You’ve Hit Your GLP-1 Weight Loss Goal. Now What?

Reaching your weight loss goal isn’t the end of your journey: It’s the beginning of another. What you do after hitting your goal weight determines whether you maintain your weight loss or end up back at the starting line.

“The most common misconception patients have at the maintenance phase is that once they’ve reached their weight loss goal, the hard work is over,” says Rekha B. Kumar, MD, who specializes in obesity and weight management and is an associate professor of clinical medicine and attending endocrinologist at the Weill Cornell Medical College in New York City. “The maintenance phase requires as much intentional engagement with nutrition, activity, sleep, and medication adherence as the weight loss phase did.”

Part of the reason is biological. Weight loss triggers hormonal and metabolic changes that push your body to regain weight and make you especially hungry. GLP-1s are appetite suppressants and will continue to help you maintain your weight loss, but if you stop taking them, your hunger may powerfully return.

These changes may persist.

“The body’s preferred weight does not change to a lower weight with prolonged weight loss,” says Dan Bessesen, MD, endocrinologist and professor of medicine at the University of Colorado Anschutz in Aurora, Colorado. “The drive to regain weight to the naturally defended weight is persistent, even years after weight is lost.”

Once you reach your goal weight on a GLP-1, you may be interested in lowering your dose. But, as of yet, there is no validated advice from health authorities or drug manufacturers on how to reduce your GLP-1 dose safely and effectively to maintain a steady weight.

Don’t try to do this on your own, however. It’s important to adjust your dose only under your doctor’s supervision.

“There is no standard of care or guidance on how to do this, so it has to be completely individualized, and it does take a pretty sophisticated metabolic health practitioner to do it,” Kumar says.

In addition to potentially not taking the right dosage if you adjust it on your own, you also might not be a good candidate for dosage changes. Even if you’re happy with your weight loss, there might be other compelling reasons to stay on the full dosage. For example, Bessesen says your doctor may recommend continuing with treatment if you have high blood pressure or diabetes that have improved while taking a GLP-1.

You’ll likely need to continue taking GLP-1s to maintain your weight loss and other health benefits.

“If a medication helps a person lose weight and they stop the medication, the basic biology regulating weight has not changed, and weight will be regained,” Bessesen says.

“I’ve seen people gain 10 pounds in two weeks [after] abruptly coming off of GLP-1s,” Kumar says. “And then I’ve had people pause it and still feel the effects of the medicine for weeks. So it’s very variable."

Stopping and Restarting GLP-1 Drugs

Experts generally caution against cycling off and back on GLP-1s as a sustainable strategy. Kumar says some people consider this strategy, resuming the medication only after their weight begins to creep back up.

Lifestyle changes like keeping a healthy diet and getting enough exercise and sleep are important throughout your weight loss journey. But Kumar says their role becomes even more influential once you’ve hit your goal weight.

“The people that have the best chance of reducing the medicine they’re on are the ones that make these changes,” she says.

For example, now isn’t the time to loosen your eating habits. You may not need to keep your daily calories as low as when you were actively losing weight, but they should be lower than what they were before you started GLP-1s, Kumar says. If you allow your daily intake to drift back to where it was before, you’ll likely begin to regain — even on a GLP-1.

“There are hormones related to body weight regulation that follow a healthy circadian rhythm,” says Kumar, referring to the body processes of sleeping and waking that follow a 24-hour cycle. “Maintaining a healthy sleep cycle will balance your cortisol and help you control your appetite.”

Tracking your progress during the maintenance phase helps ensure long-term success.

“Self-monitoring, in many ways, is more important during the maintenance phase,” Kumar says.

Although you may feel like stopping weekly weigh-ins and food tracking after you hit your weight loss goals, they may be more critical for keeping weight off than they were for losing it in the first place.

Building a support team can help. A registered dietitian can customize your diet to your new calorie needs, while a mental health professional can help you address body-image issues and your evolving relationship with food. Mental health support is also valuable for navigating the social side of weight loss — namely, the unsolicited comments that tend to appear during the maintenance phase.

“Patients start getting comments from people saying: ‘What did you do? Oh, you lost so much weight. You look so good,’” Kumar says.

Online communities, whether formal support groups or social media connections, can also provide a space to process these experiences with people who have been through it themselves.

Your doctor should remain part of that support system, too. Kumar recommends checking in every three months once you hit your weight loss goals, gradually spacing visits to every six months or once a year as you find your footing.

“Even the patients who have been doing really well for years and years, I have to see them at least once a year because any life stressor can shake up their journey,” she says.

Don’t wait for your next scheduled appointment if you notice your weight increasing. Reach out as soon as it becomes a concern. This can vary by person: Some people remain healthy after gaining back 2 to 5 percent of their body weight on a reduced dose of GLP-1, while others won’t tolerate even a slight increase, Kumar says.

She also suggests paying attention to:

• Increased food noise, or intrusive thoughts about food
• Unhealthy cravings that return
• Old habits that you might slip into

If you notice any of these red flags, reach out to your doctor. These might be signs to adjust your medication dosage or add behavioral support.

• You’ll probably need to continue taking a GLP-1 weight loss medication even after you’ve hit your weight loss goal. Without it, you’ll risk regaining the weight and losing your other health improvements.
• Many people who have stopped taking GLP-1s end up gaining weight back. It’s best to remember that obesity is a chronic condition that requires maintenance.
• There’s no guidance on changing GLP-1 dosage for weight loss maintenance, but your doctor may be willing to experiment with smaller or less frequent injections. Don’t try to tweak your dosage on your own.
• Weight loss maintenance is tough work. Keeping a healthy diet and getting enough exercise and sleep are key, as is keeping close contact with your doctor to help navigate any bumps in the road.