Do you regain weight after stopping weight-loss drugs? What the BMJ evidence shows

Weight-loss medications – so called skinny jabs – have changed the conversation around weight in a way I haven’t seen in my career before.

For many people, they work. Appetite decreases, ‘food noise’ (constant cravings) decreases, weight comes down, blood sugar improves. For some, it’s the first time in years (or decades) that things feel manageable.

But there’s a question I’m hearing more and more in clinic and conversations:

“What happens when you stop taking them?”

Not if you stop, but when. Because for most people, it’s not realistic or desirable to stay on them indefinitely.

A major paper published in The BMJ in January 2026 pulls together the best evidence we have so far on this exact question. And the findings are important – not because they’re shocking, but because they confirm something many people taking weight-loss drugs experience, often with a lot of self-blame.

Here, I am going to talk about what the BMJ evidence shows, and what it really means – especially for those of us midlife.

What did the BMJ review look at?

This paper is a systematic review and meta-analysis, which means the researchers pulled together results from multiple published studies that followed people who had taken weight-loss medications and observed then after stopping treatment.

The medications studied included:

• New GLP-1 receptor agonists, such as semaglutide (brand names Wegovy, Ozempic), tirzepatide (Mounjaro) and liraglutide (Saxenda)

• Older weight-loss drugs, such as orlistat (Xenical)

The researchers looked at:

• How much weight people regained after stopping

• How quickly regain happened

• What happened to metabolic health markers like blood sugar and cholesterol

This paper doesn’t tell us whether these drugs help with weight loss – we already know they do. It tells us what happens after the drug is removed.

So… do people regain weight after stopping weight-loss drugs?

The short answer is yes.

Across the studies analysed in this BMJ review, people regained weight at an average rate of around 0.4 kg per month after stopping weight-loss medication.

By comparison, weight regain after non-pharmacological weight loss – diet and exercise-based programmes – averaged closer to 0.1 kg per month.

In simple terms, that means weight regain is around four times faster after stopping medication than after stopping behavioural approaches.

At this pace, many people who lost weight using medication were projected to return close to their starting weight within 18–24 months of stopping treatment.

When the researchers broke the results down by drug type, the pattern became even clearer. The newer, more effective GLP-1 drugs were associated with the fastest rates of weight regain once stopped.

You can see this clearly in the BMJ infographic below: the steep long-dashed turquoise line (labelled newer incretin mimetics) contrasts sharply with the much flatter pink line representing behavioural weight-management programmes.

Figure reused under the terms of the Creative Commons CC BY 4.0 license. Copyright © 2026, The Author(s). Published by BMJ Publishing Group Ltd.

Also, improvements in blood sugar control, cholesterol and other cardiometabolic markers tended to drift back towards baseline over time.

So, these results show that the benefits of weight-loss drugs are largely dependent on their continued use.

Why this finding matters

This evidence shows that weight gain is biological, not a personal failure.

It challenges the idea that medication alone can create lasting change, and it forces an honest conversation about long-term weight loss strategies.

And this is where the midlife context becomes absolutely crucial.

Why midlife bodies are especially vulnerable to regain

As avid readers of my blog, you’ll know by now that midlife body changes are significant.

And these changes can impact our weight, such as:

• Reduced muscle mass and strength

• Lower resting energy expenditure

• Hormonal changes (including perimenopause and andropause)

• Long-standing insulin resistance

• Chronic stress and poor sleep

Weight-loss medications work primarily by suppressing the appetite, temporarily reducing the impact of all these other changes.

But when the medication is stopped, those underlying factors are still there – so weight regain after stopping medication isn’t a surprise.

It’s what we’d expect when:

• Appetite regulation returns

• Energy needs are lower than they used to be

• Muscle mass hasn’t been protected

• Eating patterns haven’t been reshaped long-term

This isn’t actually new biology. The results from this BMJ study confirm something we’ve known for decades:

The human body resists weight loss, by any method

Weight regain after a successful weight loss intervention is very common. We’ve seen weight regain after diet-only weight loss, behavioural weight loss and bariatric surgery.

The difference here is that weight-loss medications can produce larger, faster losses, which can make the weight regain feel more dramatic and distressing.

Why weight tends to come back – it’s not your fault!

Nothing in this paper suggests that people regain weight because they stopped trying, lost willpower, or didn’t stick to a plan.

The pattern of regain seen in these studies is predictable physiology. When appetite suppression is removed:

• Hunger signalling increases

• Food feels more rewarding

• Energy balance shifts

Your body is doing everything it can to fight back and bring your weight back to what it perceives to be normal – this is your biology doing exactly what it was designed to do.

And in midlife, these compensatory responses can be even stronger, because hormonal shifts, reduced muscle mass and a slower metabolism amplify the body’s drive to regain weight.

If no other systems are supporting weight maintenance, regain is likely.

So what should we take from this evidence?

This evidence isn’t telling you not to use weight-loss drugs.

It is saying that weight-loss medication should be seen as a support tool – not as a complete solution.

This paper strengthens the argument for:

• Long-term planning, even before medication is started and certainly before it is stopped

• Honest conversations about duration and expectations

• Ongoing nutrition, movement and metabolic support

Especially in midlife, we shouldn’t be asking the question: “How do I lose weight quickly?”

We should be asking: “How do I make sustainable weight maintenance physiologically possible?”

What this means if you’re considering – or already using – medication

If you’re thinking about weight-loss medication, or you’re currently taking it, this evidence isn’t a reason to panic.

But it is a reason to ask yourself some questions:

• What is my long-term plan beyond the drug?

• Am I protecting my muscle mass?

• Am I building eating patterns that I can sustain without appetite suppression?

• What support will still be there if the medication stops?

A final thought

This BMJ paper is a nice reminder that long-term health in midlife is rarely about one intervention.

And that’s where thoughtful, evidence-based nutrition still has a very real role to play.

Concerned about your midlife weight gain and need some guidance?

Get in touch if you’d like personalised guidance to help you take charge of your health.

Contact me

Disclaimer

The information and advice I provided here is of a general nature and should never replace individual health or medical advice provided by your doctor or other healthcare professional involved in your care.