Some patients discontinue. STEP-4 showed regain is the default. Here's what to expect and how to plan.
About this article
Reviewed byDr. J. Bottoni, M.D.
RoleEditor-in-Chief, Medicine
First publishedMay 20, 2026
Last reviewedMay 20, 2026
Page typeIn-depth editorial guide
Sources15+ cited sources
Why people stop
- Pregnancy planning.
- Severe persistent side effects.
- Lack of efficacy after adequate trial.
- Cost or coverage change.
- Personal choice after informed counseling.
- Surgery requirements (1 week hold for elective).
What happens after stopping
STEP-4: continuation arm gained additional weight loss; withdrawal arm regained ~7% of body weight over 48 weeks. Regain is the modal outcome.
Mitigating regain
- Maintain protein 1.6–2.0 g/kg.
- Continue resistance training.
- Sleep 7–9 hours.
- Behavioral coaching can help.
- Some patients use the structured Calibrate or Sequence year-long programs as a bridge.
Restarting
If you regain and want to control it: restart earlier rather than later. Re-titrate from a dose below your previous maintenance to avoid severe nausea.