someone starting at 220 lb (100 kg) would have lost about 38 lb (17 kg) on the medicine, then regained about 26 lb (12 kg) in the year after stopping, by our arithmetic from the averages.2 Some people regained less, some more.
A 2026 review of 37 studies and 9,341 people found weight came back at about 0.9 lb (0.4 kg) a month on average after weight medicines stopped. That review covered older medicines as well as GLP‑1s.12
What happens to blood pressure and blood sugar?
They tend to drift back too. In the STEP 1 extension, most heart and blood-sugar measures that had improved went back toward where they started within a year of stopping.2
In SURMOUNT-4, systolic blood pressure (the top number) rose 8.2 points in the group switched to the dummy injection, against 2.0 points in the group that carried on. HbA1c, a 3-month blood-sugar average, rose 0.3 points against no change.4
The 2026 review projected that heart and blood-sugar markers return to where they were within about 1.4 years of stopping.12 None of these trials included people with diabetes in the stopping groups, so the numbers may differ if you have it.3,4
Is there a US rule for when to stop?
Not a single national one. The Wegovy and Zepbound labels set no fixed stopping point; NIH guidance and insurers’ prior-authorization rules use weight-loss thresholds instead.1,6,8
- Wegovy and Zepbound labels: they say to weigh “treatment response and tolerability” when choosing the dose, and give no stopping percentage.4,6
- Saxenda label: check weight at 16 weeks and stop if you have not lost at least 4% of your starting weight.7
- NIH guidance: “If you do not lose at least 5% of your starting weight after 12 weeks on the full dose”, your clinician “will probably advise you to stop”. You can keep taking it “as long as you are benefiting from treatment and not experiencing serious side effects.”1
- Insurance renewals: plans set their own rules. One Rhode Island health plan’s 2026 policy approves 6 months at a time and asks for proof of at least 5% weight loss to continue.8
A worked example. For someone starting at 220 lb (100 kg), 5% is 11 lb (5 kg) and 4% is about 9 lb (4 kg), by our arithmetic.
What can make you lose access in the US?
Often it is money or paperwork rather than a medical decision: a prior authorization not renewed, a price offer ending, or a temporary Medicare program closing.8,9,10,11
- Medicare GLP‑1 Bridge: it runs only from July 1, 2026, to December 31, 2027.9 We found no CMS statement on what replaces it.
- Price offers with end dates: Novo Nordisk’s $199 introductory Wegovy pen price for new patients runs through December 31, 2026.10
- Refill timing: Lilly’s $449 price for higher Zepbound doses applies only if you refill within 45 days; otherwise it lists $499 to $699.11
- Renewals: plans may stop paying if the documented weight loss falls short of their threshold.8
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How do you stop, pause or restart safely?
The labels give no tapering schedule. They do say semaglutide stays in the body for 5 to 7 weeks, and that after 2 or more missed Wegovy doses you restart at a lower dose.6
- How long it lingers: with a half-life of about 1 week, semaglutide stays in the blood for about 5 to 7 weeks after the last 2.4 mg or 7.2 mg dose.6
- Restarting Wegovy: if 2 or more doses in a row are missed, the label says to restart the step-up at a lower dose to reduce stomach side effects.6
- Zepbound gaps: a missed dose can be taken within 4 days; after that, skip it and keep to your usual day.4
- Pregnancy: the Wegovy label says to stop at least 2 months before a planned pregnancy because of its long half-life.6
- Diabetes: the label says insulin or sulfonylurea doses may need lowering when a GLP‑1 is added. Ask how they should change if it stops.6
- Side effects while on it are mainly stomach effects: in the Wegovy 2.4 mg weight trials, 44 in 100 had nausea against 16 in 100 on a dummy injection.6
- Pancreatitis and gallbladder problems are label warnings for Wegovy and Zepbound.4,6
- Kidney injury can follow dehydration from vomiting or diarrhea.4,6
- Thyroid tumors were seen in rodents; both carry a boxed warning.4,6
Questions people ask
Will I gain the weight back after stopping Wegovy?
Many people regain much of it. In the STEP 1 extension, people regained about two-thirds of their lost weight in the year after stopping.2
What happens when you stop Zepbound?
In SURMOUNT-4, people switched to a dummy injection regained 14.0% of their weight over 52 weeks; blood pressure also rose.4,5
Do you have to taper off Wegovy or Zepbound?
The US labels give no tapering schedule. Semaglutide stays in the body for about 5 to 7 weeks after the last dose.6
How long can you stay on a GLP‑1?
NIH says you can keep taking it as long as you are benefiting and not having serious side effects. Your insurer may set its own renewal rules.1,8
What happens to GLP‑1 coverage after the Medicare Bridge ends?
The Bridge runs until December 31, 2027. We found no CMS statement yet on what replaces it.9
How we researched this
On October 12, 2026, we read the abstracts of the STEP 1 extension, STEP 4, SURMOUNT-4 and the 2026 BMJ review, the current US Wegovy, Zepbound and Saxenda labels, NIDDK’s page on weight medicines, CMS’s Bridge page, both makers’ published self-pay terms, and one published health-plan policy as an example of renewal rules.
The STEP trials were paid for by Novo Nordisk and SURMOUNT-4 by Eli Lilly. We give trial averages, not predictions. We name no pharmacy, clinic or telehealth service.
Before you move on
- Weight usually comes back after stopping: about two-thirds within a year in STEP 1.
- Blood pressure and blood-sugar gains tend to fade too.
- There is no single US stopping rule; NIH, labels and insurers differ.
- Talk to your prescriber before stopping, especially if cost is the reason.
More from the US blog
The monthly US update
An independent guide to GLP‑1 medicines. We don't sell medicines, take drug-company money or earn clinic commissions. Once a month: FDA approvals and safety notices, label changes, Medicare and Medicaid coverage changes, and published price changes. How we write
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, part of NIH). Prescription medications to treat overweight and obesity. Last reviewed June 2024. niddk.nih.gov
- Wilding JPH, Batterham RL, Davies M et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab 2022;24(8):1553–64. Funded by Novo Nordisk. DOI · PMID 35441470
- Rubino D, Abrahamsson N, Davies M et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance (STEP 4). JAMA 2021;325(14):1414–25. Funded by Novo Nordisk. DOI · PMID 33755728
- Eli Lilly. Zepbound (tirzepatide) injection: US prescribing information, revised 08/2026. pi.lilly.com
- Aronne LJ, Sattar N, Horn DB et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA 2024;331(1):38–48. Funded by Eli Lilly. DOI · PMID 38078870
- Novo Nordisk. Wegovy (semaglutide) injection and tablets: US prescribing information and Medication Guide, revised 06/2026. novo-pi.com
- Novo Nordisk. Saxenda (liraglutide) injection: US prescribing information, revised 02/2026. novo-pi.com
- Neighborhood Health Plan of Rhode Island. Weight loss management: Wegovy (semaglutide), Zepbound (tirzepatide). Pharmacy policy, effective 01/2026, reviewed 08/2025 (an example of a published US health-plan policy). nhpri.org
- CMS. Medicare GLP‑1 Bridge. Page last modified July 13, 2026. cms.gov
- Novo Nordisk. Wegovy cost, coverage and savings resources (self-pay prices). NovoCare, opened October 12, 2026. novocare.com
- Eli Lilly. Zepbound coverage and savings (self-pay prices for single-dose vials and KwikPen), CMAT-22250 08/2026, opened October 12, 2026. zepbound.lilly.com
- West S, Scragg J, Aveyard P et al. Weight regain after cessation of medication for weight management: systematic review and meta-analysis. BMJ 2026;392:e085304. University of Oxford authors. DOI · PMID 41500720
- Poison Control (National Capital Poison Center). Opened October 12, 2026. poison.org
Last checked Oct 12, 2026 · Next review due Apr 12, 2027 · Report an error
How this post was made. Written by the GLP Guidebook team from the sources above. It's general information, not medical, legal or tax advice. Talk to a qualified doctor, nurse practitioner or pharmacist before starting, stopping or changing any medicine. How we write