Stopping a GLP-1 medicine: what to expect and how to plan

Reasons range from practical to medical. Some people cannot tolerate the medicine. Others are planning pregnancy, which requires stopping before conception. Some experience supply interruptions or find the cost unsustainable. A prescriber may also recommend stopping if there has been inadequate response after a fair trial, or if a complication occurs.

Stopping is a legitimate decision whatever the reason. The aim of a plan is to avoid sliding back by default.

Trials in which people stopped the medicine after months of treatment reported that a considerable part of the weight lost was regained over the following year, and that improvements in blood pressure, blood sugar and cholesterol also drifted back. This is consistent with obesity being a long-term condition with strong biological drivers of weight regain. It is not a failure of willpower.

The research cannot predict what will happen for any one person, because responses vary. Some people maintain much of their loss, particularly if they have changed eating, activity and sleep habits.

• Agree the timing, ideally not alongside other big changes such as a new job or bereavement.

• Ask whether stepping down is appropriate rather than stopping abruptly.

• Set up a dietitian or behavioural review, and weigh yourself regularly to catch drift early.

• Keep strength training and daily activity going.

• Decide in advance at what point you would want to talk again about options, including re-starting or alternatives.

These medicines are not recommended in pregnancy, and product information advises stopping them before trying to conceive; the exact interval depends on the product, so ask your prescriber. Discuss how to manage weight and blood sugar in the meantime, and tell your midwife or GP which medicine you have taken. Do not wait until a pregnancy test is positive to raise it.

Supply problems have affected some products. If you miss several doses you may need to restart at a lower dose to limit side effects; do not guess the dose. Contact your prescriber for advice and avoid obtaining pens from unregulated sources, which carry real risks, including counterfeit products.

Expect appetite to return gradually. Regular meals with adequate protein and fibre, planned snacks, sleep, and avoiding long gaps without food tend to help. If you find yourself preoccupied with food, binge eating or distressed about regain, tell your clinician; support with eating behaviour exists on the NHS and privately.