Ask the Expert: The Weight Maintenance Edition

So, you’re using GLP-1 medications and you’ve hit your weight loss goal. It should be a time to celebrate your success (and it is!).

But many patients also get anxious about what will happen next: how can I maintain my weight? Do I have to keep taking the medication forever? Will I gain all the weight back if I stop?

To put your mind at ease as you reach the maintenance phase of your journey, Simple Online Pharmacy’s Chief Clinical Officer Abdal Alvi sat down with Superintendent Pharmacist Aamina Rafiq. In this episode of Ask the Expert: The Weight Maintenance Edition, they answer 16 of your most frequently asked questions about weight maintenance on GLP-1s.

Do You Have to Stay on GLP-1s Forever?

There’s no simple yes or no answer to this question. It really depends on your individual circumstances.

If you’ve got your treatment from a private provider, there’s no limit to how long you can take it for. So, in theory, you can take it forever.

However, we do encourage users to incorporate healthy habits (a balanced diet and regular physical activity) into their lifestyle. We do this so it’s easier for patients to maintain their target weight, without relying solely on the medication.

That being said, some patients may have to use the treatment long-term. Obesity is increasingly being seen as a chronic condition. So they’d use the medication in a similar way to medication for managing other chronic conditions. It’s a bit like using medication for type 2 diabetes or blood pressure.

If you’re an NHS patient, there is a cut-off. The National Institute for Health and Care Excellence (NICE), which provides the NHS with treatment guidance, states that you can take Wegovy and Mounjaro for a maximum of two years.

Can You Stop GLP-1s and Maintain Weight?

Yes, you can. Many of our patients have kept the weight off since they’ve stopped treatment. They have achieved this by changing their lifestyle in three main areas: nutrition, movement and mindset.

Doing the following can help you maintain a healthy weight for years after stopping GLP-1s:

• Add movement into your day, including resistance training.
• Eat a nutrient-dense diet, with enough fibre and protein.
• Develop a healthy attitude to your body and weight – focusing more on how you feel than fixating on a number on the scale.

Gradually reducing your dose – rather than stopping cold turkey – will also help you adjust to life without the treatment. This can reduce the risk of regaining weight.

What Happens When You Stop Weight Loss Injections?

When you take your last dose of your GLP-1 treatment, the medication will not stop working overnight. There will still be medication in your system, which will affect your gut and brain.

Instead, hunger and food noise will gradually return as the level of medication in your system decreases.

This part of the journey is not always easy to navigate. And many patients worry about undoing all their progress. But it’s normal for your appetite to increase. If the scales are going up, it might not necessarily be from fat. Instead, it could just be your body holding onto water (often called ‘water weight’).

Keep focusing on eating balanced meals throughout the day, drinking enough water and sticking to those exercise routines.

Why Do People Regain Weight After Stopping GLP-1s?

The first thing you need to know is: it’s not your fault if you regain weight after stopping treatment. It’s actually down to your biology.

Firstly, when you lose weight, your body actually increases your hunger signals to regain that lost energy.

Secondly, GLP-1s also work by mimicking hormones in the body that reduce craving and suppress appetite. So, when you stop treatment, you’ll experience those cravings and hear those hunger signals again.

And finally, when you lose weight, your body needs less energy than before. If you’re still eating the same foods (and the same amount) as when you weighed more, your weight might gradually creep up.

That’s why the weight maintenance phase of your journey is just as important as the weight loss phase. So you can build up habits and routines that can help you maintain weight after treatment.

How Long Should You Use GLP-1s?

There is no set length for how long you should use GLP-1 treatment. Each patient’s journey will look a bit different.

Our clinical team will keep checking in with you to see how you’re doing. They’ll ask about how you’re managing side effects and your levels of appetite suppression and weight loss. That information will help determine your dosing schedule and treatment timeline.

Can GLP-1 Be Used Long Term?

Yes, you can use GLP-1s long-term. No evidence exists that suggests it’s unsafe to use them for long periods of time.

If you’re a Wegovy user, you might find this interesting too: a recent trial, called the SELECT trial, found a 20% reduction in major heart events (e.g. stroke, heart attack) for patients living with obesity or who were overweight and who have already had one. And they experienced these heart benefits at the beginning of the trial – before losing large amounts of weight.

This suggests treatments like Wegovy are good for things like heart health and managing heart disease. Not just weight loss and maintenance.

What Are the Long-Term Side Effects of GLP-1 Injections?

If you’ve been on Wegovy or Mounjaro for a while, you’ll probably be familiar with the common side effects (e.g. nausea, constipation and diarrhoea). But what about longer term effects?

Long-term users should be alert to symptoms of pancreatitis. While uncommon, it is very serious. Stop the medication and seek urgent medical attention if you experience severe, persistent stomach pain that radiates to the back. You might also experience vomiting.

What is the Standard Maintenance Procedure?

There isn’t a standard procedure for maintenance dosage. Again, it depends on your own individual treatment journey.

That being said, we try to get patients to maintain on the lowest effective dose. This keeps your weight stable, so you’re not losing too much, and your appetite controlled. It should also help minimise any side effects. If your hunger returns to unmanageable levels and your weight rises, we might look at increasing your dose.

But, you might find your weight has stabilised on a higher dose. In this case, we might recommend you remain on that dose.

When Should I Move to a Maintenance Dose?

You should move to a maintenance dose when you feel stable. Stability is when you’ve reached a weight you’re happy to maintain and your diet and exercise routines feel sustainable.

The decision won’t be based just on the number on the scale or a certain body mass index (BMI). It’s much more individual than that. And we’ll provide support to help you reach this decision.

Can I Reduce My Dose After Reaching My Target Weight?

Yes, reducing your dose can be sensible when you’ve hit your target weight. We recommend patients maintain their weight using the lowest effective dose.

However, it’s important to remember that GLP-1 medications treat a chronic condition. When you reduce or stop the treatment, you can regain weight (that’s not your fault – it’s biology). So, long-term maintenance may mean continuing on a higher dose.

If you do reduce your dose, a clinician should check with you to see how you’re doing. You should do this gradually over the course of weeks or months.

What is Microdosing GLP-1 for Maintenance?

The term ‘microdosing’ refers to the act of taking smaller, non-standard doses of medication. In the case of GLP-1s, it means stretching pens out longer than intended. People might microdose treatment to save costs or to reduce side effects.

Whatever the reason, microdosing is not safe and we do not recommend it. Smaller, non-standard doses haven’t been tested, so we don’t know if it’s safe.

And when people microdose the treatment (this could be by “counting clicks”), they don’t know the exact dose they’re taking.

Also, for Mounjaro, you can only use the pen for up to 30 days after first using it. (For Wegovy you can keep it for up to six weeks). By extending out how long you use the pen for, the medication might have degraded, which can make it unsafe to use.

Is Medical Supervision Needed for Maintenance?

You don’t need medical supervision for maintenance. However, we recommend you do it with support from a clinician.

Maintenance can be a tricky part of your journey; your body might start to “push back”. That’s why patients are more likely to regain weight during this phase, according to clinical studies.

Our clinical team can help you in this phase to maintain your success. We won’t be constantly monitoring you. But we can adjust your dosage and provide lifestyle advice where you might need it.

Maintenance is just one phase of your treatment journey. We won’t cut off support just because you’ve hit a number on the scale.

Why Have I Stopped Losing Weight on GLP-1s?

Weight loss plateaus can be frustrating. You’ve been losing weight every week and then it just, well, stops.

Plateaus are actually a normal part of the weight loss journey. It doesn’t mean the treatment is not working. So why do they happen? Usually, it’s because your body has adapted to new routines.

To overcome a plateau, it can help to ask the following questions:

• Am I taking the dose correctly, storing it properly, and using it consistently? 
• What’s my behaviour like? Have I been grazing, walking less or eating less protein?

You might want to change up your diet or exercise routine. You can also let us know if you’ve stopped losing weight. It might be time to adjust your dose.

Whatever you do, we’d advise you not to chase rapid weight loss forever. It won’t lead to sustainable, long-term weight management.

Do GLP-1s Work Without Changing Your Diet?

Yes, you can lose weight on a GLP-1 without changing your diet. The treatment works by reducing your appetite so you eat less food. Even if you only eat crisps, pizza and cakes, eating a lower calorie diet will likely result in weight loss.

There’s a big but.

If you don’t change your diet and eating habits you’ll increase your chances of regaining weight after you stop using the medication. The patients who successfully keep their weight off are those who have used the treatments as tools to introduce new, healthy habits.

And if your diet is poor, you won’t get the nutrients you need from your food intake. This can lead to fatigue, muscle loss, and constipation, making long-term maintenance much, much harder.

What Happens If You Don’t Exercise on GLP-1s?

When you lose weight, it’s normal to lose a bit of muscle – not just fat.

If you don’t do any exercise at all during your treatment journey, you risk losing more muscle than you should for good health. Muscle doesn’t just have aesthetic value – it supports metabolic health, mobility and long-term maintenance.

It doesn’t mean you have to start a five-day-a-week lifting programme. But adding in some progressive resistance training can support your health. You could try a home workout or use resistance bands. You could also try the machines at the gym (a member of staff should be able to show you how to use them).

If you struggle with resistance training, going for regular walks is a great starting point.

What Are the Alternatives to GLP-1 for Weight Loss?

GLP-1 treatments are a common fixture on the news, because they’re a new, incredibly effective treatment. However, using GLP-1s isn’t the only way to manage your weight. 

If you’re wanting to stick to medicated treatment, you could try an oral weight loss pill called orlistat. It works differently to Wegovy and Mounjaro. You take it three times a day with meals and it binds with the fat you eat to reduce your calorie intake from this fat.

You could also try weight management services on the NHS. These programmes often provide structured approaches to diet and exercise. However, waiting lists can be long.

For patients with severe obesity, bariatric surgery can be an effective long-term solution.

Key Takeaways

• There’s no one-size-fits-all answer to staying on GLP-1s. Some people continue long-term, while others reduce or stop, depending on their goals, medical history, and support needs.
• You can stop GLP-1s and maintain your weight loss, but habits matter most. The strongest foundations are nutrition, regular movement (especially resistance training) and a healthy mindset around weight.
• If you stop, appetite can return gradually, and early weight changes aren’t always fat. Hunger and “food noise” may increase as medication levels drop. And the scales can rise from water weight as well as fat.
• Regain isn’t a personal failure, it’s biology. After weight loss, the body pushes hunger up and needs fewer calories than before. This is why maintenance routines are just as important as the weight-loss phase.
• Maintenance should be supported, safe and suitable for you. Aim for the lowest effective dose where possible, taper rather than stopping suddenly, avoid microdosing. Seek urgent help for warning signs like severe, persistent stomach pain (possible pancreatitis).

References

Australian Prescriber, 2025. Semaglutide for cardiovascular risk reduction in people who are overweight or have obesity without diabetes (new indication). Australian Prescriber, 48(3), pp.107–108. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12187477/.

European Medicines Agency, 2025. Wegovy (semaglutide) EPAR product information [PDF online]. Available from: https://www.ema.europa.eu/en/documents/product-information/wegovy-epar-product-information_en.pdf.

National Institute for Health and Care Excellence (NICE), 2025. Medicines and surgery. In: Obesity: identification, assessment and management (NG246) [Online]. Available from: https://www.nice.org.uk/guidance/ng246/chapter/Medicines-and-surgery.

National Institute for Health and Care Excellence (NICE), 2025. Prescribing orlistat, liraglutide and semaglutide. In: A practical guide to using medicines to manage overweight and obesity (NG246 resources) [Online]. Available from: https://www.nice.org.uk/guidance/ng246/resources/a-practical-guide-to-using-medicines-to-manage-overweight-and-obesity-15299628589/chapter/Prescribing-orlistat-liraglutide-and-semaglutide.

National Institute for Health and Care Excellence (NICE), 2024. Semaglutide for managing overweight and obesity (TA1026), Recommendations, NICE guidance [Online]. Available from: https://www.nice.org.uk/guidance/ta1026/chapter/1-Recommendations.

National Institute for Health and Care Excellence (NICE), 2023. Semaglutide for managing overweight and obesity: Technology appraisal guidance (TA875) [PDF online]. Available from: https://www.nice.org.uk/guidance/ta875/resources/semaglutide-for-managing-overweight-and-obesity-pdf-82613674831813.

NHS, 2025. Obesity – treatment [Online]. Available from: https://www.nhs.uk/conditions/obesity/treatment/.

Rubino, D., Abrahamsson, N., Davies, M., Hesse, D., Greenway, F.L., Jensen, C., Lingvay, I., Mosenzon, O., Rosenstock, J., Rubio, M.A., Rudofsky, G., Tadayon, S., Wadden, T.A. and Dicker, D., for the STEP 4 Investigators, 2021. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: The STEP 4 randomized clinical trial. JAMA, 325(14), pp.1414–1425. Available from:https://jamanetwork.com/journals/jama/fullarticle/2777886.

Wilding, J.P.H., Batterham, R.L., Davies, M., Van Gaal, L.F., Kandler, K., Konakli, K., Lingvay, I., McGowan, B.M., Kalayci Oral, T., Rosenstock, J., Wadden, T.A., Wharton, S., Yokote, K. and Kushner, R.F., for the STEP 1 Study Group, 2022. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 24(8), pp.1553–1564. https://doi.org/10.1111/dom.14725.

Authorship