Ideas for sustaining weight reduction with GLP-1-based weight problems medicine

Key takeaways:

• Lifestyle intervention is a key a part of weight problems administration and needs to be individualized for every affected person.
• Transitional pharmacotherapy is an choice for sufferers required to discontinue incretin-based medicine.

Lifestyle intervention stays a core element of weight problems administration, alongside the emergence of stronger pharmacotherapy.

The FDA approval of weight problems medicine together with semaglutide (Wegovy/Wegovy tablet, Novo Nordisk), tirzepatide (Zepbound, Eli Lilly) and orforglipron (Foundayo, Eli Lilly) led to a surge of their use. However, well being care professionals proceed to emphasise the significance of different features of weight problems remedy, like life-style intervention.

“The biggest mistake we can make right now in obesity medicine is thinking that prescribing a GLP-1 is the entire treatment plan,” Katherine H. Saunders, MD, FTOS, DABOM, cofounder of FlyteHealth and weight problems drugs doctor at Weill Cornell Medicine, informed Healio | Endocrine Today. “Effective cardio-kidney-metabolic care requires a chronic disease approach — medication, evidence-based lifestyle intervention and ongoing clinical support.”

Renee J. Rogers, PhD, FACSM, FTOS, senior scientist at University of Kansas Medical Center, mentioned the arrival of weight problems medicine that confer much more weight reduction has ushered in a “super exciting time” for weight problems clinicians.

The newer medicine mixed with life-style intervention present well being care professionals with instruments they’ve by no means had earlier than, Rogers mentioned.

“Physical activity gives a great opportunity for patients taking pharmacotherapy to feel better each and every day,” Rogers mentioned. “Behavioral interventions or lifestyle interventions are important regardless of the treatment pathway that a patient goes down. The lifestyle or the behavioral intervention should be adapted around the person to support the medical management of obesity, to support helping to change the biology.”

Fatima Cody Stanford, MD, MPH, MPA, MBA, MACP, FAAP, FAHA, FAMWA, FTOS, weight problems drugs physician-scientist at Massachusetts General Hospital, affiliate professor of drugs and pediatrics at Harvard Medical School and a Healio | Endocrine Today Editorial Board Member, emphasised the significance of the connection between clinicians and sufferers in weight problems care. Stanford mentioned there’s a behavioral and psychiatric element to life-style intervention that’s simply as vital as bodily exercise and vitamin.

“Most of my patients have been with me for a decade or longer, so building up that relationship is important for me,” Stanford informed Healio | Endocrine Today. “It’s about building their self-confidence and helping them to understand that this is not a one-off visit. I’m there for the long term.”

Obesity is a continual illness and long-term complete remedy is critical, in keeping with Healio | Endocrine Today Editorial Board Member Jamy Ard, MD, FTOS, chief science officer of Advocate Health and professor within the division of public well being sciences at Wake Forest University School of Medicine. Ard mentioned it is not uncommon for sufferers to not solely discontinue pharmacotherapy for weight problems, but in addition to cease seeing an weight problems drugs specialist recurrently after they’ve achieved weight reduction.

“We tell patients all the time: The hard work is just beginning once you’ve met your weight goal, because maintenance goes on indefinitely,” Ard informed Healio | Endocrine Today. “[Maintenance] is a reaction to changes over time with aging, your environment, life stressors, new medications [and] other health challenges. The type of treatment, the phase of treatment and intensity may change over time, but there’s still a need for treatment.”

In some instances, sufferers could also be unable to proceed utilizing an weight problems drug on account of entry or value considerations. Sangeeta Kashyap, MD, assistant chief of scientific affairs within the division of endocrinology, diabetes and metabolism at NewYork-Presbyterian/Weill Cornell Medical Center and a Healio | Endocrine Today Coeditor, mentioned well being care professionals ought to keep in mind that there are different choices for sufferers.

“We don’t stop GLP-1s cold turkey,” Kashyap informed Healio | Endocrine Today. “We try to use some sort of transition pharmacotherapy, and we get them back into intensive lifestyle and behavioral support, resistance training to preserve lean mass, frequent follow-up and structured nutrition programs.”

The affect of stopping an weight problems drug

It is widespread for adults utilizing an incretin-based remedy to discontinue remedy after a brief time frame. An evaluation of Truveta knowledge revealed in JAMA Network Open in 2025 discovered that 53% of adults who used a GLP-1 discontinued remedy inside 1 12 months of beginning the drug, and 72% discontinued their remedy inside 2 years.

Stanford mentioned the first causes for discontinuing weight problems medicines are excessive out-of-pocket prices, lack of insurance coverage protection and entry points, and antagonistic occasions, for some sufferers. However, another excuse sufferers could discontinue a drug is as a result of they don’t totally perceive the necessity for long-term remedy.

“A lot of people think, maybe if I just come off [medication], I’ll be fine; I can just use lifestyle intervention to maintain this [weight loss],” Stanford mentioned.

Ard mentioned practically three-quarters of sufferers with weight problems surveyed in his well being system mentioned they didn’t count on to be on weight problems remedy long run.

“Clinically, we’ve always seen this in the space of obesity treatment, whether you talk about lifestyle-only intervention or pharmacotherapy,” Ard mentioned. “Surgery is the one [treatment] that doesn’t have this issue just because it’s a fixed intervention. But when you look at how engaged people [with obesity] are in ongoing treatment, the number of people who come back for annual follow-up in their surgery program drops off dramatically after year 2.”

Discontinuing weight problems pharmacotherapy can reverse the advantages individuals skilled throughout remedy. A scientific assessment and meta-analysis revealed in eClinicalMedicine in 2026 estimated that sufferers who discontinued GLP-1 remedy regained about 60% of the burden they’d misplaced 1 12 months after discontinuation. The estimated most weight regain after discontinuation plateaued at 75%.

Another systematic assessment and meta-analysis revealed in eClinicalMedicine in 2025 confirmed discontinuing GLP-1 remedy additionally ends in worsening of waist circumference, HbA1c, fasting plasma glucose and systolic blood strain.

Kashyap mentioned it is not uncommon for sufferers to aim to restart an weight problems drug after discontinuing remedy for a interval. Even in these sufferers, nevertheless, there could also be destructive results. Kashyap mentioned.

“Restarting medication will have a blunted weight-loss response,” Kashyap mentioned. “What we typically notice is when there’s a break in therapy and you’re restarted, you don’t have the same success as you did the first time, and often you get restarted at the lower dose. It is a little bit of a yo-yo [effect]. That’s why the lifestyle piece becomes important.”

Keys to life-style intervention

Ard mentioned life-style intervention stays an integral part of weight problems administration, particularly because the weight problems trials carried out for medicine reminiscent of semaglutide and tirzepatide had the medicines administered together with life-style intervention.

“Lifestyle intervention helps to optimize the treatment response because it gives you a basis for ensuring that there’s quality food intake and that you have appropriate physical activity to help protect lean mass,” Ard mentioned. “Those things help to reduce adverse events and the severity of those adverse events.”

Rogers mentioned life-style interventions, significantly bodily exercise, have to be tailor-made in particular methods, noting that when discussing a bodily exercise plan with sufferers, train professionals ought to handle 5 key features: frequency, depth, length, kind and delight.

“Step one is we need to help folks develop a healthy relationship with physical activity,” Rogers mentioned. “For clinicians, we sometimes get into the conversation of how much physical activity you need to do and the fact that you need to be doing it, rather than stepping back and saying [to the patient] ‘Is there a particular reason why you don’t have a relationship with activity? Can we talk about that?’ A lot of times, for patients living with obesity, it could be pain-related, it could be functional physical limitations. I think that’s why this time of pharmacotherapy and metabolic bariatric surgery is a great opportunity to help patients when they have some of those reasons for not exercising.”

Kashyap mentioned bodily exercise suggestions for sufferers could also be so simple as encouraging them to stroll 10,000 steps per day, particularly if they’re reticent to check out different types of train.

“If they are already [walking 10,000 steps], then I will incorporate strength training,” Kashyap mentioned. “I talk about high-intensity interval training that leads to visceral fat loss.”

For vitamin, Stanford mentioned she counsels sufferers taking incretin-based medicine to concentrate on protein, fiber and carbohydrate consumption.

Lifestyle intervention goes past bodily exercise and vitamin. Saunders mentioned sufferers are inspired to regulate their behaviors and their dwelling atmosphere.

“Nutrition, physical activity, sleep and behavioral strategies support cardio-kidney-metabolic health and improve the sustainability of weight loss,” Saunders mentioned.

Moving ahead after drug discontinuation

If a affected person should discontinue an incretin-based drug, well being care professionals could prescribe transitional pharmacotherapy, Kashyap mentioned. These transition medicines embrace older weight problems medicine reminiscent of phentermine/topiramate and naltrexone/bupropion (Contrave, Currax Pharmaceuticals), or one other drug that may induce weight reduction reminiscent of metformin.

“The other option is to consider [bariatric surgery], which is a one-and-done procedure where you can get the benefits long term,” Kashyap mentioned.

Stanford mentioned well being care professionals ought to contemplate older weight problems medicines for weight-loss upkeep, significantly for sufferers who’re pressured to discontinue remedy on account of value or entry.

“I have patients who never needed GLP-1s because they were high responders to some of those traditional medications,” Stanford mentioned. “That’s the strategy that I have to employ for those patients who can no longer afford out-of-pocket costs associated with GLP-1s.”

Even with transitional pharmacotherapy, discontinuing an incretin-based remedy requires changes to life-style intervention, in keeping with Rogers.

“We have to turn our efforts to shifting the intervention to what would look more like a behavioral lifestyle intervention by itself,” Rogers mentioned. “What becomes critically important in this is we know the appetite is coming back quickly. … Biological changes are going to happen. Just exercising more won’t help with the biological piece of the hunger relationship. We may have to go back to that prescription where we are increasing the minutes of physical activity. We are having to think about it more for energy expenditure in that moment, because we do not have the pharmacotherapy.”

Even with these choices, it isn’t identified whether or not transitioning to different pharmacotherapy or life-style intervention mitigates weight achieve amongst sufferers who discontinue incretin-based medicines, Ard mentioned.

Saunders mentioned it’s essential to proceed life-style intervention and different features of medical administration following drug discontinuation, however it’s extremely tough for sufferers to keep away from weight regain with out pharmaco­remedy.

“It’s important to be honest with patients,” Saunders mentioned. “Because obesity is a chronic disease with strong biological drivers, maintaining weight loss and health outcomes without ongoing medical treatment is extremely challenging for most people.”

The way forward for weight problems administration and life-style intervention

With a number of incretin-based weight problems medicine now accepted by the FDA and extra within the pipeline, some well being care professionals concern that different professionals are forgetting life-style intervention. Ard mentioned a part of this is because of an absence of assets and coaching on weight problems administration.

“Some of it is a function of how we are providing care for obesity in some of the spaces where we either don’t have the resources, the training or the time dedicated to be able to provide more consistent, wraparound care,” Ard mentioned. “The concern that a lot of us have is that the quality of care is not as consistent.”

While life-style intervention alone could yield solely a modest quantity of weight reduction, dwelling a wholesome life-style supplies further advantages, Stanford mentioned. A research revealed in The Lancet Diabetes & Endocrinology in February discovered that adults with kind 2 diabetes who reported adhering to extra wholesome life-style habits had decrease threat for main antagonistic cardiovascular occasions, no matter whether or not they had been utilizing a GLP-1.

Rogers mentioned she believes that incretin-based medicines ought to lead well being care professionals to, relatively than forged apart life-style intervention, turn out to be extra concerned with life-style change and tips on how to speak to their sufferers about adjusting their habits.

“When I talk to clinicians about [physical activity] and educate on this, I often hear them say, ‘This is hard because I don’t have a lot of time and I have a lot of other things that I’m considering,’ or ‘I haven’t gotten a ton of training on how to do this,’” Rogers mentioned. “We’re seeing a nice push for more and more clinicians to be trained in how to talk about why physical activity is important.”

While a lot of the main focus could also be on the weight problems remedy pipeline and the way a lot weight reduction future medicine could induce, the dialog also needs to revolve round how therapies could be built-in into different key features of illness administration to optimize cardio-kidney-metabolic care, Saunders mentioned.

“The future of obesity medicine isn’t just about better medications — it’s about delivering comprehensive, long-term care that combines pharmacotherapy, lifestyle intervention and ongoing support,” Saunders mentioned.

• For extra info:
• Jamy Ard, MD, FTOS, could be reached at jamy.ard@wfusm.edu; LinkedIn @jamy_ard; X @drard.
• Sangeeta Kashyap, MD, could be reached at srk4008@med.cornell.edu.
• Renee J. Rogers, PhD, FACSM, FTOS, could be reached at rrogers10@kumc.edu; Instagram @reneejrogers_phd; LinkedIn @ReneeJRogersPhD.
• Katherine H. Saunders, MD, FTOS, DABOM, could be reached at endocrinology@healio.com or LinkedIn @katherinesaundersmd.
• Fatima Cody Stanford, MD, MPH, MPA, MBA, MACP, FAAP, FAHA, FAMWA, FTOS, could be reached at fstanford@mgh.harvard.edu; Instagram @askdrfatima; LinkedIn @askdrfatima.

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