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Here's a question I'm asked nearly every day: If I start semaglutide, do I have to stay on it forever?

Short answer: Yes

Real answer: It depends.

It depends on where you are in your health, what your goals are, and if you are open to changes.

So let's say you're 100 pounds over weight and it was caused by a medication side effect. Then yes, you will likely need to be on the medication long term. Since the weight gain was not caused by habits but as a medication side effect, then the metabolic disruption will need long term therapy to undo.

Another scenario is that you've been in a high stress situation and focused your time on crisis management, and left food to take out and never exercised. Think going through a divorce. But the stressor has ended and you are now able to get back into a healthier place. Maybe you have closer to 25 pounds to lose from this stressful event. In this case, you would make significant lifestyle changes by eating clean and exercising routinely, coupled with reduced stress overall. The semaglutide here would be temporary to help you achieve your goals, and then once you are maintaining your new weight well we would try stopping it.

A third scenario is that you've been over weight your entire life, this is how your family is as well, and you suspect it's a combination of genetics and family/cultural habits. This one can go either way. You might be so encouraged by the weight loss that you make significant lifestyle changes and no longer need the medication to help you maintain your new healthier weight. Or you may continue to live your life as you always have and rely on the medication to tell you when you need to stop eating. This would mean stopping the medication would result in regain.

Then there's the evolving data on this topic. It turns out that when people stop the GLP-1, about one third will continue losing weight, about one third will hold steady and neither gain or lose more, and one third will regain weight. So there's a lot more going on here than just calories in/calories out. We're talking about resetting metabolic hormonal balance.

A final thought here is that these medications are being developed at a rapid pace and new formulations are on the way. Some of the more powerful newer options may not require long term use for maintenance. With that said, there's no commitment to trying the GLP-1 class of medications for weight loss. You can stop at any time, and perhaps you'll be in the lucky 2/3 of people who don't have significant regain.

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