GLP-1 medications are highly effective, but they're not necessarily lifelong commitments for everyone. Understanding when and how to pause or stop—and what happens when you do—helps you make informed decisions about your treatment.
Medical Reasons to Stop Immediately
Certain symptoms require stopping the medication and contacting your provider:
Stop and seek care for:
- Severe abdominal pain that doesn't resolve: Could indicate pancreatitis
- Persistent vomiting preventing any fluid intake: Risk of dehydration and electrolyte imbalance
- Symptoms of allergic reaction: Rash, difficulty breathing, swelling of face/throat
- Signs of gallbladder problems: Upper right abdominal pain, especially after eating fatty foods
- Vision changes: Particularly if you have diabetic retinopathy (rare complication)
Contact your provider but don't necessarily stop for:
- Persistent nausea beyond 4-6 weeks at a dose
- Constipation not responding to standard interventions
- Side effects significantly impacting quality of life
- Concerns about any symptoms
Planned Pauses: Surgery and Procedures
GLP-1s affect gastric emptying, which has implications for anesthesia:
ASA guidelines recommend:
- Hold daily GLP-1s (liraglutide) the day of procedure
- Hold weekly GLP-1s (semaglutide, tirzepatide) for 1 week before procedures requiring anesthesia
- Extended fasting periods may be recommended (discuss with anesthesiologist)
Why it matters: Delayed gastric emptying increases aspiration risk during anesthesia. Undigested food in the stomach can enter the lungs during intubation—a serious complication.
Types of procedures requiring holds:
- Any surgery requiring general anesthesia
- Endoscopy/colonoscopy
- Procedures requiring sedation
Always inform your surgical team and anesthesiologist that you're on a GLP-1 medication.
Reaching Goal Weight: Now What?
You've hit your target. Do you stay on the medication?
The evidence on discontinuation:
- Studies show most patients regain significant weight within 1 year of stopping
- The STEP 4 trial showed ~2/3 of weight lost was regained after 1 year off medication
- Hunger signals return, "food noise" returns, metabolic adaptations persist
Options at goal weight:
- Continue at maintenance dose: Many patients stay on a lower maintenance dose indefinitely—similar to how blood pressure medications are used long-term for a chronic condition.
- Attempt discontinuation with close monitoring: Stop the medication while tracking weight weekly. Be prepared to restart if regain exceeds a threshold (e.g., 5-10% regain).
- Transition to less potent option: Some patients maintain on lower-efficacy medications (oral semaglutide, liraglutide) after achieving goals with injectables.
The maintenance mindset: Obesity is increasingly understood as a chronic condition, not a temporary state that "treatment" resolves. Just as you wouldn't stop blood pressure medication because your BP normalized, stopping GLP-1s because you've reached goal weight may be medically counterproductive.
Financial or Access Disruptions
Reality: not everyone can maintain continuous access. Job changes, insurance changes, supply issues, or cost barriers may force interruptions.
If you must stop due to access:
- Don't just disappear—inform your provider
- Discuss whether a lower-cost alternative exists
- Understand that some weight regain is likely
- Focus on the lifestyle factors within your control during the gap
- Plan for re-initiation when access returns
If resuming after a gap:
- You may need to restart titration from the beginning
- Your tolerance will have reset
- Side effects may return as if starting fresh
What Happens When You Stop
Immediate effects (first 1-2 weeks):
- Appetite returns—often dramatically
- "Food noise" comes back
- Portion sizes naturally increase
- Cravings that were suppressed return
Medium-term (1-6 months):
- Weight regain typically begins within weeks
- Rate of regain varies by individual and lifestyle factors
- Metabolic adaptations from weight loss (reduced metabolic rate) persist, making regain easier
What you keep:
- Habits formed during treatment (if you built them)
- Knowledge about your hunger patterns and triggers
- Any permanent health improvements that don't depend on weight (e.g., resolved sleep apnea from structural changes)
The Decision Framework
Continue treatment if:
- You can afford and access the medication
- Side effects are manageable
- You're seeing ongoing health benefits
- Historical attempts to maintain weight loss without medication have failed
Consider stopping if:
- Intolerable side effects that don't resolve
- Medical contraindications develop
- You've achieved goals and want to test maintenance without medication
- Access barriers make continuation impossible
Always do before stopping:
- Discuss with your provider
- Have a monitoring plan (weekly weigh-ins)
- Define your "restart trigger" (e.g., if I regain 10 lbs, I restart)
- Reinforce lifestyle factors that support weight maintenance
Stopping is always an option. Just make it a deliberate, informed choice rather than a drift.