Biggest Ozempic mistake people make once reaching their ‘goal weight’ that piles pounds back on: DR SHEILA reveals how to avoid unstoppable GLP-1 phenomenon

One of the most common questions that I receive from the patients on GLP-1 weight-loss medication is: ‘When should I stop taking them?’

My answer often surprises them: I don’t recommend stopping at all.

The biggest mistake many GLP-1 users make is assuming that they’ll reach their goal weight and return to their ordinary lifestyles. But the number on the scale doesn’t mark the finish line.

Obesity and weight regulation don’t work that way.

I know that firsthand.

After losing 13lbs on GLP-1s, I stopped taking the medication for approximately two months and during that time, I gained all the weight back.

Then, when I restarted treatment I found that I needed a higher dose than before to achieve the same effect. The medication simply didn’t ‘hit the same’ as it had before. I cannot say why this occurs, studies of this phenomena have yet to be undertaken. But I have seen this effect both in myself and my patients.

As a board-certified plastic surgeon and physician who routinely prescribes GLP-1s to patients through my practice Physique26, I have seen this phenomenon repeated again and again.

This cycle of stopping and restarting can be frustrating, emotionally draining and ultimately more expensive than maintaining a lower dose.

That’s why I developed a different strategy at my practice.

We call it ‘microdosing.’

Once patients reach their desired weight, I gradually reduce them to the lowest dose that allows them to maintain their results.

The goal isn’t continued weight loss. The goal is weight stability. I’ve been microdosing for roughly 18 months and the number on my scale has remained the same.

This approach allows many patients to preserve the health benefits they’ve achieved from GLP-1s while minimizing medication exposure and cost.

Of course, there are exceptions.

Occasionally, I recommend stopping treatment if a patient is becoming excessively thin (one extreme user was down to barely 100lbs), losing too much muscle mass, experiencing negative side effects or chasing a goal weight that is no longer healthy nor even achievable.

As a physician, my responsibility is not to help patients become the thinnest version of themselves. My responsibility is to help them become the healthiest version of themselves.

But, as a doctor, I must also recognize that not everyone wants to use GLP-1s in a rational way.

The recent trend toward ‘Ozempic skinny,’ for instance, has created unrealistic expectations. But being underweight is not healthier than being overweight.

Extreme weight loss can carry its own risks, including nutritional deficiencies and reduced bone density. Anecdotal evidence has also linked some GLP-1s to manifestations of eating disorders such as anorexia.

But even with all of these potential risks, I believe that when GLP-1s are prescribed responsibly and patients are treated appropriately, the drugs can be lifesavers and life-changing.

Emerging research suggests GLP-1s may reduce the risk of certain obesity-related cancers. Studies have also demonstrated significant cardiovascular benefits, including reductions in heart attack and stroke risk. Researchers are actively investigating potential protective effects against neurodegenerative diseases, such as Alzheimer’s disease, as well.

So, when patients ask me when they should stop their GLP-1 medication, my answer is often another question: ‘Why would you stop something that’s working?’

If a patient is at a healthy weight, feeling great, maintaining muscle mass, tolerating the medication well and experiencing meaningful health benefits, I generally prefer microdosing rather than discontinuing treatment altogether.

The future of weight management may not be about getting off these medications but learning how to use them intelligently for the long haul.