The statistics say 65% of GLP-1 users will regain their full weight lost, as fat almost exclusively, within a year of stopping the medication.
This data has so many flaws, that it requires an entire article not a note to unpack it. The backwards DR (that’s me) to the rescue 😉
Let’s start here. Because it’s not. But as a society we have way more weight bias than we do heart disease, depression or diabetes bias. And that’s why this data is presented as novel or medication-specific.
Know anyone who tries to stop their PPI, SSRI, insulin, statin or even vitamin D supplementation and maintains their on-medication results? I’d offer up like 99% of stoppers here “regain” their non-medication outcomes a lot sooner even.
In the case of a GLP-1 agonist it works exponentially intensely to our own — either 24hours or 24/7days of sustained receptor site receipt of the hormone where our own body only does so for 2-5 minutes several times a day — so when that medication is removed the body does not have the same amount of hormone not by a long shot.
Being on the medication likely suppresses a person’s own production because the body senses the receptor site it already satisfied, so it doesn’t need to deploy hormone to the receptor site. When coming off this medication, there is a window likely a few weeks or a month where even if your own eventually does resume full operations, it won’t begin to do so for that window.
Here’s where there is nuance that never makes it into the data. What happens after coming off is based on WHY someone is coming off, WHEN and WHAT their body has had access to (what it has gained or lost) during the medication treatment. In my work, I’ve identified four groups of people coming off this medication. Each group has different outcomes and plan needs.
Group 1) this is likely the smallest group; they will wean off the medication when they have achieved optimal fat loss or blood sugar, both and perhaps other wins such as resolved food noise, sleep apnea and cardiometabolic wins. In this case, if we use the term optimal it means their results have come without undesirable side effects. They’ve protected bone and muscle, optimized digestion and total nutrition intake so their body has been in receipt of and able to use (digest) what it gets then it may be able to sustain outcomes and not experience regain or cravings etc.
Groups 2-4) These include the other reasons for coming off but in all of them the person has not achieved optimal outcomes. These include financial / access, intolerance of the medication or its side effects, not seeing desired results, or medical necessity based on a new diagnosis or treatment need etc. In these cases, if their coming off is abrupt especially and because their coming off is showing us that the body is not operating optimally on the medication (the one caveat here could be the person who loses access) then they are more likely to have regain, more likely that it will be almost all fat (where the weight loss may have been muscle, fat, bone, water) and experience resumption of any challenges the medication had helped minimize or resolve: return to cravings, food noise, appetite issues, blood sugar worsening, and new or existing digestive challenges not improving.
What should someone ideally do before stopping a GLP-1 if they want to maintain their results?
The ideal is almost never the reality. The ideal is to wean off and optimize everything described above during that weaning process. Highly unlikely in groups 2-4. So we modify as best as we can and we manage expectations.
The “why” coming off will dictate what needs to be done. For the person losing access, the sooner we can adapt their plan the more time we have to do a modified weaning process and maintain outcomes. For the person with a new diagnosis, the pivot to what best serves their body during this time period allows us to discuss what the loss of the medication as a tool will mean - today and tomorrow.
That said there are 3 common musts. 1) optimize digestion
2) wean where possible vs abrupt stop
3) monitor for first sign of changes, to experiment with new tactics and tools. Agree upon flags such as the first 3-5 lbs of fat regain; CGM or best available data to see blood sugar changes; tracking of digestive challenges and cravings at specific times of day worsening etc.
Let’s look at these more in-depth:
1) Optimize digestion. If your body can’t use what it is getting then it will slow operations - prioritize what it deems most essential and deprioritize all else— and become irritated. When it experiences these challenges it will be more likely to gain fat and miss the signals from your own weight-health hormones. Ideally, you decode changes to digestive function as early as possible. This requires having the habit of regular digestive assessment, weekly is a good schedule, to evaluate your current signals. Digestive optimization is not just about nutrition choices but also about hydration, breathing, mid-section movement and turning down elevated stress.
2) Total nutrition meets your body’s OPTIMAL nutrient needs. The body doesn’t have fewer needs off the medication. Your own hormones require amino acids, probiotics, fibers to work and hydration demands minerals with water while all other operations still have their total nutrient needs, too. Reducing intake , resuming a “diet” mindset will challenge your body to operate optimally at a time a key tool is being taken away. That’s a recipe for failure. Liquid nutrition to make it easier to absorb nutrients, food and supplement choices that pack a lot of nutrients in versus highly processed or lots of individual supplements will prove more challenging to meet those needs.
3) Follow your data: your blood sugar, your mood and energy, and your weight composition not your total weight. Fat, muscle, bone and water - the types amounts and locations - tell the story about whether your body is able to use and if it has what it needs to do all its tasks. Follow weekly trends to see the first moments something shifts unfavorably.
THE top tip is to not pick a top tip. We can’t pick one aspect of nutrition. over the other. Better nutrition by my definition is “giving your body what it needs to run better today while reducing what can irritate overwhelm and disrupt those efforts”. It’s made up of four pillars: timing, quantity, quality and balance — they all matter equally. Off the medication, you may notice you struggle more with one than you did on the medication. You will want to work to optimize that one but not at the cost of upsetting another pillar.
Hey Stacy, we broke up remember? Yeah quoting Wayne’s World here because we no longer do or use “weight loss” as a goal or measure. So what happens to your strength needs when you stop a GLP-1? Nothing. They were there before and they are here now. Because the body has muscles, they need to be consistently nurtured and we do that by challenging them. So, using your muscles is essential- GLP1 medication or not — to maintain optimal weight composition. If you’ve lost muscle (remember the digestive tract are muscles too) due to an illness, a stressful inactive period or because you didn’t prioritize protecting yours while losing weight, metabolic operations will suffer and you are more likely to experience negative post-medication results. How you do that can vary - some people do a lot of strength work in their day carrying kids, lifting stuff at work etc they may need less “training” time than someone who is more sedentary but it’s not optional for anyone.
Hope this doesn’t feel controversial but I don’t recommend the DR here I recommend the RD or other weight health nutritionist who can personalize a plan, monitor and help them optimize it - medication or not. This can be done in collaboration with their DR for sure but not exclusive of the practitioner trained to optimize nutrition, digestion and navigate the impact of lifestyle choices.
One final note. Stopping this medication even if you’ve achieved your current goals does not make you a winner or a success or a failure. Your medication is a tool. If it works for you and you have access to it, that’s great. If it doesn’t or that changes, that’s just data and we move on to other tools. And life changes and you need it again and you have access, then we resume it. That doesn’t make you a failure. Restarting any medication should not be perceived as a failure. They are tools to use and personalize to each individuals needs and timing.
Do you have a question about your GLP-1 therapy? Please share so we can debunk the myths and help you get what you need. And consider sharing this if it helps anyone you know
Ashley Koff RD
the backwards DR
No posts
Comments
Nothing yet. Say the first thing.
Sign in to join the conversation.