Why So Many People Stop Semaglutide and Tirzepatide, and How to Protect Your Weight Loss

By Katie Sorensen, NP | Weight Loss NP

GLP-1 medications like semaglutide and tirzepatide are incredibly effective tools for weight loss. But using medication alone is only one part of a proper metabolic health strategy.

A new study published today in JAMA Network Open found that nearly half of people who started semaglutide for obesity management had discontinued it within one year. This is similar to data other studies have found in the last couple of years.

Fifty Percent of people discontinue their GLP-1 within one year…. That number should get our attention.

People aren’t stopping their GLP-1 medication because it’s not helping them lose weight – many times they’re stopping it because they indeed reached their goal weight with its help. Unfortunately, the issue is that obesity is a chronic condition, and too many treatment plans are still built around getting weight off without enough thought about what happens next.

At Weight Loss NP, we think about maintenance from the beginning.

If you are using semaglutide or tirzepatide for medical weight loss in Denver, Arvada, Colorado, Utah, or Florida, your plan should include not only how you will lose weight, but how you are going to protect that progress later.

A New Study Found Nearly Half of Semaglutide Users Stopped Within a Year

Let’s dive in to the study and give this conversation more context. The new JAMA Network Open study on semaglutide discontinuation followed 157,822 adults in Denmark who started semaglutide for obesity management between December 2022 and November 2024.

The results were interesting:

• 13% had discontinued by 3 months
• 27% by 6 months
• 39% by 9 months
• 49% by 12 months

And this was not isolated to one particular type of patient. The risk of discontinuation was at least 41% across every patient subgroup researchers evaluated.

The study also found higher discontinuation among younger adults, men, people living in lower-income areas, and patients with certain health conditions or prior gastrointestinal or psychiatric medication use.

The researchers pointed to cost and side effects as likely contributors.

That makes complete sense clinically.

GLP-1 medications can be life-changing, but treatment still has to be tolerable, affordable, convenient, and realistic enough to continue.

One of the Most Interesting Findings: People Often Came Back

Here’s another part of the study that’s interesting to me, and that aligns well with what we see in our practice: One in four people who discontinued semaglutide restarted it within only three months.

To me, that says something important.

For many patients, stopping may not actually mean they were “done” with the medication.

It may mean:

• Cost became difficult
• Side effects became frustrating
• Access changed
• They wanted to see if they could maintain without it (the reason I see most often)
• They spaced doses farther apart on their own
• They lost support
• Hunger or food noise returned
• Weight loss stalled and they got frustrated

This is exactly why I do not love the idea of someone reaching their goal weight and suddenly hearing:

“Great! You’re done. Stop the medication.”

Obesity biology does not necessarily disappear because the scale hit a target and that fact can become apparent to people within weeks to months after stopping a GLP-1.

Why Weight Regain After GLP-1s Happens

GLP-1 medications help reduce hunger, increase satiety, quiet food noise, and improve metabolic signaling. When the medication is removed, some of those biological effects can fade.

Appetite may increase.

Cravings may come back.

Portions can slowly increase.

Weight-regulating hormones can push the body toward its previous weight.

And your body may require fewer calories after significant weight loss than it did at your starting weight.

None of that means someone failed.

It means we need a better maintenance strategy that is discussed from the beginning. We also need continued knowledge and cultural support around treating obesity like the chronic disease it is.

Previous research has also shown that weight regain is common after GLP-1 medications are discontinued, which is why weight maintenance planning needs to be treated as an essential aspect of obesity treatment itself, not as an afterthought at the end.

At Weight Loss NP, Maintenance Starts on Day One

One of the biggest differences in how we approach medical weight loss is that we are already thinking about maintenance from the day we start your weight loss journey. We do not wait until you reach your goal weight and then suddenly ask:

“Okay, now what?”

From the beginning, we work on the things you will need later, including lifestyle strategies like:

• Eating Adequate protein
• Preserving and building muscle
• Strength training
• Meal structure
• Hunger awareness
• Managing emotional and stress eating
• Sleep
• Metabolic health
• Hormone health when appropriate
• Learning what your body needs at a lower weight
• Building routines that actually fit your life

Medication can make those changes dramatically easier to build, so the goal is to use that opportunity well!

This is also why our GLP-1 weight loss program is not simply about handing someone a prescription.

You Do Not Necessarily Have to Stop a GLP-1 After Losing Weight

At our practice, we support people who want to taper off a GLP-1 medication once they’ve reached their goal, and even those who want to try off it altogether. We specialize in personalized obesity medicine, after all! Especially for people who had less weight to lose, or who have not struggled with obesity for a long period of time, reducing or stopping the GLP-1 can be a feasible option – one that we’ve absolutely seen work.

That said, it’s important for people who start on a GLP-1 to know: There is no rule that says every patient needs to come completely off their GLP-1 once they reach a goal weight. In fact, the clinical guideance is the exact opposite. For people who have struggled with obesity for decades, or who have lost significant weight, long term medication may make sense.

There are options up for discussion here that can include:

• Staying on a lower GLP-1 dose for maintenance
• Carefully spacing doses farther apart
• Continuing the same dose if medically appropriate
• Changing medications to a more affordable or an oral med option

This is a medical decision, and it should be individualized with the help of a provider who knows you well.

There are patients with strong genetic obesity risk, significant insulin resistance, PCOS or PMOS, metabolic disease, or very persistent appetite dysregulation who may simply do better with ongoing medication support.

That is absolutely okay!

We do not tell people with high blood pressure that success means eventually throwing away their blood pressure medication.

Obesity deserves the same thoughtful long-term approach.

Another consideration supporting long term use of GLP-1 medications for weight maintenance are the many additional benefits of taking a GLP-1 evidence is accumulating to show:

Lower cardiovascular risk, including fewer major cardiovascular events in people with overweight or obesity and established cardiovascular disease.

Improved blood sugar control and insulin sensitivity, with reduced risk of progression to type 2 diabetes.

Improvement in fatty liver disease, including reductions in liver fat and inflammation in patients with metabolic dysfunction-associated steatohepatitis.

Reduced inflammation and cardiometabolic risk, including improvements in blood pressure, triglycerides, and other metabolic markers.

Kidney-protective effects, especially in people with diabetes or chronic kidney disease.

Improvement in sleep apnea, particularly when excess weight is a major driver.

Better mobility and physical function as weight and metabolic health improve.

A More Affordable Maintenance Option Matters

The new JAMA study also highlighted something patients already know very well: cost and insurance coverage affects whether people can stay on treatment.

In the Danish population studied, semaglutide cost roughly $2,500 to $4,200 per year depending on dose, without reimbursement. The authors specifically identified financial burden as a likely contributor to discontinuation.

That is one reason we have intentionally built a more cost-effective, yet supportive GLP-1 maintenance program at Weight Loss NP.

Maintenance usually does not need to look exactly like active weight loss treatment.

For stable patients, our maintenance approach can include:

• Quarterly medical follow-up instead of more frequent active weight-loss visits
• Individualized medication and dose management
• Easy Refill support
• Ongoing access to our GLP-1 Success App
• Nutrition and muscle-preservation guidance
• Accountability and education
• A plan for catching regain early rather than waiting until 20 or 30 pounds have returned

You can read more about our GLP-1 weight loss maintenance approach.

The goal is to make long-term treatment supportive, convenient, and financially realistic.

Catching Regain Early Is Much Easier Than Starting Over

This is another key strategy for the long term maintenance of weight loss after a GLP-1. If someone gains even 3-5 pounds and we notice appetite, cravings, or food noise returning, we need to address it quickly for the best odds of avoiding further weight regain.

Maybe the dose needs adjustment.

Maybe protein has slipped.

Maybe strength training disappeared.

Maybe perimenopause is changing the metabolic picture.

Maybe sleep has fallen apart.

Maybe life simply got really busy.

That is very different from disappearing from care and coming back after regaining 30 pounds.

Our goal is not perfection. It is early course correction.

GLP-1 Maintenance in Denver, Colorado, Utah, and Florida

Weight Loss NP provides medical weight loss and GLP-1 maintenance support for patients throughout Colorado, including Denver and Arvada, as well as patients in Utah and Florida through telehealth.

We work with patients using semaglutide, tirzepatide, and other medical weight loss strategies while keeping the bigger goal in mind:

Not simply losing weight.

Keeping the health improvements you worked so hard to achieve! Whether you’re just starting your weight loss journey, or if you need a better plan to support you through long term weight maintenance and metabolic risk reduction, we’d love to support you!

Our GLP-1 Success App also provides ongoing education, practical nutrition support, accountability, private content, community, and tools designed for both active weight loss and maintenance.

The Bigger Picture

I do not think the takeaway from this study is that half of people “fail” semaglutide. I think the takeaway is that long-term treatment is complicated. Cost, side effects, access, support all have hands in why people are able to continue GLP-1 treatment, or why they choose to stop.

Discussing long-term strategy from the very start should be standard in obesity medicine. It is Weight Loss NP.

If you are currently losing weight on a GLP-1, approaching your goal, or already noticing weight returning after stopping medication, we can help you build a maintenance plan that fits your health, lifestyle, and budget.

Schedule a FREE consultation with Weight Loss NP.