The Maintenance Phase

Maintenance phase on GLP-1 means you've hit your weight goal and now focus on keeping it. Instead of losing more, you work to hold your progress and stop the weight from creeping back.

You’re not chasing progress now. You’re defending it. Many say this is the hardest part.

The Maintenance Mode Is Different Game

When you first start a GLP-1 medication, life accelerates. Every week brings a new discovery: a sudden shift in hunger, a surprising side effect or a milestone that once seemed impossible. The journey can become all-consuming, a full-time job for your body and mind.

There is the constant tracking, the learning, the adjusting. You connect with communities of people who just get it. It feels vital to track everything, to share insights, to help those walking the same path just a few steps behind you.

But then, something shifts. You move into Maintenance mode, and the sense of urgency begins to fade. Your days are no longer centered around dosing schedules or analyzing every tiny weight fluctuation. The process stabilizes. Your body adjusts. Your mind, blessedly, is no longer preoccupied with food.

The very thing that demanded so much of your attention becomes just another part of your life, rather than its defining feature. And honestly? At first, this quiet can be unsettling. After being so immersed in the fight, the peace can feel like a void. There's a lingering sense of obligation to keep sharing and engaging with the same intensity.

This doesn't mean the journey wasn't important. It simply means the goal was never to stay in the process forever. The goal was to get here: to a place of stable health, a free mind, and a life that has expanded beyond the confines of weight and hunger.

But it's a completely different story now, one focused on not losing your new body to your old cravings.

Why Maintenance Can Feel Like the Toughest Part

The goal to lose weight is now behind you. This new stage has a different set of key factors to think about, which go far beyond what the scale shows.

There is the persistent concern about regain - the thought that the "food quiet" might fade and old habits could return. Alongside this is the question of tolerance, wondering if the medication will remain as effective over the very long term. The idea of navigating those old challenges again can feel daunting.

Accepting that obesity is a chronic condition and that GLP-1 may be a long-term part of your treatment is a difficult shift. It means letting go of the idea of a finish line and stepping into ongoing care. This realization brings up expected money and practical questions: "Can I pay for this forever?" "Will my insurance keep paying for it?". You might worry about losing a tool that's become so important to your health.

What the Research Says About GLP-1 Maintenance

The medical consensus is clear: obesity is a chronic disease and when an effective treatment is withdrawn, the underlying condition tends to return.

Here is my brief review of all available studies and their findings on the maintenance phase. I've included links so you can explore further.

✓ Weight maintenance on cost‐effective antiobesity medications after 1 year of GLP‐1 receptor agonist therapy: a real‐world study (2024)

Focus: Evaluated whether patients who lost weight on GLP-1 could maintain weight loss using older, generic antiobesity medications after stopping GLP-1 therapy.
Maintenance Outcomes: Patients who transitioned to generic antiobesity medications after 1 year of GLP-1 therapy maintained their weight loss, with some even showing further reduction. Suggests cost-effective maintenance is possible after initial GLP-1-induced weight loss.

✓ Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined: a randomized controlled trial (2024)

Focus: Investigated if weight loss and improved body composition are better sustained 1 year after stopping GLP-1, exercise, or both.
Maintenance Outcomes: Weight regain was significantly less in those who combined GLP-1 with supervised exercise versus GLP-1 alone. Combination therapy helped more participants maintain ≥10% weight loss after stopping medication.

✓ Continued Treatment With Tirzepatide for Maintenance of Weight Reduction (2023)

Focus: Randomized trial examining tirzepatide’s effect on maintaining weight loss after initial reduction.
Maintenance Outcomes: Continued tirzepatide use was associated with sustained weight loss during the maintenance phase, highlighting the need for ongoing therapy to prevent regain.

✓ Real-world persistence and adherence to glucagon-like peptide-1 receptor agonists among obese commercially insured adults without diabetes (2024)

Focus: Assessed persistence and adherence to GLP-1 in maintenance users without diabetes.
Maintenance Outcomes: Persistence at 1 year was 32.3% overall, but higher for semaglutide (47.1%) than liraglutide (19.2%). Adherence is a challenge, especially in long-term maintenance.

✓ Impact of Glucagon-Like Peptide 1 Agonist Deprescription in Type 2 Diabetes in a Real-World Setting: A Propensity Score Matched Cohort Study (2024)

Focus: Evaluated effects of stopping GLP-1 therapy after initial success, with continued nutrition therapy support.
Maintenance Outcomes: No significant difference in weight or HbA1c at 12 months between those who stopped and those who continued GLP-1, if intensive nutrition therapy was maintained.

There is also an interesting analysis from Epic, the electronic health records company. Looking at over 20,000 patients, they found that a majority (56.2%) either maintained their weight or continued to lose weight after discontinuing semaglutide or liraglutide.

While this large-scale report is not peer-reviewed and doesn't yet explain the factors behind these different outcomes, it provides a significant counterpoint to the common assumption of automatic weight regain.

In the next post, I'll cover concrete strategies that can carry you through the GLP-1 Maintenance. This phase is hard, but with the right approach, it’s not just doable. It’s sustainable.

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Disclaimer: The information in this article is based on the author's personal experience and research. It is not intended as medical advice. Please consult with a qualified healthcare professional before making any decisions about your health or treatment plan.