Joseph Zucchi, PA-C, MPAS · Obesity Medicine Visuals Evidence reviewed October 12, 2026
A new phase of success
Reaching your goal is a milestone. Maintaining it is treatment, too.
Obesity is a chronic condition. After weight loss, the biological signals that influence hunger and energy use can still favor weight regain. Medication can continue to provide support after the scale settles.
Needing that support does not mean you failed. And a stable weight can be a sign that your treatment is doing its job.
In withdrawal trials, continuing medication generally protected weight loss better than stopping it. These are averages from research groups, not a forecast of your future.
After 36 weeks on tirzepatide, 670 adults were randomly assigned to continue treatment or switch to placebo. Both groups continued lifestyle support.
Continued tirzepatideSwitched to placebo
Week 36: some participants switched to placebo ↓
Swipe the graph sideways for a closer view.Approximate observed group-average trajectories redrawn from Figure 2. These are visual estimates, not individual data. Published statistical estimates below differ slightly from observed curves.
25.3%below starting weight with continued treatment
9.9%below starting weight after switching to placebo
Continuing treatment helped protect the initial weight loss and supported further loss.
Study details & original source
Adults without diabetes who completed the initial treatment phase; tirzepatide 10 or 15 mg weekly. Published overall changes use the treatment-regimen estimand. During weeks 36–88, weight changed by −5.5% with continued treatment versus +14.0% after withdrawal, relative to week-36 weight. Those percentages are not percentages of lost weight regained. Error bars are omitted here; see the original figure.
Lifestyle support continued. The paths still separated.
After 20 weeks on semaglutide, 803 adults were randomized to continue it or switch to placebo. Both groups continued diet and activity counseling.
Continued semaglutideSwitched to placebo
Week 20: some participants switched to placebo ↓
Swipe the graph sideways for a closer view.Approximate observed trajectories redrawn from Figure 2C. Published statistical estimates are summarized below. This is a separate trial, not a head-to-head comparison with tirzepatide.
7.9%additional loss with continued semaglutide
6.9%weight gain after switching to placebo
Nutrition and activity remain essential. Medication can provide additional biological support.
Study details & original source
Adults without diabetes who reached semaglutide 2.4 mg weekly during the run-in. The two percentages above describe change from week 20 to week 68, relative to week-20 weight (treatment-policy estimand). They are not total loss from study entry. The chart uses starting weight. Trial averages do not predict individual outcomes. Error bars omitted.
A subset of 327 participants was followed after the 68-week trial. Semaglutide and structured lifestyle support both stopped.
Previously received semaglutidePreviously received placebo
Week 68: assigned treatment stopped ↓
Swipe the graph sideways for a closer view.Published key time points joined by straight lines. Connecting lines summarize endpoints; they do not reproduce the measured week-by-week trajectory. Both groups stopped assigned treatment at week 68.
17.3%average loss at the end of treatment
5.6%average loss still present one year later
About two-thirds of the previous weight loss returned on average. Regain was variable, not inevitable for every person.
Study details & original source
Observational extension in a selected subset without diabetes, not a new randomized comparison of continuation versus withdrawal. Participants previously receiving semaglutide regained 11.6 percentage points. Some cardiometabolic improvements moved back toward baseline. Ending lifestyle support alongside medication limits attribution to medication withdrawal alone. Rounded means do not subtract exactly.
Long-term treatment can sustain meaningful progress.
The 176-week extension followed adults with obesity and prediabetes, then observed 17 weeks off treatment. The graph illustrates the 15 mg and placebo groups.
Tirzepatide 15 mg, then stoppedPlacebo, then stopped
Week 176: assigned treatment stopped ↓
Swipe the graph sideways for a closer view.Approximate trajectories redrawn from Figure 1B, restricted to participants with weight measurements at both weeks 176 and 193. This subset curve differs from the main trial estimates. End labels are published week-193 values.
176 weeksof treatment before the off-treatment period
17 weeksof observation after treatment stopped
Maintenance lasted for years during treatment. Weight regain was observed even after this longer treatment period ended.
Study details & original source
1032 participants had obesity and prediabetes at study entry. Main treatment-regimen estimates at week 176 were −12.3%, −18.7%, and −19.7% for 5, 10, and 15 mg, versus −1.3% for placebo. These estimates use a different analysis from the illustrated follow-up subset and should not be spliced into that curve. Two of four groups shown for readability; error bars omitted.
Some people keep more weight off than others after stopping. These studies support planning for maintenance, not telling every person they must take the same medicine forever. They also do not compare one medicine against another.
Protecting what you have gained
Less weight can be part of the story. Better health is the bigger goal.
Treatment decisions should consider the improvements that matter to your life: blood sugar, blood pressure, sleep, mobility, and other health conditions, alongside weight.
Cardiovascular health
In SELECT, semaglutide reduced major cardiovascular events in adults with established cardiovascular disease and overweight or obesity, without diabetes: 6.5% versus 8.0% over about 3.3 years.
In SURMOUNT-1 participants with obesity and prediabetes, diabetes developed in 1.3% with tirzepatide versus 13.3% with placebo during 176 weeks. These results apply to that study population.
SURMOUNT-OSA found improvements in obstructive sleep apnea severity with tirzepatide in adults with obesity. Better symptom control can be an important treatment goal alongside weight.
In the STEP 1 extension, several improvements in blood pressure and metabolic markers moved back toward baseline after treatment and structured lifestyle support ended. That is a reason to follow health markers when changing treatment, not only weight.
Sometimes the rest of your medicine list can change.
In STEP 4, among people taking blood pressure medicines at randomization, 25.5% continuing semaglutide had treatment stopped or reduced, versus 11.9% switched to placebo. This was a descriptive medication-use analysis, not a guarantee for an individual. Your clinician should review any changes.
Different medicines have different evidence and approved uses. Cardiovascular and sleep-apnea trials were not withdrawal trials: they do not tell us exactly how quickly those benefits might change after stopping. A lower dose or different schedule is not proven to preserve every benefit of the original regimen. Continue other indicated care, including PAP therapy, unless your treating clinician recommends a change.
A plan with room to adapt
Long-term does not have to mean the same plan forever.
01
Continue what is working
When benefits outweigh side effects and the plan is affordable and sustainable, ongoing treatment can be a positive choice. Revisit goals, nutrition, strength, symptoms, and health markers regularly.
02
Discuss a lower dose
A lower maintenance dose may work for some people. SURMOUNT-MAINTAIN directly studied reducing tirzepatide to 5 mg weekly after initial treatment. Responses varied, so follow-up matters.
03
Consider another treatment
Side effects, access, preferences, or changing health needs may lead to a different medicine or treatment approach. Switching requires a clinician-guided plan; treatments are not interchangeable.
04
If you need or want to stop
Plan follow-up and agree on what changes in hunger, weight, symptoms, or lab results would prompt a review. If weight returns, asking for support is a useful next step, not a failure.
Evidence for flexibility · SURMOUNT-MAINTAIN
A lower dose can be an alternative to stopping.
After 60 weeks of tirzepatide, participants continued 10 or 15 mg, reduced to 5 mg, or switched to placebo. At week 112, average weight remained below the original starting weight by:
Continued 10 or 15 mg21.9%
Reduced to 5 mg16.6%
Switched to placebo9.9%
Bars start at zero and show total weight loss, not the percentage of prior loss retained. Modified treatment-regimen estimates; rescue therapy was available from week 84 for substantial regain. Continued higher-dose treatment performed best overall. Dose reduction did not preserve all initial loss for everyone.
Reduced-frequency dosing is being explored, but evidence for spacing weekly semaglutide or tirzepatide includes case observations and mathematical modeling rather than robust proof of equivalent long-term outcomes. It is off-label and is not an established substitute for the prescribed weekly schedule. Discuss any change with your prescriber.
Cost, side effects, pregnancy plans, and the burden of treatment deserve a real conversation. Long-term care means regularly weighing benefits and risks with you, and making a plan you can actually follow.
Bring your priorities
What should my maintenance plan look like?
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You deserve support that lasts as long as you need it.
The goal is a healthier life and a sustainable plan. Medication can be part of that plan, alongside nutrition, movement, strength, sleep, and ongoing care.
Sources, chart methods & educational notes
All graphs are original OMV educational redraws. SURMOUNT-4, STEP 4, and SURMOUNT-1 use approximate visually transcribed trajectories from the cited published figures. STEP 1 shows published key endpoints only. No individual patient data are shown. Confidence intervals are omitted for readability. Each graph identifies its population and analysis; numerical summaries may use a different prespecified analysis from observed curves.
The tirzepatide trials were funded by Eli Lilly; the semaglutide trials were funded by Novo Nordisk. Read the linked publications for full methods, safety results, funding, and disclosures. This is an educational synthesis, not a recommendation for a particular product or a substitute for individual care. These trials do not establish lifetime outcomes.
Side effects and contraindications matter. Review the current Medication Guide and manufacturer instructions with your care team. Prepared by Joseph Zucchi, PA-C, MPAS. Sources reviewed October 12, 2026.
My maintenance visit
Questions to discuss with my care team
Obesity Medicine Visuals · obesitymedicinevisuals.com/getting-started/maintenance/
