Understanding Weight Regain After Weight Loss Drugs

Recent research, however, has found that when people stop taking these medications, weight regain can occur, a phenomenon that has been called “Ozempic rebound” and “Mounjaro plateau.”

RELATED: Everyday Health’s Survey and Special Report: Weight Loss Reframed

So how can you stem that weight regain if you must or choose to stop taking one of these medications? Here’s what you need to know.

Understanding ‘Post-Medication’ Weight Gain

Drugs like Ozempic work by temporarily altering hunger mechanisms in your body. “They provide a synthetic form of the GLP-1 hormone that helps you feel less hungry and more satisfied,” McGowan says.

Blood sugar can also improve. These medications lead to an increase in insulin response to food, which helps to reduce blood sugar. They also lead to a reduction in glucagon release, a hormone that opposes insulin and tends to increase blood glucose. “The net effect of more insulin and less glucagon is improved blood sugar control and improvement in diabetes,” McGowan says.

When you stop taking these medications, though, human physiology prevails. The hunger hormone ghrelin increases and your basal metabolic rate slows. “This evolutionary process makes your body think you’re dying by not getting enough food, so it tries to help you,” Dr. Laster says. As a result, people often report a rapid onset of hunger and weight regain, even though they continue the same lifestyle modifications, McGowan says.

And as you might expect, the benefits you see in blood sugar from being on these medications will disappear within a few days to weeks as the body’s glucose-controlling mechanisms return to their normal levels. The upshot? Lower insulin levels, higher glucagon levels and an increase in blood sugar. “Over time, this will lead to a rise in A1C, which reflects a three-month ‘snapshot’ of blood sugar control,” McGowan says.

Note, though, that weight regain is not unique to these medications. “No matter how you lose weight, whether through diet and exercise, gastric bypass or these medications, the physiological changes are the same, which means weight regain is a possibility,” Laster says.

How Common Is Weight Regain After Stopping Ozempic?

Nobody wants to see lost weight return. Turns out, though, that it’s common for a person to regain weight after they stop Ozempic or a similar medication.

“This is the reason we emphasize the need to stay on these medications long-term,” McGowan says. “It’s not to be pessimistic, but realistic, as these are fantastic treatments when you can stay on them.”

Weight-Management Tips Post-Ozempic

Although weight loss without medications like Ozempic will most likely be more difficult, it’s not impossible, especially if you make dietary and lifestyle changes while you’re taking the drugs. “Many people regain weight after they stop taking these drugs because they didn’t make these changes,” Laster says. Here are ways to stack the odds in your favor.

Make Healthy Lifestyle Choices

Three key strategies include the following:

• Eat a plant-forward diet. The No. 1 thing Laster teaches her patients is to eat more fiber, noshing at least 20 to 25 grams (g) a day. “Fiber makes you more satiated and feel fuller longer,” Laster says. It also increases your overall gut health, which can help with your energy levels, blood sugar, and bowel movements.

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   She recommends two to three servings of fruits as well as vegetables every day and then loading your diet with beans, legumes, and whole grains so that you’re eating a predominantly plant-based diet. You know you’re eating enough fiber if you’re pooping at least once a day, she adds. Protein is also important, namely to preserve lean muscle mass, but Laster wants people to focus on non-animal sources. “Patients who need to lose weight also have high blood pressure, high cholesterol or a family history of colon cancer, and animal foods are not what you want to eat if you want to reduce your risk of those things,” she says.

• Get active. One study found that two hours of exercise that raises your heart rate and makes you breathe hard every week while on these drugs helped stem weight regain after participants stopped the weight loss drug.

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  Your exercise program should include cardiovascular exercise and strength training, which is key to preserving lean muscle mass and amping your metabolism, McGowan says. Although this will depend on each individual, he generally recommends logging 150 minutes of cardiovascular exercise and two to three days of full-body resistance training every week.

• Prioritize sleep. Weight loss isn’t only about diet and exercise but proper sleep, too. “When you’re well rested, you have more energy and less brain fog and can make better food choices,” Laster says. You’ll also notice that cravings for sugary processed foods decrease. Aim for seven to eight hours a night, making sure you’re shutting off your devices at night.

Use Strategies for Long-Term Success

In addition to forming good daily habits, there are some other ways to avoid weight regain after you quit Ozempic or other weight loss drugs.

• Hold yourself accountable. Monitor your progress to maintain healthy lifestyle habits and keep weight from creeping back on. There are various ways to do that. Try, for instance, keeping a food journal, using an app, and noticing how your clothes are fitting, McGowan says.
• Get support. With weight loss medications, it’s critical that you work with an obesity medicine specialist in a program that has nutritional support. Even after you quit the medication, you should be able to check in with your medical team to stay on track. You can also tap friends, family, and support groups to stay motivated.
• Manage stress. “Weight loss is as much a mental challenge as a physical one, McGowan says. Stress can cause a domino effect of poor health outcomes, so make sure you have healthy coping techniques to handle life’s bumps without sacrificing your health. You may even find it helpful to work with a therapist or psychologist.
• Treat underlying conditions. If there are other physical issues at play that are causing weight gain, make sure to address those with a qualified professional.

If you’re doing everything you can and still feel like your weight is out of control once you stop medication, it’s best to consult the doctor who oversaw your weight loss treatment about next steps.

Summary

Before taking any GLP-1 agonist, have a serious conversation with your medical provider and make sure you’re ready to stay on them long-term, McGowan says. If, though, you need to stop them for whatever reason, work closely with your doctor to facilitate the transition. And know that “the medications are always there for you if you need to come back on them,” Laster says.

Everyday Health‘s Weight Loss Reframed Survey queried 3,144 Americans nationwide ages 18 and older who have tried losing weight in the past six months. The study was fielded between July 10 and August 18, 2023, across demographic groups, genders, and health conditions. Survey recruitment took place via an online portal, in-app, and email. The margin of error for the sample size of 3,144 is +/–1.7 percent at a 95 percent confidence level.