This is the question that sits in the back of a lot of minds: what happens if I stop? The research on this is more direct than most topics, so let me give you what the trials actually found, then the part that is in your hands.
What the withdrawal trials show
Two studies tell the core story. In the STEP-1 trial extension, participants who had lost weight on semaglutide and then came off it regained a large share of the lost weight over the following year, and much of the improvement in cardiometabolic markers drifted back toward baseline as well (Wilding et al., 2022). In the STEP-4 trial, people who continued treatment kept losing and settled at roughly a seventeen percent reduction over the full study, while those switched to placebo at week twenty steadily regained (Rubino et al., 2021).
The honest read: the research points to significant weight regain as the common pattern after stopping, and it is not a matter of willpower failing. These medications change appetite signaling while you take them. Remove them and that signaling largely returns to where it was, which means hunger and food noise can come back.
Why this is not a moral failing
It helps to frame regain correctly, because people are hard on themselves about it. The biology that made the weight come off is partly the medication's effect on appetite. When that effect ends, the underlying drivers reassert themselves. Regaining under those conditions is a physiological response, not a character flaw. Understanding that is not an excuse to be passive. It is the correct starting point for planning.
The part that is in your hands
Here is where the story is not fully written by the drug. Two things shape what happens after, and both are worth building now rather than later.
First, muscle. If you spent your losing phase also building or protecting lean mass through resistance training and adequate protein, you finish with more muscle, and muscle raises the amount of energy your body burns at rest. That is a structural advantage that does not evaporate the day you stop. The training you do now is partly an investment in the after.
Second, habits. The eating and activity patterns you actually practice while on the medication are the ones you carry off it. If the losing phase was purely the drug doing the work while nothing changed underneath, there is little to stand on afterward. If you used the window to build durable habits, you have a foundation. The medication can be the thing that makes new habits possible by quieting the noise long enough to practice them.
The conversation that matters most
Whether, when, and how to stop or continue is a medical decision, full stop. The trials show continuation maintains the result and stopping usually brings regain, but the right path depends on your health, your goals, and your prescriber's judgment. Do not stop or change a medication based on an article. Use the research to ask better questions at your next appointment.
References
Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564.
Rubino D, Abrahamsson N, Davies M, et al; STEP 4 Investigators. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414-1425.