Drugs such as semaglutide (Ozempac, Vigovi) and terzapatide (Monjaro, Zipbound) have changed the landscape of weight management, offering hope where traditional methods have stalled.
Both drugs work by mimicking gut hormones that regulate insulin release, slow digestion and reduce appetite, with the overall effect of making you feel fuller faster and for longer. Many patients diagnosed as clinically obese report double weight loss while taking this drug.
But what happens when you stop taking them?
David Mottola, MD, is a general surgeon with Baptist Health who specializes in bariatric and minimally invasive surgery and his clinical interests include both medical and surgical weight loss. He says recent studies provide the first real look at what happens when patients stop medical weight-loss treatment—and the findings are clear.
Obesity: An American Epidemic
America’s struggle with obesity is no longer a public health concern—it’s a defining feature of modern medical care. From primary care clinics to cardiology offices, obesity affects daily clinical decisions.
The area is amazing. Researchers report that the number of American adults living with obesity has more than doubled in the past three decades, reaching an estimated 107 million by 2023.
For decades, the prescription for obesity was simple but difficult: eat less, move more. While lifestyle changes are the foundation of health, maintaining significant long-term weight loss through behavior alone is extremely difficult.
A new era of weight loss therapy
Semaglutide and tirzepatide were originally approved by the US Food and Drug Administration (FDA) for the treatment of type 2 diabetes. But what began as a treatment for blood sugar control revealed a profound secondary effect: significant weight loss. Clinical trials consistently show an average double-digit weight loss. In 2021, the FDA approved semaglutide for weight loss management, followed by terzapatide in 2023.
For patients with type 2 diabetes, this drug offers two powerful benefits for one, according to Dr. Mottola.
“For these patients, drugs like semaglutide and terzapatide do double duty,” he says. “They improve blood sugar control while also helping patients achieve significant weight loss, which further reduces their long-term risk of heart disease.”
Dr. Mottola emphasizes the systemic effect of this treatment. “We’re not just treating a number at scale,” he says. “We’re treating a chronic metabolic disease—obesity—that affects nearly every organ system in your body.”
In one trial, semaglutide was associated with a 20% reduction in adverse cardiovascular events such as heart attack and stroke in people who were overweight or obese and had developed heart disease.
Other health benefits of weight loss pills
Other than weight loss, the drug offers life-extending benefits that are less immediately apparent, Dr. Mottola says.
- Diabetes Relief: Studies have reported remission of type 2 diabetes in some patients after significant weight loss.
- Improving quality of life: Improvements in sleep, acid reflux and bone density have been noted.
- Reducing the risk of cancer: Emerging evidence suggests reduced long-term risks for certain cancers, including breast, endometrial and prostate cancer.
Due to their success in treating obesity, the demand for these drugs was unprecedented. In 2023 alone, nearly 26 million semaglutide and more than 6 million tersepatide prescriptions were written in the United States, with these numbers expected to rise dramatically by 2025, indicating a shift in how both patients and providers view obesity—not as a failure of will but as a treatable medical condition.
The rebound effect: What happens when you stop?
Despite the impressive before and after photos, however, the story doesn’t end when the prescription ends. Like diabetes or high blood pressure, obesity is a chronic disease with powerful biological drivers. When the medication stops, these drivers often relapse, Dr. Mottola notes.
Recent data paint a clear picture of the “recovery effect”:
- Semaglutide: In the STEP 1 extension trial, participants who stopped taking the drug regained two-thirds of their lost weight within a year. By week 120, most cardiometabolic improvements were returning toward baseline levels.
- Terzepatis: In the SURMOUNT-4 trial, participants who switched to placebo experienced significant weight regain—about 14%—during the follow-up period.
- General trends: Extensive analysis by British Medical Journal found that after discontinuing weight-loss drugs, people regained an average of about one pound per month, often returning to their original weight within two years without additional support.
“At Baptist Health, we find that weight loss medications can help control appetite while someone is taking them,” says Dr. Mottola. “When the drug is stopped, the body often feels hungry again, and so the weight can be regained.”
Moving towards long-term solutions
Data suggests that for many, these drugs are not a short-term solution but a long-term maintenance treatment, such as drugs for high blood pressure or high cholesterol. However, Dr. Mottola emphasizes, medication is not the only option.
“The most important thing for people with obesity is to talk to their doctor. For some patients, medication is enough. For others, there are additional options such as bariatric surgery that can help achieve long-term results and improve long-term health,” explains Dr. Mottola. “We help patients review all their options and find a treatment plan that works for their long-term health.”
Semaglutide and terzapatide represent powerful, evidence-based tools in the fight against obesity and offer unparalleled benefits for cardiovascular health and metabolic stability, concludes Dr. Mottola. Yet, as research shows, they work best when understood not as short-term sprints, but as part of a comprehensive, lifelong commitment to health.
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