Off-ramp planner

Life after a GLP-1 — planned, not guessed

The decision almost no one prepares you for: continue, step down, or stop. This won’t tell you what to do — it shows the real evidence, the honest trade-offs, and the exact questions to take to your clinician. No doses, no advice about your situation.

Where are you?

What matters most? (pick any)

First, the reality: what happens if you stop

On treatment (avg loss) Stop, no plan — ~⅔ regained in a year Maintained habits (emerging — not guaranteed)

Average % body-weight change. The post-stop regain line reflects the STEP 1 trial extension, where people regained about two-thirds of their lost weight within a year of stopping. The “maintained habits” path is emerging — protein and resistance training appear to help, but no trial guarantees the result. Individuals vary widely; not a prediction. Sources:STEP 1 extension (DOM 2022),keeping weight off.

Your three paths

Continue

Established that it holds loss

In randomized withdrawal trials (STEP 4, SURMOUNT-4) people who kept taking the medicine held their loss; it’s the most reliable way to maintain. Trade-off: ongoing cost, ongoing side-effect management, and it treats obesity as the chronic condition it is.

Step down

Limited evidence on how

Some people and clinicians try a lower maintenance approach. The honest state of evidence: trials studied *continuing* vs *stopping*, not an optimal taper — so “how to step down” is a clinician decision, not a settled protocol. This page gives no doses.

Stop

Regain is the documented default

Stopping is followed, on average, by substantial regain (~two-thirds within a year) as appetite returns — because the drug was managing the biology, not curing it. Not a failure; expected physiology. If you stop, a maintenance plan is what changes the trajectory.

The levers that actually move the trajectory

supported-but-limitedAdequate protein
Higher protein during and after weight loss helps preserve lean (muscle) mass versus lower intake. Targets are individual — frame them with a clinician or dietitian.
emergingResistance training
Building and keeping muscle was the habit that best survived treatment cessation in the maintenance trial. Even a “minimum effective” strength habit matters.
emergingMaintained activity
People who kept moving after stopping held their loss better than those who relied on the medicine alone. Activity has to be deliberate — the weight loss doesn’t create it.
supported-but-limitedA planned transition (not cold-turkey)
Stopping with a plan — habits in place first, clinician aligned — beats stopping abruptly and hoping. For people with diabetes, an unplanned gap is itself a risk to discuss first.
established (process)Coverage & cost options
If cost is the driver, a covered indication, the 2026 Medicare Bridge, or a manufacturer program may change the math before you stop. See the Coverage Checker.
establishedMonitoring what matters
Track function and the markers your clinician cares about (not just the scale) through any change, so you catch drift early.

Questions to take to your clinician

Given my situation, what are my real options — continue, step down, or stop — and the trade-offs of each for me?
If we change anything, what should I watch for, and how do we prevent or catch regain early?
How do we protect my muscle and function through this — protein, training, monitoring?
If cost is the issue, what covered options or assistance programs apply before I stop?
I have other conditions (e.g. diabetes) — is an interruption itself a risk, and how do we manage it?
What would make us reconsider — restart, or change course — and how soon would we know?