GLP-1 medications such as Ozempic, Wegovy and Zepbound have transformed weight management and diabetes control, but research shows many patients discontinue them within a year. Dr. Frank Dumont warns that stopping can expose patients to six potential rebound risks.

Dumont, an internal medicine physician and executive medical director at Virta Health in San Francisco, said patients stop for several reasons. Some have medical concerns or side effects, while others do not want to remain on medication over the long term.

Common side effects include nausea, vomiting, constipation and diarrhea, which can make it difficult for some patients to eat enough food for adequate nourishment. Dumont said patients should work with their physicians when deciding whether continuing treatment is appropriate.

More serious complications can require immediate discontinuation, including acute pancreatitis, which Dumont described as rare but potentially life threatening. Certain GLP-1 medications also carry a thyroid tumor warning based on animal studies, although the risk to humans remains unknown.

These drugs should not be used by people with a personal or family history of medullary thyroid carcinoma. They are also not intended for people with multiple endocrine neoplasia syndrome type 2, known as MEN 2.

The first rebound risk is the return of intense cravings and a sharp increase in appetite, sometimes called food noise. Dumont said patients may mistakenly view GLP-1 treatment as a brief prescription that can be stopped after reaching a target weight or blood sugar goal.

The American Medical Association and the Obesity Medicine Association classify obesity as a chronic condition that generally requires continuing management. Dumont said hunger and cravings will likely rise if patients stop treatment without significantly changing the types of food they eat.

Weight regain is another major concern. In the STEP 1 trial extension, participants regained about two thirds of the weight they had lost within one year after ending semaglutide and lifestyle interventions.

The SURMOUNT-4 trial produced a similar warning for tirzepatide. Patients switched to a placebo after 36 weeks of treatment regained more than half of their lost weight during the following year, despite receiving diet and exercise counseling.

“That's just so devastating for people who felt like they'd finally found a solution that would work,” Dumont said. The reversal can be especially difficult for patients who have spent years moving through diets and programs without lasting success.

Blood sugar, blood pressure and cholesterol are among the biomarkers that tend to improve during GLP-1 treatment. Dumont said those gains can reverse after treatment ends unless patients counter the change through their diet.

Improvements in fatty liver disease may also fade after discontinuation. According to Dumont, patients who return to their previous eating habits can see those indicators worsen after the medication is removed.

Body composition presents another risk because GLP-1 related weight loss can include both fat and lean muscle mass. In a body composition study involving tirzepatide, about 25% of the weight lost was lean mass, including muscle and other nonfat tissue, while 75% was fat.

Dumont expressed concern that people who regain weight may not fully recover the muscle they lost. Repeatedly starting and stopping treatment could lead patients to lose fat and muscle, regain fat, and then lose fat and muscle again during another treatment period.

Preserving muscle remains important for metabolism, injury prevention and routine activities. At the same time, discontinuation can weigh heavily on mental health, leaving some patients feeling disheartened and without the control they believed treatment had provided.

Cardiovascular protection may also diminish. An observational study in BMJ Medicine found that adults with type 2 diabetes who stopped GLP-1 treatment faced a higher risk of major cardiovascular events than those who continued, with longer treatment gaps linked to greater risk.

Dumont said improved cholesterol, blood sugar and inflammation during treatment can help lower the risk of heart attacks and strokes. If those markers worsen after discontinuation, the consequences can affect quality of life and potentially shorten it.

Lasting lifestyle changes may help some patients preserve progress after reaching their metabolic goals. A Virta affiliated observational study examined selected type 2 diabetes patients in a structured nutrition program, but its findings may not apply to every GLP-1 user.

“The GLP-1 is not the only solution,” Dumont said. “It needs to be coupled with ... a way of eating that's going to work for you for the long term that allows you to stop the medicine successfully if you need to.”