Why You Are Stopping a GLP-1 Matters for How You Stop.

We’ve heard the statistics — 80% of those who lost weight regain some after stopping; 60% of weight regained in the first year; return to diabetic or pre-diabetic status; the same with cardiometabolic benefits, returned to pre-medication status. Thus, we can infer that the best medicine is to stay on this medication for life.

But what this data doesn’t tell us matters, and addresses what in many cases isn’t a feasible, if not desired protocol.

What then? Are we doomed to diet-like statistics?

Or could we personalize plans that change these outcomes?

In my work — and what I share in the bestselling weight-health playbook for patients and practitioners: Your Best Shot: the personalized plan for optimal weight health: GLP-1 shot or not — patients and practitioners can secure different, better outcomes. And it begins with their “why”.

Weight Bias Note: what I am about to share is true for any and every medication.

Much of the research on stopping GLP-1s lumps everyone of the participants into a group “person on a GLP-1” and then looks at “person off a GLP-1”. In some studies, the patients know they are stopping their medication — imagine the psychological impact of having felt somewhat or a lot amazing on a medication then being told you don’t have it anymore — and others unknowingly get a placebo.

In both cases, the only thing measured are the markers being assessed in the study.

And it appears that in all studies, no one is given a plan for how to a) restart their own hormones which function vastly different (2-5 minutes vs sustained 1-7 days), b) how to address any new side effects of this change c) guidelines for what will happen to their body off medication over different time periods (the first few weeks, months, year).

In data taken from the general population of people reporting GLP-1 medication usage the same happens. Two buckets. On of Off. And here, we don’t have any data about their initial diagnosis or rationale for using the medication.

There’s so much missing from this data. But the most important thing is their why. Let me explain.

When patients tell me they are stopping, have stopped, or inquire about a plan to stop, I have identified they fall into 1 of 4 groups. These groupings are the foundation of my initial care plan for them. Their group dictates what we do, when we do it, and how we do it — and the results confirm that this matters the most.

1. Group 1: Optimized Weight Health. These patients have data that they’ve achieved their goal and now want to come off the medication or its being recommended that they stop. This group represnts the smallest set of patients I have seen stopping the medication (to date) - and those that qualify to start my weaning program or move to maintenance (even if they’ve been on a low dose or “micro” dose) is even smaller. Keep reading or jump down to see what I recommend for this group.

2. Group 2: Medication “did not work for me” is the deciding factor for these patients. Or they report their practitioner notes based on results including potentially intolerable or unhealthy side effects, the medication is no longer a recommended treatment. A large subset of these patients are ones that have gone on the medication on their own which I define as without ongoing evaluation and personalization of their plan. Most have purchased online or through a doctor that is only involved for the prescription [note: this may be what the patient chose for financial or other reasons not because that is how the doctor wanted to treat them]. It is typical that I am seeing these patients for the first time after they have tried to self-address or worked with practitioners to attempt to find a way for this medication to “work for me”.

3. Group 3: Losing / Lost Access. Finances, changes in insurance, availability of the medication - these are all the reasons someone may no longer have access to their medication. In most insurance instances, there is a time period where they no access is going to change or be eliminated — that matters and we will discuss in our plan tips below. That said, especially in today’s economy and where millions are choosing to have access via an online provider who sets costs, the change can be more abruptive.

4. Group 4: Must Stop Due to New Health Status. For exciting and positive reasons, and for new health diagnoses and challenges, these patients experience an almost “in the moment” learning that they should no longer or cannot be on this class of medication.

From a practitioner that has been doing this for 10 years. Noting newer versions of medications are shifting aspects of the plan, the approach beginning with their why stopping is always the same.

“Starting, using, and coming off of a GLP-1 medication should include collaboration with a “backwards DR” — a weight-health nutrition expert like me, and RD, or a CNS or an MD/ND etc. only if they are someone who practices personalizing plans for total nutrition and digestive health.”

Sadly, the above needs to be said on repeat. It is probably the biggest issue in poor outcomes coming off a GLP-1 medication. Too often patients have been given “the basics” of more protein, fiber, strength-training and then assessed with a once a month BIA (weight composition) or DEXA scan to evaluate progress. This impersonalization or, at best, partially personalized plan will result in suboptimal outcomes when stopping, even if they were able to navigate using them to some or significant success on the plan. [That’s why I called the “GLP-1 Bridge” a plank instead. Because it made access “affordable” which is a win at $50/mo but did expand or make access more available for weight-health nutrition professionals. To quote Pretty Woman “Big mistake - HUGE”.

Collaboratively, a weight-health practitioner team can develop and optimize plans for stopping based on that important “Why” data and type using these insights (and the plan-building protocols in my book or for practitioners in my GLP-1 Weight Health certification).

Are you interested in joining my free training on how to stop a GLP-1 successfully? Please share in the comments and let me know if you are a practitioner, coach or just an interested person :)

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In all cases, the most important thing we can do is manage expectations. Help patients understand what happens when their body goes from having a sustained, elevated hormone(s) level to, at best, one that has minutes to get where it is supposed to go. Help them understand that this would be the same as stopping other hormones, or similar to stopping all medications, or even on par with abrupt quitting of smoking or caffeine. Use this conversation to establish new goal(s) based on being informed about what the body will experience and what they can and choose to sustain in terms of choices (nutrition, lifestyle etc.).

1. Group 1: The goal(s) here are to protect any wins, to maintain their current weight health and to be able to optimize it as their life happens. This patient group feel they’ve reached their goal or are told they are at a BMI that no longer requires this medication as a tool. That’s awesome — on one hand. Their data may or may not include what is needed to know where they actually are in their weight health optimzation process. As I outline in my work on weight-health hormone assessment (I created the first and to date, only, clinical tool for full assessment), these data include weight composition not just total weight, expanded blood sugar data ideally a continuous glucose monitor for 14 days, and most important, a thorough digestive assessment (this is in my book and also in an article here on Substack for your reference), and insights about their overall health and recovery. That’s step one. Always. The second step, when ready, is to set assessment parameters. These range from the obvious of weight composition and blood sugar, to the less like assessment of cravings, fatigue, mood and food noise. Ideally these components are in place well before starting the weaning process, but they are essential for it. They will be what we put in place to measure (timing depends on weaning plan) and direct plan optimization.

2. Group 2: The goal(s) here is to help them experience weight-health wins. This will look different for each patient and is likely a combination of addressing and correcting any health challenges or side effects along with maintaining or improving their key goal (for which they went on the medication). My heart goes out to these patients as they navigate another perceived failure in their weight health journey. My goal with my book, my training programs and the content I share is to create less of this group. But here, we can help them turn a perceived failure into a better plan and longer-term weight health wins. They have been battling no appetite or no changes in cravings/hunger/food noise, malaise, poor energy, hair and muscle loss, life- interfering digestive issues in addition to suboptimal weight loss or blood sugar optimization outcomes. Often these patients have escalated to the highest dose or tried different versions. For these patients, I frequently find their weight loss has only been measured as a total (vs weight composition), that they had pre-existing digestive issues, likely or confirmed suboptimal nutrient statuses before initiating medication, and are or were on other medications that likely impact their outcomes. And that is where I start. Not with what has happened or not happened on the medication, but with a thorough assessmen of what was or wasn’t happening before the medication. We build a plan that optimizes and repairs current health challenges. And in many cases, that leads us back to the medication but done differently, in a body that is now going to receive it differently. In other cases, we use other tools.

3. Group 3: The goal(s) here is to protect any weight-health wins and help them transition to a plan that continues to optimize weight-health informed by no longer being on the medication (at this time, they may resume). It’s ideal to have as much time as possible to build and implement a plan before the patient no longer has access. I almost never get a patient in an ideal scenario, so we meet where they are not blame them for failing to have a plan sooner. The plan components will depend on if the person in this group is more like a Group 1 versus a Group 2 member. Note: Budgeting conversations should be part of every treatment plan in healthcare (in my professional opinion (IMPO)). We have the “no surprise” act designed to help, but often that does not include things like supplements, gym access, practitioner support (trainer, RD, coach etc.) and testing. And too often, it doesn’t include the predatory tactics of medications that bring you in at a significant discount and then escalate too higher prices etc. For this group, having those conversations whenever you meet them is imperative to avoid any sense of being a victim to their financial or job etc. circumstances.

4. Group 4: The goal(s) is to optimize weight health in the context of their new health situation. It will be vastly different depending on the reason for example it may be that we are now looking at life-saving, disease addressing concerns or a new baby on the way. What is the same, however, is that without the medication their body will very quickly experience its absensce. Everyone in their care needs to understand what that means. When blood sugar escalates is that gestational diabetes or a rebound of stopping the medication; in either case, helping them optimize their total nutrition and activity (especially post consuming calories) will ensure better outcomes. Digestion will change dramatically coming off the medication especially if at higher doses. This should be considered with other medications and treatments being initiated to address the new health concern.

Collaboration with the right team can turn a difficult situation into a long term win. Hopefully the insights I’ve shared here about the work my team and I do to personalize plans at every stage for patients including those coming off a GLP-1.

We need better headlines and much more targeted research to help patients and practitioners choose the right path for lasting weight-health outcomes. In the absence of that, this content is here to help you navigate considerations and personalization.

With that said, did it help you? I would love to know if you feel you learned something that will help you — and if it can help someone else please “restack” or share. And for more content like this, consider adding me to your subscriptions:

the “backwards DR”