Design for the Numbers 1 Through 9

Real World Data Say Not Everyone Regains All Their Weight

One of the more annoying generalizations in obesity is the assertion that when people lose weight, everyone inevitably regains it all and perhaps even more. When said about metabolic surgery, it’s utterly false. But that doesn’t stop people from saying it – even people who pose as medical experts.

More broadly in the medical management of obesity, this generalization is more of a partial truth. The truth it conveys is that obesity is a chronic and usually progressive disease. Simply losing weight is not a one-and-done solution for obesity. But the lie woven into that partial truth is a suggestion that managing obesity is a futile exercise. To the contrary, obesity care can do much to improve a person’s health and wellbeing.

Real World Data on Regain After GLP-1 Medicines

The partial truth of weight regain is getting a lot of play right now in public discourse about GLP-1 medicines like semaglutide. New data published yesterday from an analysis of 38,007 patient records tells us quite clearly that not everyone regains all their weight when they stop taking a GLP-1.

In fact, less that 20% do. Most of them maintain the weight they’ve lost and some (about 35%) actually lose additional weight.

Much to Learn

By no means is this the final word on the subject of weight regain after stopping a GLP-1. This analysis comes from Epic Research, a rapid publication platform for sharing insights from electronic medical records. It has not gone through the rigors of publication in a peer-reviewed journal. It summarized only a year of data after stopping therapy. None of this is to imply these observations have dubious value, but there are plenty of unanswered questions.

Our top question is what other weight management tools might have come into play after these patients discontinued their GLP-1. From the methods the authors describe, it  is possible that some of them received other medicines for obesity that were not GLP-1 agonists. The report simply does not provide any detail about this.

Moreover, both patients and providers have much to learn about long-term practices and outcomes for obesity in the era of advanced obesity medicines. No doubt, different patients will need different approaches. This is both a chronic and heterogeneous disease.

So the 18th Century witticism of Lady Mary Wortley Montagu is indeed correct: “General notions are generally wrong.”

Click here for the report from Epic Research, here and here for further reports on it. For further perspective on weight regain, click here and here.

Design for the Numbers 1 Through 9, heliography by Theo van Doesburg / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


January 25, 2024

2 Responses to “Real World Data Say Not Everyone Regains All Their Weight”

  1. January 25, 2024 at 9:06 am, Angie Golden said:

    It seems as if they would like to imply that metabolic adaptation is not occurring in a majority of people. Yet their data is so incomplete. If someone stops one medication and starts another it is not a surprise that weight regain is mitigated. Fatima Cody Stanfords work post bariatric surgery has demonstrated this quite elegantly. The surgery literature has been showing 35% of people post surgery have no weight regain but 65% DO. So we need real peer reviewed data with answers for why SOME people done have weight regain. Even in the clinical trials where medication was stopped for Wegovy and Zepbound weight regain began very quickly, perhaps not all weight is regained but there doesn’t seem a signal that there are people that continue weight loss in the trials after treatment stops. That is true for other chronic diseases when treatment is stopped – why would we think obesity is different.

    • January 25, 2024 at 3:19 pm, Ted said:

      Like you, I know that the chronic disease of obesity requires chronic treatment. But these are just snippets of real world data. They do not show that people maintain their weight loss without further treatment. They just show that, one way or the other, after they discontinue treatment with a GLP-1, many people find a way to maintain a lower weight. This data tells us nothing about how they did so. This is why I wrote “By no means is this the final word on the subject of weight regain after stopping a GLP-1” and “there are many unanswered questions.”