A few posts ago, I discussed the fact that—absent a change— complete weight regain is the usual expectation for those who discontinue treatment with injectable weight-loss medicines. Only a small number of clinical trials involving these meds put in the effort to track patients after the treatment phase ended. The few that did failed to follow participants long enough to understand the weight-regain story.
There is a huge amount of interest in finding a way to maintain weight-loss from Zepbound and Wegovy therapy after the drugs are stopped. Personally, I think maintaining long-term weight loss after stopping the meds will prove impossible.[i] It is also interesting to me that we care about it. I mean, nobody is wracking their brains searching for ways to keep cholesterol down after stopping Lipitor. We just take Lipitor. The strange urgency to escape applies only to obesity medication. This phenomenon seems like evidence that, alas, there is still a stigma attached to obesity and obesity treatment. For some reason, we can’t stop regarding obesity as different from other chronic health problems.
In any event, nobody has yet figured out how to do it.[ii] Nonetheless, some of the strategies that have been tried so far are worth looking at. Besides being interesting in and of themselves, they also provide an opportunity to see why it’s important to dig into the details of clinical studies. “Reading the fine print” as such is necessary to know whether the study’s conclusions are believable.[iii]
Dose Tapering
Dose tapering (“weaning”) is the idea that you can discontinue weight-loss medication without total loss of effectiveness if you withdraw it very, very slowly. Is it logical that it would work? Not really. It’s reminiscent of a stand-up bit by comedian Sebastian Maniscalco, wherein he describes how he uses a “soft release” when placing too-heavy luggage on the scale at the airport. He points out the humorous absurdity of trying to trick a scale into thinking a bag doesn’t weigh what it weighs. Normally, we reduce the dose of medicine when we want less effect, not when we want it to stay the same.
Even though tapering to zero is talked much about, no prospective clinical trials have tested it. I found a single retrospective study[iv] out of Denmark in which the authors initially claimed[v] to have successfully tapered some 240 people down to zero, without subsequent weight regain[vi], by using the study sponsor’s proprietary app (Embla™).
The authors presented their taper data at the European Congress on Obesity, in 2024. At the conference, they presented data showing that they tapered 240 patients down to zero semaglutide with no weight regain. These tapered-to-zero patients were followed for 26 weeks, during which they did not exhibit weight regain. At the end of 26 weeks, a bunch of them went back on semaglutide. The reasons they resumed medication were not given.
Twenty-six weeks is only six months, which is a fleeting time considering the usual scope of weight-loss trials. We know from clinical trials of intensive lifestyle-modification programs (think “boot camp”-like programs) that it’s possible to browbeat a group of people into losing significant amounts of weight for six months.[vii] The Embla company obviously had a lot to gain by demonstrating successful taper, and it’s not difficult for me to imagine the patient-facing staff being highly motivated—perhaps even financially compensated—to cajole, bribe, and harry their assigned patients across the finish line at the desired weight. The fact that many of those patients resumed semaglutide as soon as they were allowed reinforces the idea that there was some kind of “race to the finish line” going on there, but who knows.
Despite the short duration and general sketchiness of the taper arm, in a press release Embla ApS put out at the time, the Chief Medical Officer, Dr. Henrik Gudbergsen, declared, “The combination of support in making lifestyle changes and tapering seems to allow patients to avoid regaining weight after coming off semaglutide.” Dr. Gudbergsen’s statement gives the impression that tapering unequivocally works, maybe even in the long term. In any event, he sure didn’t go out of his way to highlight the bad news—the short duration of the supposedly successful tapering experiment and many participants’ prompt return to semaglutide after 26 weeks.
Now, the Embla ApS corporation may be a bunch fine, ethical fellows. I don’t have grounds to assert otherwise. But, I will say that it pays to be suspicious of studies that are funded by corporations with an obvious interest in a particular outcome. That warning goes double when such studies unexpectedly find said desired outcome. I don’t think this trial can be taken as evidence that successful taper in real-world conditions is possible.
To be continued!
[i] Obesity has been studied as thoroughly as any other disease in medicine. There are more than ten thousand clinical trials looking at obesity treatments from the era predating the injectable medications. Most of those treatments involve a diet of some kind combined with some other therapeutic intervention, like medication, cognitive-behavioral therapy, hypnosis, etc. If you spend an afternoon perusing those studies, you’ll see that (1) there are a host of different diets that help obese people lose weight temporarily, and (2) the number of trial participants that are below their starting weight three years into the trial is almost zero.
[ii] I’m not sure it’s rational to expect to find a way to extend these drugs’ effectiveness after they are stopped. I mean, nobody has suggested it’s possible to sustain the effects of any other drugs after they are discontinued. It may be a fool’s errand.
[iii] Sometimes they are baloney.
[iv] Seier S, Stamp-Larsen K, Jensen SBK, Torekov SS, Gudbergsen H. Treat to target in weight management with semaglutide: Real-world evidence from an eHealth clinic. Diabetes Obes Metab. 2025 Dec;27(12):6979-6987. doi: 10.1111/dom.70096. Epub 2025 Sep 3. PMID: 40903862; PMCID: PMC12587240.
[v] The authors initially presented this study at the European Congress on Obesity in 2024, at which time they presented data showing that they tapered 240 patients down to zero semaglutide with no weight regain. When the study results were published in a peer-reviewed journal in 2025, the mention of patients successfully tapered off medication had been removed.
[vi] For just twenty-six weeks.
[vii] Think “The Biggest Loser.” The problem with intensive or immersive lifestyle-mod programs is that eventually everybody has to return to real life. When they stop living the bootcamp lifestyle, regain occurs.