Weight regain after stopping GLP's

[tubby]

it kinda feels like we are all having the same mindset, but on opposite ends of the spectrum. we all agree GLPs are helpful, needed and effective. i feel like we are all kind of discussing different levels of dependance on them rather than the use of them as a tool. i myself find even taking 1.25mg/week of my tirz puts me in a much better state of mind to be able to make the right decisions when its needed and to pull myself back from the cliff of a binge. i dont want to waste the meds or set myself back from my progress i want and that thought is what helps me break the cycle, and even when i was off of it for 6 months i knew that just because i was hungry didnt mean i had to eat, so i just ate the same things everyday regardless of hunger levels.

some people seem to rely solely on the meds to achieve their goals. i mean just look at the number of threads in the fitness/nutrition category vs any other non specialized section here. if you stop the meds of course you will gain the weight back. same thing with if you stopped food tracking and/or exercise, i don't think anyone is arguing otherwise. i just personally feel like an over dependance on them will lead to these statistics to stay true, and anecdotally i would guess the ones that you see saying "im not hungry at all but im not losing weight" would be the reason they stay at 95% weight regain after quitting.

so people like me are viewing it from the angle of diet and exercise first then meds, compared to (admittedly most likely people that would be outliers in the studies mindset based only on the limited comments from forums like these without knowing all the work they put into weight management) meds as the heavy lifter and only thing that works.

again im unaware of any studies on this subject aswell, but ive seen a regular thought process from naturally thin people to be "ya im hungry but i dont have time to eat right now so ill just eat later." its not as much of a matter of hunger ques but more so mental awareness on what hunger ques mean, and would be interested to see what would happen if they had a super effective GLP that did nothing but remove the food noise completely., while leaving the appetite suppression and gastric emptying alone. what those studies would look like.

What is missing from lessthanhalf's point of view is that he's conflating all diets with calorie-restriction diets. Calorie-restricted diets are extremely challenging to maintain long-term. In fact, I might say that a pure calorie-restriction diet (in which you don't change what you're eating, but just how much of it you're eating) are likely the most challenging to maintain.

Meanwhile, I think you may be underappreciating the full hormonal significance of GLPs. From your perspective, GLPs are helping you make better decisions. Let's say hypothetically that for you GLPs + better decisions lead to a 50 pound weight loss before you plateau. If from that point you stopped GLPs entirely, but kept making the better decisions (perhaps you formed new habits that allowed you to avoid binging), you would likely regain some amount (perhaps 10 to 20 pounds) of that 50 pounds before plateauing. I like your approach and your attitude towards it, but I think it's good to acknowledge that your loss is going to be a mix of better habits (enabled by GLPs) and hormonal influence on weight.

 

[bbbilly]

Meanwhile, I think you may be underappreciating the full hormonal significance of GLPs. From your perspective, GLPs are helping you make better decisions. Let's say hypothetically that for you GLPs + better decisions lead to a 50 pound weight loss before you plateau. If from that point you stopped GLPs entirely, but kept making the better decisions (perhaps you formed new habits that allowed you to avoid binging), you would likely regain some amount (perhaps 10 to 20 pounds) of that 50 pounds before plateauing. I like your approach and your attitude towards it, but I think it's good to acknowledge that your loss is going to be a mix of better habits (enabled by GLPs) and hormonal influence on weight.

my main point im trying to say is simply that it appears that glps are so retally available that most people seem to only be interested in eliminating the idea of worrying about food by completely eliminating hunger and food noise without giving much if any attention to healthy eating habits. especially in this grey market category where you can get a lifetime supply for the cost of what would be only a few months of the name brand stuff.

and there is nothing inherently wrong with that. i myself am going to be putting in an order relatively soon for something like 10 kits, which at my low doses should last anywhere from 20-30 years depending if i want to increase or decrease for cuts/bulks in those years for the price of what would be 6 months worth of my zepbound.

but my point is that these studies where they regain the weight after are somewhat misleading because so many people have that mindset of "let the glp do all the work and ill eat whatever i want, i just cant eat that much of it" so of course they will regain the weight. just like when people go on a diet just to lose the weight to be summer ready. they don't really care about maintaining that body composition, they just want to be in shape for the summer then go back to their normal way of eating rather than changing their lifestyle.

but it would be interesting to see why those 5% do manage to keep the weight off after. did they completely remodel their lives? was there some sort of metabolic adaptation that happened? to me that seems like the more promising part of all this, not the fact that 95% regained the weight...as i would expect most to.

 

[Grogu]

What is missing from lessthanhalf's point of view is that he's conflating all diets with calorie-restriction diets. Calorie-restricted diets are extremely challenging to maintain long-term. In fact, I might say that a pure calorie-restriction diet (in which you don't change what you're eating, but just how much of it you're eating) are likely the most challenging to maintain.

I'm probably one who would be considered a jedi master of calorie restriction. It's my go to weight loss method and I've had success using the method. But I agree with you 100% that calorie restrition is tough. It's not easy to track calories and it's a pain in the ass, but 110 pounds later, the method has served me well. Restricting calories comes with both a reduction in the amount of food eaten, but also what is eaten because you can't keep eating less of the same stuff and stay within the calorie goal, it's just impossible.

I fully believe that a person has to eat less calories than they expend to lose weight. The type of diet to me matters less than just consuming fewer calories. So, if someone feels better on Keto, Paleo, Carnivore, Atkins, or whatever, and it results in fewer calories consumed, then go for it. But bottom line is that to lose weight, more calories have to be expended than taken in.

Meanwhile, I think you may be underappreciating the full hormonal significance of GLPs. From your perspective, GLPs are helping you make better decisions. Let's say hypothetically that for you GLPs + better decisions lead to a 50 pound weight loss before you plateau. If from that point you stopped GLPs entirely, but kept making the better decisions (perhaps you formed new habits that allowed you to avoid binging), you would likely regain some amount (perhaps 10 to 20 pounds) of that 50 pounds before plateauing. I like your approach and your attitude towards it, but I think it's good to acknowledge that your loss is going to be a mix of better habits (enabled by GLPs) and hormonal influence on weight.

Studies have shown that the average weight regain is more like 75% of the excess weight lost when stopping glp-1 tereatment, so even with the new habits formed, under the scenario of someone losing 50 pounds, developing new habits, and then stopping glp-1 treatment, the weight regained will be more like 38 pounds not 10 to 20 pounds.

 

[Flexon]

There is no doubt that diet and exercise can cause weight loss. What the evidence says , is that it does not work long term for nearly everyone, only about 5% or so of people who have massive weight loss from diet and exercise , or GLP's that then stop the GLP's, keep that weight off or most of it off long term. There are thousands of studies. So as far as I am concerned it is not an effective treatment. When there were no better options, it was definitely better than nothing and even medium term improvements of 5 to 10% can improve metabolic health. GLP medications can realistically cause 20 to 29% long term weight loss on average for tirz or reta.

I think there is pretty good scientific evidence that the appetite control system in people with severe obesity is pretty broken, and that losing weight does not fix it. Eating satiating food in the right amounts for health is not going to provide the correct signals to stop eating if the system controlling eating is not working properly. And after large weight loss metabolic adaptation to low calorie input requires eating quite a lot less calories to maintain weight than an equivalent weight person who had not lost weight. And hunger signalling is increased by weight loss. These 2 effects independently of broken appetite regulation make maintaining weight loss extremely hard.

I lost about 70kg with diet and exercise without glp's in 2022-2023, I had to maintain a calorie intake of about 1600 kcal/day to maintain weight, and despite a very carefully designed diet , I was hungry most of the time, and going on past experience , sooner or later putting the weight back on was the most likely outcome. Thankfully after about a year of this, GLP medications became an option instead.

GLP drugs help to lose weight and are equally effective at keeping it off long term so long as you keep taking them. Obviously eating a healthy diet and exercising is a good thing, but weight loss and the health benefits of these medications do not require this to work. The health benefits are no doubt larger if diet is good and exercise is happening, but GLP medications do improve food choices without any effort. And make exercise easier and safer after weight loss.

So comparing lifestyle changes to GLP therapy , one works OK in the short term with extremely low long term success rates and the other is more effective in the short, medium and long term in causing and maintaining weight loss. It really is that simple, one works, the other does not.

You did a great feat of will by loosing 70kg, especially considering you did it by limiting calorie intake. What kind of food did you eat during that period? Did you try different diets? There's a possibility some other diet could be more satiating while leading to similar result. There is no one 'ideal' diet, I learned it by experience, what works in one context/timeframe might not in other one.

Experimenting and tweaking is necessary. What is necessary too is changing patterns of behavior, but built on solid information, unfortunately prevailing nutritional paradigm isn't necessarily the right answer, so leaps of fait might be necessary, by testing what prevailing narratives consider 'dangerous'. Like some peptides, BPC 157 for example is 'research only', 'not tested on humans', 'unknown territory', etc. Yet some people had success using it for different problems. My n1 research showed it's not at all effective in relieving a problem I tried to 'cure' with it (probably because my problem was something else), but very effective in relieving another debilitating condition I wasn't aware it could be helpful with.

 

[lessthanhalf]

I had unfortunately had a lot of practice at losing weight, and I had read as much research as I could find. For me the biggest problem was the chronic hunger while trying to maintain weight loss but worse was the extreme and essentially uncontrollable hunger in that state that happened a few hours after eating high calorie, highly rewarding foods even in small quantities, and once that started I found it very hard to stop, and could put back on a lot of weight quickly.

Something was very definitely going seriously wrong in the chemicals controlling appetite in that state.

So I tried to design a diet that would not trigger this response, and tried to minimise hunger, so very high protein up to 50% of calories, almost no fat , zero high glycemic index carbs, basically very lean meat , low fat high protein dairy , fruit and vegetables, and ideally nothing over about 1.5 kcal/gram. And it worked to lose the weight and keep it off, and as I understood what triggered uncontrollable hunger I had to totally and completely avoid those foods that could trigger it, and have continued to do that for 3 1/2 years now, but without adding in GLP medication after a year or so it was still fairly difficult. Apart from being a bit low in some types of fat it is essentially a fairly healthy diet. The diet was designed to avoid rapid shifts in blood glucose and any weird hormonal or brain chemistry responses to those shifts, and it works fairly well at controlling hunger, much better than the same number of calories from smaller amounts of higher calorie foods. Many aspects of this diet would be regarded as good by nutritionists except for the extra high protein and extra low fat aspects.

I think there is no doubt that calories in have to be lower to lose weight but it can be a bit tricky, from the start of weight loss to the end my energy expenditure dropped by almost exactly half, losing 6kg/month at the start to zero at the end on the same calorie intake of about 1600kcal/day, which is where it stayed since then. Different diets do not change the fundamental thermodynamics of weight, at best they help to control hunger or be more tolerable, and keto has some mild appetite suppressing effects, but less than GLP's. There is definitely no free lunch from any diet, although reta comes close boosting metabolic rate by 1-200 kcal/day, and slgt2is can make you pee out a couple of hundred calories of sugar a day.

Magical thinking is super common when people think and talk about diets and weight loss. If i follow this new diet, this time it will work, or if I fix my eating patterns this time it will work, despite all the evidence from all of the rest of your life trying these things that did not work in the end. I think being honest with yourself and accepting that you have a problem with weight is not a bad thing , and using an effective drug to manage that problem is absolutely not some sort of weakness or admission of defeat, it is just a sensible rational way to manage a problem. And I think most of the time trying to stop it after weight loss is more magical thinking, you got overweight in the first place for a reason or reasons, and those generally do not go away, they are built into you. Accepting this and continuing to use an effective treatment is the escape from the diet and relapse pattern that nearly everyone with weight issues has experienced.

 

[staffn1]

There are a ton of people who post in some Facebook trizepatide groups I'm in where they developed good eating habits, exercise, etc, lost good weight on the shot. And then for whatever reason when they stopped the shot it was horrible, food noise, and rapid weight gain. That also included a lot of inflammation.

 

[Flexon]

It’s possible after the body suffers a prolonged injury from obesity / unhealthy food / bug or fungal infections etc., satiety signal paths are affected, for example. Fortunately, body has almost miraculous abilities for healing, but the challenge is placing it in an appropriate context, with drugs or otherwise.

Many people can function with high protein, others have success with high fat (70% of calories or more), saturated preferably. This kinda works for me, but with caveats. My problem was with maintaining weight after removing everything but beef, salt and water, it helped with almost everything else, but my gut after having problems with other foods eventually had problem with this too. I had to experiment with reintroducing some of the “offender” foods back again. It took me a few years to tweak a diet to be sustainable, with minimal side effects, but adding occasional sauna sessions, to sweat out the toxins.

 

[tubby]

The type of diet to me matters less than just consuming fewer calories. So, if someone feels better on Keto, Paleo, Carnivore, Atkins, or whatever, and it results in fewer calories consumed, then go for it. But bottom line is that to lose weight, more calories have to be expended than taken in.

This is the part most people get wrong. Basic internet "keto" ("eat less than X grams of carbs per day") isn't guaranteed to be a weight loss diet, but there are more finely tuned formulations of keto that are extremely effective and are performed without conscious calorie restriction. People stuck in a CICO mindset assume that's because a particular diet is appetite-reducing, leading to less total calories to be consumed, but that's not generally true. There are high-calorie versions of keto that (despite being high-calorie) still will lead to weight loss.

But I think in pointing this out, it's important to clarify that I don't think "keto" (alone) is the solution. I think keto is the proof of concept that the hormonal impact of food choices tweak our bodies hormones in mysterious (and poorly understood) ways. Keto proponents will advance the carbohydrate insulin model (CIM) as a rationalization for why a high-calorie keto diet sometimes works, which seems to work and hold under certain conditions (but not generally across all conditions).

 

[tubby]

I'm probably one who would be considered a jedi master of calorie restriction. It's my go to weight loss method and I've had success using the method.

But here (in my view) is the fundamental tension that exists in standard calorie restriction diets:

Not all obese people have a binging problem, but it is common. In those that have a binging problem, an analogy to alcoholism (or drug addiction in general) is useful. You don't help an alcoholic get their life under control by telling them "cut back to 1-2 drinks a night and you'll be okay." Some nights they might be able to win that battle, but many nights they won't and then the entire bottle is gone and their life goes back to being a mess again.

For the alcoholic the fundamental insight is typically to realize that the only way they'll truly control that demon isn't moderation, but cutting alcohol 100% from their lives. The challenge in applying this approach to obesity is that you obviously can't cut out food in general from your life. But what you can do is setup systems in your life that remove easy access to the categories of food that you tend to engage in binging behavior with and make a conscious decision that you simply won't eat those foods.

That really sucks if those foods represent more to you than just sustenance and for some that's simply a non-starter. Others will implement other control measures, like "cheat days," eating other (less binge-inducing) foods at meals before the binging foods, etc.

You could probably boil this down to saying that to the extent that binging (and similar) behavior contribute to your obesity, simple calorie restriction is either going to fail or is going to require constant mental effort to the point where it takes over your life. A person can succeed with it (and you and lessthanhalf deserve gold medals in my view for accomplishing what you did), but (without GLPs) such an approach comes with accepting that struggle for the rest of your life.

Every diet is going to be restrictive in some manner, but for me personally, diets that eliminate categories of food (e.g. I simply won't eat X, Y, and Z) are easier to process mentally and maintain than diets that keep all the same foods but where you eat less. Obviously, that's not true for all people. I just mention that because most people won't really know how they deal with different approaches without actually trying them for several months and seeing what shakes out from each.

 

[Grogu]

Every diet is going to be restrictive in some manner, but for me personally, diets that eliminate categories of food (e.g. I simply won't eat X, Y, and Z) are easier to process mentally and maintain than diets that keep all the same foods but where you eat less. Obviously, that's not true for all people. I just mention that because most people won't really know how they deal with different approaches without actually trying them for several months and seeing what shakes out from each.

I think you’ve hit on something important here—people need to find what works for them both mentally and physically. Food is inherently more complicated than alcohol because we all have to engage with it every day. Unlike alcohol use disorder, where abstinence is an option, that’s simply not possible with food.

A better analogy might be something like credit cards rather than alcohol. Some people can use them responsibly, while others are better off not using them at all. The strategy depends more on the individual. But regardless of the approach, the underlying principle still holds—if you want to get out of credit card debt, you have to stop spending more than you can afford to pay.

 

[Calm Logic]

it kinda feels like we are all having the same mindset, but on opposite ends of the spectrum. we all agree GLPs are helpful, needed and effective. i feel like we are all kind of discussing different levels of dependance on them rather than the use of them as a tool.

If it's only a "tool," it is interchangeable with other tools and therefore unnecessary at any point. It is also possible to walk to NYC from LA, instead of fly. Maybe find a cross-country running forum, instead of one on GLPs.

We have rehashed the tool debate with so many gym/Meso bros on this forum, it's not even funny:

A hard truth about GLP-1s and Body Transformations

GLP-1s can help with weight loss, but it won't give you the dream body or lasting results you're actually looking for. So let me drop some value that might save you from future disappointment. Weight Loss ≠ Muscle Building GLP-1s suppresses appetite and slows gastric emptying. You might get...

glp1forum.com

GLP-1s 'cheating' OR a TOOL

Hi all! I am having an interesting spiral of thoughts right now.. I see so many people online saying GLP1s are 'cheating'. But lets be real. How is it cheating if it isn't a game? This is life. This is my health and my journey in taking back my body and being able to live the healthy life I...

glp1forum.com

Usually it's the same guys on all kinds of "compounds" (steroids) or at least some injections like L-carn and HGH or a ton of oral supplements. So they are using all kinds of things, but they want to tell other people to get their shit together.

You lost 100 pounds on Zepbound, but it's just a "tool:"

[archived internal link]

Almost everyone I know on GLPs is eating more healthy than before. And exercising more than before, if anything. So in some ways you are also speaking to the choir. But you can be on GLPs and still do all these things. They are not mutually exclusive, and some super-responders microdose GLPs even for losing weight. There's also the anti-inflammatory or bloodwork benefits.

 

[woundcarping]

Oxygen is just a tool for cellular respiration, you can live the rest of your life without it.

 

[mainefungi]

Staying committed to the lifestyle is important. Also, you should titrate down the way you titrated up. Concentrating on learning to resist the food urges at each step. You NEED to have an exit plan.

 

[woundcarping]

I plan on working my dose down in amount and frequency when I get where I'm going, but I'm not willing to white knuckle life when there's no signs that point to actually NEEDing an exit plan for long term viability.

I have a 50 year exit plan, but I don't think that's what you're referring to.

 

[Calm Logic]

You NEED to have an exit plan.

You need to mind your business. You do you, doc.

 

[trojanpeptide]

I have maybe a few pounds of flab, nothing major, I need to hit the gym (I've been reno'n my basement over the winter and my weights are stored atm), although even if I hit my weight, I'm not planning on quitting . I may taper to one pin a week (instead of the current two split dose), and maybe reduce my 3.5 mg (weekly total) dose, but unless there is some long term data suggesting harm, I don't think there's a reason to stop. I've shared this video with a few people. Idk how legit this Quinn Stillson is, as everybody wants to make a buck, maybe he's shilling, but nevertheless, it's a fun video for us pep-heads. Anyhow, guess which peptide came in 1st place? That's my point.

 

[tubby]

I think you’ve hit on something important here—people need to find what works for them both mentally and physically. Food is inherently more complicated than alcohol because we all have to engage with it every day. Unlike alcohol use disorder, where abstinence is an option, that’s simply not possible with food.

A better analogy might be something like credit cards rather than alcohol. Some people can use them responsibly, while others are better off not using them at all. The strategy depends more on the individual. But regardless of the approach, the underlying principle still holds—if you want to get out of credit card debt, you have to stop spending more than you can afford to pay.

I appreciate your response, but you seem to have completely misunderstood what I said.

The point is that just as alcohol is "triggering" to the alcoholic, perhaps simple processed carbs (e.g. pasta, pizza, crackers, etc) are triggering to the binge eater. Setting a rule like "I won't have those in my house and I won't eat those things when out" would be analogous to an alcoholic setting a rule "I'll have all the non-alcoholic beverages I want, but I won't drink any alcohol." Just as the alcoholic still needs to drink stuff (just not alcohol), the binge eater still needs to eat things (just not the things they frequently binge on).

I'm not suggesting you have to or even should adopt such an approach. I'm simply giving it as an example of a type of diet that takes a different approach from "calories" or "eating less."

 

[tubby]

You lost 100 pounds on Zepbound, but it's just a "tool:"

I think you might be reading what you want to hear rather than that bbbilly is actually saying. "Tool" is a very apt description of what a GLP is doing.

One path is to stay on that tool long-term and that will likely be the best path and the path of least resistance for many people here, particularly if they wish to continue eating what might be dubbed "modern" foods.

Another path would be to use a GLP as a form of training wheels to test run a dietary change that may currently feel impossible otherwise. On one hand this will probably give you a false sense of confidence in your ability to sustain such a diet (without GLPs) and I suspect withdrawals will be hell during the transition. On the other hand, I don't have the graph handy, but there's an interesting waterfall plot of weight change after discontinuing GLPs out there where a small percentage of people actually continue to lose weight AFTER stopping a GLP, which is pretty wild! I wouldn't bet on being in that smaller percentage, but that does serve as a proof of concept that some people will be able to succeed with such an approach.

 

[Calm Logic]

"Opposite ends of the spectrum" is pretty clear. In any case, I was not going on just the "tool" word. I may be an idiot, but I know my gym bros.

He is assuming a lot about people here (or "some people," as they say) so I feel at liberty to do the same about him:

Weight regain after stopping GLP's

I thought this study was interesting Trajectory of weight regain after cessation of GLP-1 receptor agonists: a systematic review and nonlinear meta-regression https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00043-X/fulltext It shows that people who lost weight on GLP's might...

glp1forum.com

He wonders why we don't have more threads on nutrition or fitnes vs. GLPs. Hello, this is a GLP forum. This isn't diet controversy of the week forum, or gym bros united .com. That doesn't mean people here are eating garbage or are married to their couch. The opposite is true.

 

[tubby]

very high protein up to 50% of calories, almost no fat , zero high glycemic index carbs, basically very lean meat , low fat high protein dairy , fruit and vegetables, and ideally nothing over about 1.5 kcal/gram.

Hormonally, that could be a perfectly suitable diet for someone who wants to maintain a normal weight; however, a subset of obese and/or insulin resistant people are going to really struggle to lose significant weight with that. Your ability to do so is some very impressive determination and between that and your very informed and articulate responses gives me a lot of respect for you and the information that you share here.

The struggle I'm referring to is that although you're focusing on low-glycemic carbs (which will keep your blood sugar and insulin levels reduced), a high-protein diet is still going to raise and maintain your blood insulin levels higher than a low-protein diet would. I suspect you're already familiar with this, but others reading this response may not realize that protein spikes insulin levels (google "insulin index" for more details on this).

And as an important disclaimer here for others: Although I might advocate for protein-restriction on a non-GLP weight loss approach, that goes out the window when someone is on GLPs and I would NOT advocate low-protein for GLP weight loss.

Magical thinking is super common when people think and talk about diets and weight loss. If i follow this new diet, this time it will work, or if I fix my eating patterns this time it will work, despite all the evidence from all of the rest of your life trying these things that did not work in the end.

I appreciate your tactful way of calling "bullshit" on my dietary claims and I understand where you're coming from. There's close to zero clinical research to support such claims, but in my own experience and that of others, there's enough anecdote to support that there's something there (although I don't think we've nailed down what exactly). As I said, the significant results some people experience with keto (while simultaneously not experiencing significant levels of hunger) serves as a proof of concept.

Now I'm not claiming thermodynamics is violated and after the fact (by definition) a calorie deficit obviously existed there since the person lost weight. The point is that chasing a calorie deficit (while still eating the same foods that worked poorly for you) is all but guaranteed to fail, similar to how you can't hold in your pee forever. You're fighting a natural biological urge and you will almost surely lose. That's not a moral failing in any way and in that I agree with you.

However, if one stops restricting hunger and starts restricting their diet in different targeted ways, they will almost surely gain or lose weight with different approaches, until they plateau with each new approach. These approaches come with their own challenges, of course, and there's no guarantee a person will find an approach to reach their desired goal weight. That's where GLPs are great (and why we're all here). But let's not pretend that different diets don't play a major role too or that it all comes back to "calories." The foods you eat (or don't eat) have significant hormonal impacts on your body and interact with each other in complex ways. If you prefer to remain stuck in a CICO view then you could say that these hormonal changes impact CO, such that a calorie deficit is gained or lost. You obviously can't prove that's correct (other than definitionally), since outside of a metabolic ward with sophisticated equipment CO is always an inferred quantity and something that can't be directly measured.