Millions of people have turned to GLP-1 drugs like Ozempic, Wegovy and Zepbound to lose weight or manage type 2 diabetes. But research shows many patients stop taking these medications within a year — and doctors say that decision can come with real risks.
Dr. Frank Dumont, an internal medicine physician and executive medical director at Virta Health in San Francisco, spoke with Fox News Digital about why patients discontinue GLP-1s, what can happen afterward, and how to protect the progress they’ve made.
Why people stop
Some patients stop because of side effects such as nausea, vomiting, constipation and diarrhea. Dumont said these can become severe enough to interfere with eating.
“Those types of things can become troublesome enough that people actually have a hard time eating enough food to get good nourishment,” Dumont said. “Working with your physician to make a decision about whether it’s right for you to stay on the medicine or not is important.”
More serious side effects, like acute pancreatitis, would prompt immediate discontinuation. “We know that’s fairly rare, but if the pancreas becomes involved, that is not a good thing,” Dumont said. “It can be very serious. It can even be life-threatening.”
Certain GLP-1 medications also carry a warning about thyroid tumors based on animal studies, though the risk in humans is unknown. They should not be used by people with a personal or family history of medullary thyroid carcinoma or a condition called multiple endocrine neoplasia syndrome type 2.
Other patients simply don’t want to stay on a medication long-term, even though major medical groups, including the American Medical Association and the Obesity Medicine Association, classify obesity as a chronic condition that typically requires ongoing management.
Six risks after stopping
Appetite and cravings return. The most immediate effect patients notice is a sharp rise in hunger and what Dumont called “food noise.” He said that unless people have changed what they eat while on the drug, they tend to drift back to old habits. “Unless you have significantly changed what you’re doing in terms of the types of foods you’re eating, it’s likely you’ll go back to the same foods you were eating before, and hunger and cravings will go up,” he said.
Weight tends to come back. In the STEP 1 trial extension, participants regained about two-thirds of the weight they’d lost within a year of stopping semaglutide and lifestyle support. In the SURMOUNT-4 trial for tirzepatide, patients switched to a placebo after 36 weeks regained more than half their lost weight over the following year, even with diet and exercise counseling. “That’s just so devastating for people who felt like they’d finally found a solution that would work,” Dumont said.
Blood sugar, blood pressure and cholesterol can worsen. These biomarkers typically improve on a GLP-1, Dumont said, but can reverse once the drug stops if diet doesn’t change.
Fatty liver disease can return. “We know that these medications can help to decrease some of that steatotic or fatty liver disease that occurs,” Dumont said. “And when you go off the medicine, if you go back to eating the way you did before, those numbers have a tendency to worsen.”
Muscle loss can compound over time. Weight lost on a GLP-1 isn’t just fat — in a body-composition study of tirzepatide, about 25% of weight lost was lean mass, including muscle, with the rest fat. Dumont warned that patients who regain weight after stopping may not regain the muscle they lost. “There’s a bit of a ratcheting-down effect if someone is on and off these medications, where they lose fat and muscle, stop the medicine, regain fat, go back on the medicine, and lose fat and muscle,” he said, noting muscle matters for metabolism, injury prevention and daily function.
Mental health can take a hit. Many patients have cycled through failed diets for years and viewed GLP-1s as a last resort. Dumont said a setback after stopping can feel like a “regression on all fronts.” “It can make you feel disheartened and like you don’t have the control you thought you did,” he said.
A broader cardiovascular concern
An observational study published in BMJ Medicine found that adults with type 2 diabetes who stopped GLP-1 treatment had a higher risk of major cardiovascular events than those who stayed on it, with longer gaps off the drug tied to greater risk.
Dumont said the stakes of stopping go beyond the scale. While on a GLP-1, lower inflammation and improved cholesterol and blood sugar help cut the risk of heart attacks and strokes. “But again, if you stop the medicine and you haven’t changed the way that you eat, then all of those numbers can worsen … and that can then increase the risk of those bad things happening — things that can be devastating from a life quality standpoint, but also can shorten your life,” he said.
How to stop more safely
Dumont said reaching metabolic goals and building lasting lifestyle changes can help patients hold onto their progress after stopping. “We actually have peer-reviewed published data demonstrating that you can indeed stop one of these medications when you reach your metabolic goals,” he said, though he noted that the Virta-affiliated study behind that finding looked at selected type 2 diabetes patients in a structured nutrition program, so it may not apply to every GLP-1 user.
He recommended patients build sustainable eating habits before stopping the drug. “The GLP-1 is not the only solution,” he said. “It needs to be coupled with … a way of eating that’s going to work for you for the long term that allows you to stop the medicine successfully if you need to.”
Dumont advised working with the prescribing clinician on a plan for tapering off treatment and monitoring weight and blood sugar afterward.
