After people stop a weight-management medicine, weight tends to come back. In a 2026 BMJ review of 37 studies and 9,341 people, the average rate was about 0.4 kg a month. For the newer incretin drugs in that review — semaglutide and tirzepatide — the same paper estimated about 0.8 kg a month. The paper reports kilograms. At 2.2 pounds per kilogram, 0.4 kg is 0.88 lb and 0.8 kg is 1.76 lb. The ranges below stay in kilograms, as published.
That does not mean the drug “failed,” and it does not mean you failed. The review describes obesity as a chronic, relapsing condition. A clinician decides the dose and whether to stop. This page has no plan for stopping on your own, and it does not suggest a supplement, a powder, or fiber as a replacement.
Ozempic, Wegovy, Mounjaro, and Zepbound show up here because those are names people type into search. The trials studied the molecules — semaglutide and tirzepatide — at the doses written into those protocols. A dose in a table below is a fact about that trial. It is not a dose to copy, and it is not a description of every pen sold under those brand names.
What the 2026 BMJ review measured
Sam West and colleagues asked what happens to weight after a weight-management medicine is stopped. They included randomized trials, non-randomized trials, and observational studies: treatment of at least 8 weeks, and at least 4 weeks of follow-up after it stopped. They screened 9,288 titles and kept 37 studies, 63 treatment arms, 9,341 participants. Treatment lasted 39 weeks on average (range 11 to 176). Follow-up after stopping lasted 32 weeks on average (range 4 to 104). Only one study in the whole set followed people beyond a year.
A mixed model put the monthly regain at 0.4 kg (95% confidence interval 0.3 to 0.5) for any of these drugs: 63 arms, 6,322 people. For all incretin drugs together the estimate was 0.5 kg a month (0.4 to 0.7): 32 arms, 4,757 people. For the newer, more effective incretins — the paper names semaglutide and tirzepatide — it was 0.8 kg a month (0.7 to 0.9): 10 arms, 1,776 people. The authors call the evidence for the rate moderate certainty.
In the first year after stopping, the same model estimates about 4.8 kg regained (3.6 to 6.0) for any of the drugs, about 6.0 kg (4.8 to 8.4) for incretins as a group, and about 9.9 kg (8.4 to 10.8) for the newer incretins. At 2.2 lb per kg, 4.8 kg is 10.56 lb (about 10.6 lb) and 9.9 kg is 21.78 lb (about 21.8 lb). Those products are arithmetic on the point estimates, not a second measurement.
A straight-line projection puts weight back at the starting point about 1.7 years after stopping any of the drugs (1.3 to 2.1), about 1.6 years for incretins as a group (1.1 to 2.1), and about 1.5 years for the newer incretins (1.0 to 1.9). Those lines run past the follow-up the authors actually had. For the newer drugs, the figure caption says follow-up data were not available beyond 52 weeks, and the discussion says that group was eight studies with a maximum of 12 months after stopping. The 1.5-year mark is the model extended past those data. Adding a curve did not fit better than a straight line in their checks. A straight line is still a projection.
Against a control group, in the randomized trials only, the full paper estimates 0.3 kg a month more regain (confidence interval 0.3 to 0.4) for all of the drugs. The abstract prints that interval as 0.2 to 0.4. The results section is the figure used here.
Regain was faster than after behavioral weight-management programs, by about 0.3 kg a month (0.22 to 0.34). The comparison is indirect: the behavior programs come from an earlier review that was not searched again, and the authors say the people in the two sets of studies could differ. In a check that fixed the initial loss at 5, 10, or 15 kg, a larger loss was followed by faster regain for both drugs and programs, and the drug side stayed faster. The abstract’s phrase is that the gap did not depend on how much weight had been lost.
The same paper did not find that the intensity of behavior support changed the rate of regain after the drug stopped. During treatment with incretins, support was linked with more weight lost (6.7 kg, interval 2.7 to 10.5). After the authors adjusted for that larger loss, the regain rate did not differ by how much support people had. “No difference found” is not the same sentence as “support is pointless.” The World Health Organization still says structured food and activity support may be offered alongside these drugs. That recommendation is below, and it is low-certainty.
Cardiometabolic markers — HbA1c, fasting glucose, cholesterol, triglycerides, and blood pressure — were estimated to be close to baseline by the end of the observed follow-up. Extrapolation suggests a return to baseline within about 1.4 years. In the time-to-event model, fasting glucose, systolic pressure, total cholesterol, and triglycerides were projected within a year, and HbA1c and diastolic pressure within 1.4 years (0.4 to 2.4). That is a model, not a promise that a particular person’s labs move on that calendar.
The work was funded in part by the NIHR Oxford Biomedical Research Centre. S. A. Jebb receives a Novo Nordisk Foundation research grant, and S. West and J. Scragg are partly funded by it. The paper says the funder had no role in the design, the analysis, or the decision to publish. Read the figures as an average scientific report.
Weight regain after stopping Ozempic, next to two trials
The direction matches earlier trials: after the drug stops, average weight goes up, and a large share of the loss is back within a year. Neither trial below shows a full return to the starting weight, as the average, inside 12 months. The BMJ line out to a year and a half or two years is a longer extrapolation.
| Trial | While the drug was used | After it stopped |
|---|---|---|
| STEP 1 extension | Semaglutide 2.4 mg once a week, plus lifestyle support, for 68 weeks. In the extension group, mean loss was 17.3%. | Over the next year, without the drug and without that same support, 11.6 percentage points came back. Net loss from the start was 5.6%. |
| SURMOUNT-4 | Tirzepatide at the maximum tolerated dose of 10 or 15 mg, for a 36-week open lead-in. Mean loss in that lead-in was 20.9%. | People switched to placebo gained 14.0% from the weight at the switch, over 52 weeks. People who stayed on the drug lost a further 5.5%. From the original start to week 88: a 9.9% reduction on placebo, 25.3% if treatment continued. |
The STEP 1 extension included 327 people, and the analyses were exploratory. The drug in that protocol was semaglutide 2.4 mg once a week. The authors write that, one year after withdrawal, participants regained two-thirds of their prior weight loss. At week 120 the semaglutide group was still 5.6% below the start, not at zero. Blood pressure, glucose, and lipids had mostly moved back toward baseline. Lifestyle support stopped at the same time as the drug. The 2.4 mg figure is the trial’s dose, not “any pen called Ozempic.”
In SURMOUNT-4, 783 adults started the open lead-in. At week 36, 670 were randomized: continue tirzepatide or switch to placebo for 52 more weeks, with diet and physical activity still in the protocol. From week 36 to week 88 the change was −5.5% versus +14.0% (difference −19.4 percentage points, interval −21.2 to −17.7). The plus 14% is from the weight at the switch, not from day 1. At week 88, 89.5% of people still on tirzepatide had kept at least 80% of the lead-in loss, compared with 16.6% after the switch to placebo. The 10 mg and 15 mg doses are protocol facts, not a recommendation.
Why appetite comes back
WHO’s questions-and-answers page says these medicines slow the process of food digestion and increase feelings of fullness, so people eat less. While the drug is there, a smaller intake is easier. When the drug is gone, that effect does not stay behind as a habit by itself. Appetite returns. If intake is again above what the body uses, weight that left on the lower intake starts to return.
This page will not add a hormone story with numbers the sources do not give. Energy balance is enough, plus the description both WHO and the STEP 1 authors use: obesity is chronic and tends to recur. That is biology, not a comment on character.
What the sources actually support
Only what the sources support. None of it cancels 0.4 or 0.8 kg a month, and none of it replaces a conversation with the prescriber.
Muscle, during treatment. A 2025 joint advisory in the American Journal of Clinical Nutrition says that while someone is taking a GLP-1 medicine, preserving muscle and bone means resistance training and an appropriate diet. It lists nutrition after the drug is stopped as an area that needs more study, not as a method already shown to hold the weight. A separate 2026 meta-analysis compared how much of the lost weight was lean mass. On incretins that share was 25% to 39%: point estimates 35.2% for semaglutide, 25.4% for tirzepatide, and 26.8% for liraglutide. Lifestyle programs were 26.2%. Where resistance training was added to lifestyle, the share was 17.5% (14.2 to 20.8). That is the composition of the loss, not proof that lifting stops regain after the drug is gone. Neither abstract assigns a personal protein target in grams per kilogram. On this site that means ordinary meals with protein, not a powder as a required step: protein and fullness and home workouts for beginners.
Behavior support, offered alongside the drug. On 1 December 2025 WHO issued a conditional recommendation: intensive interventions that include a structured healthy diet and physical activity may be offered to adults with obesity who are prescribed a GLP-1 medicine. The basis is low-certainty evidence that this may improve treatment outcomes. “May be offered” is not a promise that the weight stays off. WHO’s news item also says medicines alone will not solve obesity. The release: WHO guideline on GLP-1 medicines for obesity.
Walking, as one ordinary piece of that wider day. WHO puts the drug inside food, regular activity, and support from a professional, not as a shot that replaces the rest. A walk on this site is the simplest version of that activity, with no claim that it cancels regain: walking and weight loss.
The scale as a diary. A single scary morning is a poor summary. How to read jumps, including when to weigh less often, is in why the scale jumps. This page does not repeat that article’s weighing studies.
What these averages cannot say about you
The BMJ authors say the figures are averages and, as with behavioral programs, a small proportion of people kept the weight off. The review does not predict who.
There is no taper schedule in the review. The authors looked for studies of stopping, not for instructions to reduce the dose a little at a time. A personal calendar for coming off the drug cannot be built from this page.
Follow-up is short. Average follow-up after stopping was 32 weeks. For the newer incretins, eight studies and no follow-up past 12 months; the line past that is drawn by the model. One study of semaglutide at 1 mg — that trial’s dose, not a suggestion — had follow-up of two years. Many of the included trials were at high risk of bias. The comparison with lifestyle programs is indirect.
Your pen may not be the STEP 1 or SURMOUNT-4 protocol. Do not carry 17.3% or 20.9% over to any brand name.
If stopping is already being discussed
- Talk with the prescriber before the last dose, not after appetite is back and the mornings feel frightening. There is no “how to come off it yourself” plan here.
- Strength work and protein in ordinary meals make sense while the drug is still there, for the muscle-and-bone point above, not as a new crash diet. If you want a calm picture of a week of food, that is calorie deficit in plain language.
- Agree in advance what weekly average is a reason to write the prescriber. You and they name the threshold. This page does not.
- Do not answer the fear with a hungry week. One heavy evening does not have to become a ruined week: a gentle return after a slip. If the average is flat and it feels as if everything broke, start with the plateau piece.
These pages are general reading. They do not replace the clinician who prescribed the medicine. More in the disclaimer.
In short
A 2026 review found about 0.4 kg a month regained after weight-management drugs stop, and about 0.8 kg a month after semaglutide or tirzepatide, with a larger first-year figure for those newer drugs. STEP 1 and SURMOUNT-4 point the same way and still show an average that is below the starting weight at the end of their follow-up. The longer “back to baseline” dates are projections. None of this is a dose, a taper, or a substitute you can buy.
Common questions
Is this a medicine you stay on for life?
WHO describes GLP-1 therapies, in general, as long-term treatment: six months or longer. The same questions-and-answers page says data on long-term efficacy and safety, and on the timing and effects of stopping, are still being monitored, and that WHO does not yet have specific guidance on stopping. “For life” does not follow from that, and neither does “fine to stop on your own.” WHO also says these drugs should be prescribed by a clinician who has the person’s history in view, and the guideline’s long-term option is framed for adults with obesity (body mass index 30 or above). The length of treatment is a conversation with that clinician. The page: WHO questions and answers on obesity and GLP-1 therapies.
The scale is already up after stopping. What should I look at first?
The weekly average, not one frightening morning: why the scale jumps. If that average has been rising for several weeks, that is a reason to contact the prescriber, not a reason for a hungry week. While you wait, the supports above are the same ones: protein in ordinary meals, strength work you can actually do, walking, and no punishment for one dinner. If the scale is flat and the feeling is still “I lost all of it,” the plateau piece is the next read.
Sources
- West et al., BMJ, 2026: meta-analysis of weight regain after weight-management medicines stop.
- Wilding et al., 2022, STEP 1 extension: one year after semaglutide 2.4 mg and lifestyle support were withdrawn.
- Aronne et al., JAMA, 2024, SURMOUNT-4: continued tirzepatide versus a switch to placebo.
- WHO, 1 December 2025: guideline on GLP-1 medicines for obesity.
- WHO questions and answers: how long treatment is framed, and what is known about stopping.
- Mozaffarian et al., American Journal of Clinical Nutrition, 2025: nutrition and resistance training during GLP-1 treatment.
- Eisa and Barood, 2026: share of weight lost as lean mass on incretins, lifestyle, and resistance training.
What readers think
Lean Wisely articles are general reading. See the disclaimer.