Stop Ozempic or Wegovy? Here’s how to keep the weight off

I’m a registered dietitian, and lately, I’ve seen a lot of interest in pharmacological approaches to weight loss in my patient population. Most patients fall into one of two categories: patients wishing to compensate for any weight gain they may have experienced after stopping one of these drugs and patients who want the benefits of these drugs but cannot take them due to side effects or cost.

How GLP-1 agonists like Ozempic and Wegovy work to boost weight loss

The latest drugs that consumers are using to lose weight are called GLP-1 agonists. These drugs, such as Saxenda, Trulicity, and Ozempic, were developed for people with diabetes, but are now used, many off-label, for their impact on weight loss. Currently, the only GLP-1 agonist approved for weight loss is Wegovy, Ozempic’s sister drug. These drugs work to suppress appetite, slow the rate at which the stomach empties, and control blood sugar. Common side effects of the drug may include nausea, diarrhea, vomiting, and constipation. When you stop taking the drug, the feeling of fullness that kept you from eating goes away. You start to feel those usual hunger pangs again, and as a result, you may start eating more to satisfy that hunger. Increasing your intake can lead to regaining lost weight. A 2022 study found that most individuals regain weight a year after stopping the drug.

5 ways to maintain weight after Ozempic or Wegovy

The question I get from my patients is, how can I keep the weight off and keep it off? The response involves an appropriate transition from pharmacological intervention to lifestyle changes. Here’s what I advise my patients to do to have a better chance of losing weight.

1. Moderate your carbohydrates.

Benefits seen in some of the new weight loss drugs include reduced appetite and better blood sugar control. Both can occur when changing carbs to 130g or less per day (considered a moderate carb approach). A 2017 randomized controlled trial found that low-carb approaches were more effective than low-fat diets in increasing satiety. Additionally, low-carb strategies are also effective in managing diabetes and weight loss. In a sense, this diet can mimic many of the benefits seen in pharmacological approaches without the addition of extreme restriction. Look at your diet and find your carb sources, then assess where you can find cuts or healthy alternatives. For example, if you usually eat pretzels as a snack, consider swapping them for almonds. If your favorite breakfast is a pastry, consider switching to plain Greek yogurt with berries. If your lunch is usually a sandwich, consider replacing the bun with a cauliflower bun or a low-carb tortilla. Instead of a pasta dish at dinner, consider wild salmon with quinoa and broccoli.

2. Make a plan to move more.

Regular physical activity is effective in preventing chronic disease, improving bone health, and improving mental health. Physical activity after weight loss can also help maintain that weight. A 2017 analysis suggests that maintaining weight loss can be improved by moderate to vigorous activity for at least 150 minutes per week. If exercise wasn’t a priority before, you can make it a priority now by starting small. Start with walking at night, or take an even more baby-step approach by simply parking further away from destinations, taking stairs above elevators, or using a standing desk over a sitting desk. Once your doctor is on board and you feel up to it, increase your intensity and time and add other activities, such as resistance training.

3. Make sleep a priority.

The latest weight-loss drugs basically lead to a reduction in food intake. Once the drug is stopped, your sleeping habits will play a role in weight maintenance. Skimping on sleep has been linked to weight gain and poor blood sugar control. Lack of sleep has also been linked to increased hunger. Making sleep a priority is just as crucial as other lifestyle changes to keep weight gain at bay. These changes can include setting the appropriate temperature (experts recommend the room be between 60 and 67 degrees Fahrenheit, removing light sources from the room (consider good quality blackout shades), and turning off electronics a few hours before bedtime. Studies also show that keeping your sleep hours consistent can also help you manage your weight. And weekends.

4. Find foods that fill you up.

There’s a reason it’s easy to quit eating broccoli but hard to quit eating pizza. Studies show that eating super tasty foods can override messages in the brain that tell you you’re full – therefore, you keep eating. In contrast, there are foods that create fullness, such as foods high in fiber (think fruits, vegetables, and whole, intact grains), lean sources of protein, and healthy fats. All of these foods are associated with increased satiety, or fullness and satisfaction. Consuming more of these foods (and less junk food) can help you eat less overall. One diet that contains these complete components is the Mediterranean diet. Studies show that the Mediterranean diet can be an effective way to lose weight and manage blood sugar.

5. Focus on health, not weight.

With all the attention on weight loss, it can be easy to forget what’s really important: your health. Physical and mental health are key factors in living not just longer, but better. Being thin or at the bottom of the BMI chart is not a surefire marker of good health. Focus on numbers, such as blood sugar, cholesterol, and liver enzymes, rather than the number on the scale.

Drugs currently used for weight loss may make sense for many people, such as those with chronic health conditions. For anyone who may not be able to continue or even start taking these medications, it’s about finding alternatives. There’s no one-size-fits-all approach – find a long-term diet that keeps you full, happy, and satisfied.

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