Coming Off Mounjaro or Ozempic: How to Keep the Weight Off

I get asked this a lot now. “What happens when I come off the jab?” These medications have helped plenty of people lose weight they’ve struggled with for years, and nobody wants to lose two stone and put it back on. So here’s what the research says, why it happens and what you can do about it.

What happens when you stop

A big review in The BMJ looked at 37 studies and over 9,000 adults. On average, people regained about 0.8kg a month after stopping semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro). At that rate, most would be back at their starting weight in around 18 months. That’s faster than the regain after stopping a diet or lifestyle programme.

Then there’s a trial called SURMOUNT-4. Everyone took tirzepatide for 36 weeks and lost an average of 21% of their body weight. Half then carried on, and half were switched to a dummy injection. The ones who carried on lost another 5.5%. The ones who stopped put back 14% within a year, and only 1 in 6 of them kept most of their weight loss.

To be fair, the researchers say these timelines are projections and there isn’t much long-term data yet. It doesn’t mean everyone regains everything. But the message is clear: stopping with no plan usually means the weight comes back.

Why the weight comes back

• Hunger comes back. The jab turns down your appetite and the constant thinking about food. When it stops, that noise often returns within weeks.
• Muscle gets lost along the way. In the big trials, somewhere between a quarter and 40% of the weight lost was classed as lean mass. Some of that is water rather than muscle, but it’s enough to matter. Less muscle means you burn less each day and feel weaker. I wrote more about this in my post on Ozempic muscle loss after 40.
• The habits haven’t had time to form. If food was easy to ignore, you may not have built the routines that keep things steady once the jab stops.

How to give yourself the best chance

Start before you come off, not after.

• Strength train two to four times a week. This is the single best thing you can do. In one review of older adults, resistance training prevented about 93% of the muscle loss that comes with eating less. Keep it simple: a squat, a hinge, a push, a pull and a carry, and add weight over time.
• Eat enough protein. Aim for around 1.2 to 1.6g per kilo of body weight a day. When your appetite is low it’s easy to fall short, so build every meal around it. My post on protein after 40 shows you how.
• Walk every day. Pick a step target you can hit on a bad day and build from there. It protects your joints, burns energy and is easy to keep going for life.
• Plan the handover. Going from a suppressed appetite to a normal one overnight is a big jump. Speak to your prescriber or a dietitian about how to step down and bring food back up gradually.
• Look after your sleep. Poor sleep and high stress both turn the hunger up. It isn’t exciting, but it matters.

What to track

Don’t live on the scale. Weigh yourself once or twice a week and look at the average. Keep an eye on your waist, how your clothes fit and what you can lift. If your strength is going up and the scale is steady, you’re winning.

The bottom line

Stopping a weight-loss jab doesn’t mean you’ll put everything back on. But the research is clear that, on average, the weight comes back quicker than people expect, and it comes back fastest when there’s no plan. Muscle, protein, walking and a proper handover with your prescriber tip the odds your way.

This article is general information, not medical advice. Speak to your prescriber before making any changes to your medication.

Neil McGuigan is a personal trainer with 18+ years of coaching behind him and a background representing Ireland in international athletics, working with men and women over 40 across UNTIL Soho, Marylebone, Liverpool Street, and Canary Wharf.