I’ve seen shoppers begin GLP-1 drugs filled with hope, and cease them feeling betrayed by their very own biology. Some reached their restrict with unintended effects: relentless nausea, fatigue, or the quiet lack of pleasure in consuming. Others merely couldn’t afford to remain on. A couple of by no means noticed the promised outcomes in any respect. However for almost all of them, the story ended the identical method: one step ahead, 5 steps again.
We have a good time the success tales of GLP-1s, however we hardly ever speak concerning the crash that follows when therapy stops. And it’s not simply psychological. The physique rebounds quick: starvation, weight, and metabolic chaos rush again in.
The issue isn’t the treatment itself. It’s that we’ve constructed a sublime on-ramp for GLP-1s, and virtually no off-ramp in any respect.
The proof is already warning us
The information couldn’t be clearer. Within the STEP-1 extension trial, contributors who stopped semaglutide regained roughly two-thirds of the load they’d misplaced inside one 12 months. Their blood strain, ldl cholesterol, and blood-sugar ranges slid again towards baseline.
A virtually equivalent sample appeared within the SURMOUNT-4 trial for tirzepatide: Those that continued remedy maintained (and even deepened) their weight reduction; those that stopped quickly regained.
In the meantime, the SELECT cardiovascular outcomes trial confirmed semaglutide decreased main cardiac occasions in folks with chubby and weight problems. That’s a significant win, but additionally a reminder that stopping abruptly can erase a lot of the profit.
Each the American Diabetes Affiliation 2025 Requirements of Care and the American Gastroenterological Affiliation tips now emphasize persevering with anti-obesity pharmacotherapy past preliminary weight reduction targets. The implication is straightforward: for many sufferers, GLP-1s should not a 12-week intervention; they’re persistent remedy. But in actual life, persistent use isn’t all the time reasonable.
Why so many will cease anyway
Insurance coverage protection ends. Provides run brief. A job modifications, or a deductible resets. Some sufferers plan a being pregnant, expertise insupportable unintended effects, or just need to know who they’re with out the injection. Others plateau regardless of excellent adherence and really feel the drug has stopped working. In every case, the end result is similar: withdrawal with out a plan.
And what follows seems much less like a mild decline than a metabolic whiplash. Urge for food returns quick, however satiety alerts lag. Inside weeks, the size turns into a scoreboard of defeat, and disgrace creeps again in. These should not failures of willpower. They’re failures of system design.
The case for a GLP-1 exit plan
If we settle for that many individuals will come off these drugs, deliberately or not, then an Exit Plan should turn out to be a medical commonplace of care. A considerate off-ramp would come with 4 important pillars:
1. Tapering as a substitute of termination
Formal tapering research are restricted, however real-world expertise means that progressively lowering the dose helps blunt the rebound in starvation and nausea. It buys the mind and intestine time to recalibrate. “Cease and hope” just isn’t a technique.
2. Lean-mass protection
Fast weight reduction on GLP-1s typically contains muscle loss, which might impair long-term metabolic well being. As dosing tapers, resistance coaching, satisfactory protein, and micronutrient-dense entire meals ought to turn out to be non-negotiable. These aren’t wellness traits; they’re biochemical stabilizers.
3. Glycemic and hormonal stability
Put up-GLP-1 transitions can produce unpredictable glucose swings and hormonal shifts. Structured monitoring: fasting glucose, HbA1c, or steady glucose knowledge, can information early intervention with metformin, micronutrient help, or dietary shifts.
4. Identification and conduct re-engineering
GLP-1s don’t simply quiet urge for food: they quiet the reward loop tied to meals. When that loop reawakens, folks want new rituals, not disgrace. Behavioral scaffolding, mindset retraining, and sleep-stress alignment could make the distinction between relapse and renewal. In my very own work, I name this the “after part.” It’s the place we train the physique and thoughts to cooperate once more, to belief starvation, rebuild power, and interpret cravings not as failure however as suggestions.
Past sufferers: a systemic problem
Pharmaceutical innovation obtained us to the beginning line. Sustainability will depend on how we design the end. If GLP-1s are persistent remedy, payers should step up and canopy ongoing therapy or fund structured aftercare that protects the beneficial properties. With out that bridge, we create a revolving door, sufferers biking by pricey weight reduction and inevitable regain, on the expense of each metabolic well being and psychological well-being. In the event that they’re time-limited interventions, clinicians should construct exit protocols, simply as they do for steroids, antidepressants, or insulin titrations. Medical care doesn’t cease when the prescription ends; it transitions. That very same responsibility of continuity ought to apply right here. In the event that they’re to turn out to be a part of long-term public well being technique, policymakers should tackle affordability and entry, not by rationing drugs, however by supporting the infrastructure that retains folks nicely after they go away them. Meaning investing in diet literacy, conduct change teaching, and DNA-guided precision well being approaches that cut back relapse danger.
This isn’t nearly weight regain. It’s about metabolic resilience, serving to folks maintain decrease irritation, improved insulin sensitivity, and cardiovascular beneficial properties as soon as pharmacologic scaffolding is eliminated. With out an exit framework, these hard-won enhancements vanish, and the system pays once more for problems that would have been prevented. The chance is right here, to deal with GLP-1s not as a end line, however as a part inside a continuum of care. Pharmaceutical innovation has rewritten what’s doable for weight reduction. Now well being care innovation should be sure that chance endures. And at last, sufferers have to be invited into the dialog, not blamed for biology doing precisely what it’s designed to do. Empowered off-ramping isn’t indulgent, it’s important to lasting well being outcomes and financial duty alike.
The actual measure of success
The query isn’t whether or not GLP-1s “work.” They clearly do, whereas they’re in use. The actual query is whether or not our well being care system can help the after. As a result of success isn’t simply what occurs on the treatment. It’s who an individual turns into once they step off it.
Holli Bradish-Lane is a well being coach.
