Review of obesity drugs including semaglutide finds regain of about 0.4 kg a month after stopping

A systematic review and meta-analysis published by BMJ estimates that adults with overweight or obesity regain weight at about 0.4 kg (roughly 0.9 pounds) per month after they stop taking a weight-management medication, and that improvements in cardiometabolic markers are projected to return to pretreatment levels within about 1.4 years ^[1].

The review pooled 37 studies, 63 intervention arms and 9,341 participants. Databases and trial registries were searched from inception through February 2025 for randomized controlled trials, non-randomized trials and observational studies in which adults with overweight or obesity took a weight-management medication for at least eight weeks and were followed for at least four weeks after stopping. Average treatment duration was 39 weeks (range 11 to 176 weeks), and average follow-up after stopping was 32 weeks (range 4 to 104 weeks) ^[1].

The pooled monthly rate of weight regain was 0.4 kg (95% confidence interval 0.3 to 0.5). In randomized controlled trials, which compared a medication with a control group, the mixed-model estimate was 0.3 kg (0.2 to 0.4) per month. The authors report that the estimates and their precision were robust in sensitivity analyses ^[1].

Regain was faster after a weight-management medication than after a behavioral weight-management program — by 0.3 kg (0.22 to 0.34) per month — and that difference was independent of how much weight someone had lost during treatment ^[1].

The analysis covers weight-management medications as a group, including newer incretin mimetics such as semaglutide and tirzepatide. Figures in the paper note that follow-up data for the newer, more effective incretin mimetics did not go beyond 52 weeks, so the projected time for weight to return to baseline in that group comes from an extended model prediction rather than observed data. Regain rates for individual drugs were not reported separately ^[1].

The authors write that the results "suggest caution in short term use of these drugs without a more comprehensive approach to weight management" ^[1].

The review was funded in part by the National Institute for Health and Care Research Oxford Biomedical Research Centre. Several authors report roles in publicly funded trials for which weight-loss interventions were donated to the University of Oxford by Nestle Health Science, Oviva or Second Nature, and some authors receive or are partly funded by a grant from the Novo Nordisk Foundation. The authors state these relationships did not lead to payments to them and report no other conflicts of interest ^[1].

Why it matters for patients

Weight regain after stopping is one of the most common questions for people taking GLP-1 medications such as Ozempic or Wegovy (semaglutide) and Mounjaro or Zepbound (tirzepatide). This review puts an average figure on what happens across weight-management drugs generally: about 0.4 kg, or roughly 0.9 pounds, coming back each month after treatment ends ^[1].

That is an average across dozens of studies and several different drugs, not a prediction for any one person. The review does not report who regained more or less, how much the drug itself mattered compared with other factors, or whether the pattern differs by medication. Those details have not been reported ^[1].

The projection that cardiometabolic markers return to baseline within about 1.4 years is also a group-level estimate. It rests on modeling, and for the newest incretin mimetics it extends past the 52 weeks of data the authors had ^[1].

The review does not address how to stop a medication, whether tapering changes anything, what happens if someone restarts, or how to maintain weight loss after stopping. Those questions are not answered in this analysis ^[1].