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At this point, millions of people in the U.S. have tried at least one of a variety of glucagonlike peptide 1 (GLP-1) receptor agonist drugs such as Zepbound or Wegovy. For some, these medications have led to profound weight loss and often improvements in heart health. But many have ended up discontinuing the use of the drugs—despite the fact that they have been touted as lifelong treatments. That raises the question: What happens to people’s health after they stop taking these medications?

A new review study offers some clues to the answer. Research published on Wednesday in the BMJ found that people who stopped taking weight-loss drugs, including GLP-1 medications, are likely to see all the weight-loss and heart health benefits disappear in less than two years. The results also indicated that people who discontinue any kind of weight-loss medication regain the weight four times faster than those who stop dieting or working out to shed pounds.

“Weight regain after a period of weight loss is really common, no matter what approach you take,” says Sam West, lead author of the study and a research scientist at the University of Oxford, who specializes in integrated metabolism. “The fact that people regained weight after stopping medication wasn’t too surprising, but what was striking is just how fast it occurred.”

In addition to the newer GLP-1 drugs on the market, the study evaluated clinical trials on various weight-loss drugs, including older-generation GLP-1 medications and those outside of the class, such as orlistat and the combination of phentermine and topiramate. They compared the data on those treatments with a previous analysis on behavioral weight-loss interventions that included different dieting programs and exercise regimens.

People who took weight-loss drugs regained about a pound (0.4 kilogram) a month on average after they stopped treatment. All their cardiometabolic markers, including blood glucose levels, blood pressure, and cholesterol, also reversed.

Ultimately, people may see weight return to its pretreatment level within 1.7 years of stopping the drugs, and heart health markers return to their pretreatment state within 1.4 years, the study estimated. West says long-term data are needed to confirm these projections, however.

What these findings suggest is that, while weight-loss drugs lead to faster results than diet and exercise alone, quitting them also results in weight being regained much faster, regardless of how much was initially lost.

“If you look at the study’s charts, which I thought were striking, you see that you might regain more weight and end up worse off than you were before,” says Rozalina McCoy, an endocrinologist and internist at the University of Maryland School of Medicine, who was not involved in the study.

People who take a weight-loss medication lose fat, muscle, and bone mass—but they tend to mostly regain fat if they don’t regularly exercise, McCoy says. “Even if you end up at the same weight as you were before, metabolically, you are likely a lot less healthy,” she says.

One possible strategy would be for people to go straight into a behavioral program, such as a diet or exercise regimen, as they came off the drugs. But that approach would need to be trialed and tested, McCoy says.

West says more assessments of people’s weight and health reversals after they stop treatment, conducted outside of the clinical trials, would help researchers fully understand what’s happening.

But the study “is on par with what we see clinically” in many people who stop GLP-1 medications, says Chika Anekwe, an obesity medicine physician at Massachusetts General Hospital Weight Center, who was not involved in the research.

“It goes back to the effects that the GLP-1 medications have on appetite control. And once that’s gone, it’s really difficult to maintain any sort of behaviors that were helping you to keep the weight off,” she says.

Treating obesity is not just a matter of willpower for some people, Anekwe says, and the results underscore what happens when a helpful weight-loss intervention is interrupted.

“I think it’s a good reminder to insurance companies: when they change patients’ coverage abruptly or limit access to the medications, it may have long-term effects,” she says.

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