By Dr. Sende, Double Board-Certified Weight Loss Physician, Miami
“I’ve dropped 30 pounds on my GLP-1 medication, and my doctor says I might need to stay on it forever. Really?”
Sound familiar? You’re definitely not alone. In my Miami practice, I have this exact conversation with patients every single day. And honestly? It’s one of the most important discussions we can have. Thousands of my patients have asked me this same question after watching those pounds just melt away with GLP-1 medications like semaglutide or tirzepatide.
Here’s what I tell them (and what I’m telling you): Most folks need to keep taking GLP-1 medications long-term if they want to keep the weight off. But not to worry, we just need to see what works best for you. Maybe it is tapering off or microdosing.
I know—that’s probably not what you were hoping to hear. Trust me, I wish I could give you a different answer. But let me walk you through why this happens and what it actually means for your health journey. As someone who’s sat with thousands of patients through this exact conversation, I’ve learned that obesity really does require ongoing management, just like diabetes or high blood pressure.
Different Paths for Different People
The “Lifer” Approach
Some people decide early on they’re in it for the long haul. They view it like taking medication for any other chronic condition and plan accordingly. This works well for people who:
- Have multiple health conditions that benefit from the medication
- Experienced dramatic quality of life improvements
- Have solid insurance coverage or can afford the cost
- Tolerate the medication without major issues
The “Transition” Strategy
Others use GLP-1 medications as a springboard for major lifestyle changes, with hopes of eventually maintaining through other means. This might involve:
- Working intensively with nutritionists and trainers while on medication (our patients get personalized meal plans that help them build sustainable eating habits for life)
- Switching to less expensive oral medications for maintenance
- Gradually tapering while closely monitoring weight
- Having a clear game plan for what to do if weight starts creeping back
The “Cyclical” Approach
Some people (with medical supervision) use these medications in cycles—staying on until they reach their goal, tapering off, and returning if they regain significant weight. This isn’t ideal, but it’s reality for people dealing with cost or access issues.
Why Can’t I Just Stop After I Hit My Goal Weight?
Let me tell you about Sarah (not her real name, but this story plays out in my office all the time). She dropped 45 pounds over eight months on semaglutide. She felt incredible. Her clothes fit perfectly, her energy levels soared, and she was on cloud nine. “Dr. Sende, I’ve got this figured out,” she told me at her follow-up. Despite my warnings, she decided to stop taking the medication to save money.
Six months later, she’s back in my office, frustrated and defeated. She’d packed on 30 of those 45 pounds again. This happened despite sticking to everything we’d talked about—her healthy eating, her exercise routine, everything.
Here’s the thing: Sarah’s story isn’t unique. I see it over and over. Here’s what the research tells us about what happens when people stop these medications:
The Weight Creeps Back
Scientists followed patients who quit semaglutide after successful weight loss. What they discovered might shock you: participants regained two-thirds of their prior weight loss within just one year. Even worse? They kept up their healthy habits the entire time.
But here’s the kicker—a massive study tracking over 120,000 people found that most quit taking these medications within two years. That means tons of people ride this frustrating roller coaster of losing weight and gaining it back.
Your Body Fights Back (And I Promise, It’s Not Your Fault)
Okay, let’s bust a huge myth that I hear in my office every day: gaining weight after you stop GLP-1 medications has absolutely nothing to do with your willpower or character. Nothing.
When you stop these drugs, those hunger signals that had been quietly sleeping in the background? They wake up angry. Your body literally goes into battle mode to get back to its previous weight through incredibly complex hormone changesthat you simply cannot willpower your way through.
Here’s how I explain it to my patients: if you have high blood pressure, you wouldn’t expect six months of blood pressure medication to cure you forever, right? Your body would go right back to high blood pressure if you stopped. Obesity works exactly the same way—it’s a chronic medical condition that usually needs ongoing care.
But Here’s Some Really Good News
Now, before you get discouraged, let me share the flip side. The patients in my practice who stick with these medications long-term? They see absolutely incredible, life-changing results that just keep going.
Four Years and Still Crushing It
The longest study we have followed over 17,000 people taking semaglutide for four whole years. The folks who stayed on the medication kept off an average 10.2% of their body weight at the four-year mark.
Now, 10.2% might not sound huge, but let me put this in perspective: for someone who weighs 200 pounds, that’s over 20 pounds gone and staying gone. When I see patients maintain that kind of weight loss, we’re talking about completely transforming their diabetes control, their sleep apnea, their joint pain—their whole quality of life.
Tirzepatide Packs an Even Bigger Punch
If you’re taking tirzepatide, you might see even better results. Head-to-head studies show people on tirzepatide lost an average 20.2% of their body weight compared to 13.7% with semaglutide over 72 weeks.
“But Dr. Sende, My Friend Stopped and She’s Fine…”
Oh, I hear this one all the time! And you know what? Your friend might be telling the truth. Some people—not many, but some—can successfully transition off these medications and keep their weight stable. I’ve seen it happen in my practice too.
The patients who tend to do well stopping usually have a few things in common:
- Lost weight quickly (fast responders often do better long-term)
- Built solid lifestyle changes while taking the medication
- Work with a complete medical team
- Gradually taper off instead of stopping cold turkey
The Slow-and-Steady Approach
Fresh research from Denmark shows that patients who slowly reduced their dose over about nine weeks instead of stopping abruptly had better luck maintaining their weight loss. Picture it like removing training wheels—you don’t yank them off all at once.
Making It Work in Real Life
Let’s get practical. Long-term medication use brings real challenges:
Let’s Talk About the Elephant in the Room: Money
Look, I’m not going to sugarcoat this. These medications are expensive as heck—we’re talking $800-$1,300 per month if you’re paying out of pocket. Health economists have crunched the numbers and found that while these drugs work amazingly well, they’re just not cost-effective at what they’re currently charging.
It breaks my heart when I see patients who are doing great on these medications but have to stop because of the cost. Here’s how my patients and I work together to make it more manageable:
- Fighting with insurance for prior authorizations
- Hunting down patient assistance programs
- Switching to cheaper generic weight management medications after hitting initial goals
- Pushing for coverage based on other health conditions (diabetes, heart disease, sleep apnea)
The Side Effects Real Talk
Most of my patients deal with some stomach stuff when they start these medications—nausea, constipation, maybe some diarrhea. I always warn them upfront because I don’t like surprises. The good news? For most people, these side effects get better after a few weeks once your body adjusts. The not-so-good news? Some folks just can’t tolerate them long-term, no matter what we try.
If side effects are making your life miserable, please don’t just suffer through it. Come talk to me! Here’s what we can try:
- Talk to your doctor about adjusting your dose
- Consider switching between semaglutide and tirzepatide
- Ask about strategies to minimize stomach problems
- Don’t suffer in silence—solutions usually exist
What I Always Tell My Patients (That Other Doctors Sometimes Don’t)
Here are the conversations I make sure to have with every single one of my patients:
The Lifestyle Foundation
Exercise won’t usually help you lose weight initially, but it’s crucial for keeping weight off. Use your time on medication to build habits that’ll serve you whether you stay on the drug or not:
- Find physical activities you actually enjoy (not just what you think you “should” do)
- Work with a nutritionist to learn sustainable eating patterns (in my practice, we provide complimentary personalized nutrition plans to help patients maximize their GLP-1 results and build lasting habits)
- Tackle emotional eating with a therapist if needed
- Build your support network
Your Personal Risk Factors
Your individual situation matters enormously:
- Diabetes: You might need to stay on for blood sugar control regardless of weight
- Heart disease: These medications protect your cardiovascular system beyond weight loss
- Sleep apnea: Weight regain can make this dangerous condition worse
- Mental health: Some people experience better mood and eating behaviors on these medications
Questions You Should Ask Yourself
Before making any decisions about stopping or continuing, think about:
- What do I really want to achieve? Just weight loss, or broader health improvements?
- How do I feel on this medication? Both physically and mentally?
- What’s my support system like? Do I have help with lifestyle changes?
- What are my risk factors? What happens if I gain the weight back?
- Can I afford long-term treatment? What are my realistic options?
Red Flags: When to Call Your Doctor Right Away
Don’t try to navigate medication changes solo. Contact your healthcare provider if you experience:
- Severe or ongoing side effects
- Rapid weight regain after stopping
- Blood sugar problems (especially if you have diabetes)
- Depression or mood changes related to weight regain
- Thoughts of disordered eating behaviors
Here’s What I Really Want You to Know
Listen, I’ve had this conversation with thousands of patients over the years, and here’s what I always tell them: there is absolutely zero shame in needing long-term medication for weight management. None. Zero. Zip.
You wouldn’t beat yourself up for taking blood pressure medication every day, right? Weight cycling—that frustrating yo-yo effect—actually increases your risk of heart disease and death, so keeping that weight stable is literally protecting your health.
Now, these medications work their best magic when they’re part of a bigger picture that includes:
- Realistic lifestyle changes you can actually sustain
- Professional support (medical, nutritional, psychological)—which is why we include complimentary nutrition counseling with our GLP-1 treatment plans
- Clear understanding of your personal risk factors
- Honest conversations about cost and accessibility
What Real Success Actually Looks Like
Success isn’t about staying on medication forever or getting off it completely. That’s not how I measure success with my patients.
Real success is:
- Feeling better in your body and keeping those health improvements that matter to you
- Having open, honest conversations with your medical team (like we’re having right now!)
- Making decisions based on what actually makes sense for YOUR life and YOUR body
- Giving yourself grace for needing medical help with a medical condition—because that’s exactly what this is
Looking Forward
The obesity medicine field evolves rapidly. New medications are in development, costs may drop, and we’re learning more about personalized treatment approaches. Researchers actively study better strategies for medication compliance, nutritional support, and weight maintenance after stopping treatment.
So, Where Do We Go From Here?
Look, I know this is a lot to think about. When patients leave my office after we’ve had this conversation, I can see the wheels turning in their heads. So let me give you the same roadmap I give them:
- Have an honest conversation with Dr. Sende – and I mean really honest. Talk about your goals, your fears, what keeps you up at night worrying about money, all of it. Your doctor can’t help you make the best decision if they don’t know what you’re really dealing with.
- Start building your foundation now – Whether you stay on medication forever or transition off someday, you need those healthy habits. Think of the medication as giving you breathing room to build something sustainable.
- Don’t go it alone – Seriously, get your people together. That might be a therapist, a workout buddy, a nutrition coach, or just your family understanding what you’re going through. (And if you’re my patient, you know you’re getting that nutrition support built right in—no extra charge, no hassle.)
- Think bigger picture – This isn’t just about the next six months. What do you want your life to look like in five years? Ten years? Make decisions that fit that vision.
- Give yourself a break – I tell every single one of my patients this: you’re dealing with a complex medical condition. You’re not supposed to have all the answers figured out. Cut yourself some slack.
Here’s the thing I want you to walk away remembering: You’re not just working on a number on a scale. You’re working on getting your life back—more energy to play with your kids, sleeping better, feeling confident in your own skin, maybe getting off some of those other medications. That’s what really matters.
Whatever you decide, make sure it feels right for YOUR life, not what worked for your neighbor or your coworker or that person you follow on social media. This is your journey, and it should fit you.
About Dr. Sende
Dr. Sende is a double board-certified physician specializing in obesity medicine and internal medicine, practicing in Miami, Florida. With decades of experience helping patients achieve sustainable weight loss, Dr. Sende has guided thousands of individuals through their weight management journeys using the latest evidence-based treatments, including GLP-1 medications. His comprehensive approach includes personalized nutrition plans developed by registered dietitians at no additional cost to patients, recognizing that successful long-term weight management requires both medical intervention and lifestyle support. He is committed to providing personalized, compassionate care that addresses the complex medical, psychological, and lifestyle factors involved in long-term weight management.
The journey with GLP-1 medications is highly personal. This post helps you think through the considerations, but your healthcare provider is your best partner in making these important decisions about your treatment plan.
