Glucagon-like peptide-1s (GLP-1s), a class of medications that includes semaglutide (sold as Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound), have become widely used for weight management.¹ Clinical trials and research have shown substantial weight loss during the first year of treatment.²,³ Less is known about what happens to weight among people who remain on a GLP-1 beyond a year, such as whether the weight loss they achieved in the first year was maintained or regained with continued use. Understanding this trajectory in everyday practice can help patients and clinicians set realistic expectations for long-term therapy.
We studied 25,213 U.S. adults without diabetes who started a GLP-1 medication, stayed on it continuously for at least a year, and lost at least five pounds during that first year. We then tracked their weight at monthly checkpoints from 13 to 24 months after starting treatment, measuring how much of each patient’s first-year weight loss was maintained or regained. Patients were followed only while they remained on the medication; anyone with a gap of more than 60 days between prescriptions was no longer counted from that point forward.
Among adults without diabetes taking semaglutide, weight loss in the first year was largely maintained through the second year, with regain occurring slowly. One month past the one-year mark, 83.8% had held their weight steady and 9.0% had continued to lose; only 7.2% had regained at least a quarter of their first-year loss. Over the following year, that regain share rose gradually to 14.9%, while the steady-plus-continued-loss share remained the large majority (85.0% at the two-year mark). Full return to baseline weight remained rare, ending at 1.5%. Because patients were followed only while they stayed on semaglutide, those still being measured at later checkpoints reflect people who tolerated and responded to the medication, which may make weight-loss retention look more favorable than it would in a group that included those who discontinued treatment.
Patients on tirzepatide without diabetes maintained their first-year loss even more consistently than semaglutide patients. At one month past the one-year mark, 89.0% had held steady and only 4.2% had regained at least 25% of their weight loss. By the two-year mark, 52.9% remained steady, and a notably large 39.3% were still losing weight, while meaningful regain reached only about 8% and full regain to baseline remained at or below 1% of the population. As with semaglutide, this favorable picture partly reflects that the patients at later months are those who stayed on the medication, so the figures describe weight trends among continuing users rather than everyone who ever started.
