Keeping it off: what happens when you stop, and how to not regain

The uncomfortable trial result first, then the maintenance calculator, then the five things that separate people who keep it off from people who don't.

What the trials show about stopping

2/3 regainedOne year after stopping semaglutide, participants had regained about two-thirds of what they lost (STEP 1 extension, 2022)
+14% vs −5.5%SURMOUNT-4: after 36 weeks on tirzepatide, people switched to placebo regained 14% over the next year; those who stayed on lost 5.5% more
Not willpowerAppetite hormones rebound within weeks of stopping. Regain is physiology, which is why the plan below is about structure, not resolve

The practical reading: obesity medicine treats this like blood pressure, not a course of antibiotics. Many people stay on a maintenance dose long term; some step down with their prescriber; some stop and hold with structure. All three are legitimate. Stopping cold without a plan is the one with the worst data.

Maintenance calorie calculator (metabolic adaptation included)

Weight-reduced bodies burn roughly 10–15% fewer calories than a body that was always that size (adaptive thermogenesis). The calculator subtracts that. It's an estimate; your scale over 3 weeks is the real number.

The five things that predict keeping it off

1. A trigger weight

Pick a number 3–5 lb above where you settle. Weigh weekly. Cross it two weeks running → you act (tighten protein, log for a week, talk to your prescriber). No trigger means the regain is 15 lb before anyone notices.

2. Resistance training, twice a week

The single best predictor of maintained loss in the registry data, and the only thing that reverses the lean mass lost on the way down. Two 30-minute sessions. Compound lifts or machines, doesn't matter.

3. Protein stays where it was

1.2–1.6 g/kg didn't stop mattering when the scale stopped moving. Satiety per calorie is highest for protein, and appetite comes back when the drug goes.

4. Steps, not "cardio"

People who keep weight off average 60+ min/day of mostly low-intensity movement. 7,000–10,000 steps is the practical version. Walking after meals also blunts glucose spikes.

5. Don't drink calories, don't skip breakfast

Two boring habits with the most consistent maintenance data behind them. Liquid calories bypass satiety; skipping the first meal front-loads hunger to the evening.

Stepping down the dose

Some prescribers taper (e.g. 2.4 → 1.7 → 1 mg over months) or stretch the interval. Data is early but the logic is to let appetite return gradually while the habits above are already in place. Not something to do alone.

Set the habits up now

The weekly habit tracker covers exactly these six things and saves on your device.