For years, weight loss has been a monumental struggle for millions of Americans. Endless fad diets and pseudo-scientific advice columnists have made it difficult for many to discern what’s real when it comes to effective weight loss strategies. Simple approaches like increasing activity levels and watching what we eat, though effective, are not so easy when we are short on time and constantly being bombarded with persuasive advertising for delicious treats. The problem can seem intractable.

Cue Ozempic, a brand-name formulation of semaglutide that entered the market as an anti-diabetic medication. Since its days of off-label prescription for weight loss, it has reached acclaim and popularity (and FDA-approval for weight loss under other formulations and branding) through its widespread promotion and use by prominent media figures as a quick and easy way to cut pounds.

It seems even the manufacturers of Ozempic, Novo Nordisk, had trouble predicting their product’s massive popularity, as supplies have regularly struggled to meet demand. Now, significant numbers of Ozempic patients may find they are forced with the prospect of coming off this drug, and potentially winding up back at square one when it comes to weight loss.

Our Bodies on Ozempic

Semaglutide, the active chemical in Ozempic, is known to scientists as a GLP-1 receptor agonist. This fancy term means that it triggers receptors in the body that play roles in digestion and metabolism. Specifically, it stimulates the release of pancreatic insulin, slows the digestion process, and reduces glucose production from other sources in your body.

The net effects of Ozempic’s GLP-1 receptor agonism are several. For diabetics, the primary benefits are an improvement in overall blood sugar control through better insulin sensitivity and reduced glucose release. A reduction in the incidence of cardiovascular disease in type 2 diabetics has also been reported in those taking it.

For others, namely those taking Ozempic to help lose weight, they primarily enjoy the reduction in appetite that this drug can cause. As a result, these patients tend to full more full more often, crave carbohydrate-rich foods less often, and consume fewer calories overall. When compounded over an extended period of treatment with Ozempic (and combined with other lifestyle interventions), patients can lose substantial amounts of weight that they would have otherwise struggled immensely to achieve.

Our Bodies Off Ozempic

Due to its popularity, regular reports have indicated manufacturers are having trouble matching supply of these medications to their outsized demand. Ozempic shortages might force some users into a position where they need to contemplate cutting back or stopping their treatment altogether.

Others might wish to cease treatment for other reasons – perhaps they are experiencing negative side effects that no longer justify the benefits, or perhaps they simply have reached their goal weight and no longer feel the need for medical assistance with weight loss.

Regardless of the reason why someone might wish to come off of Ozempic, doing so is a significant decision that will almost certainly correspond to changes – some of which may not be welcome. However, this is not true across the board for everyone. Taking Ozempic can itself be a source of unpleasant side effects, in which case discontinuing the medication can lead to an improvement in those respects. Nausea, fatigue, and “Ozempic face” (a condition where the patient’s facial skin begins to sag due to a loss of structural subcutaneous fat) are all examples of potential Ozempic side effects that may be altogether reversed upon discontinuing treatment.

But just as some negative side effects may disappear, so too will the desirable effects of the medication likely cease. This is to be expected; after all, Ozempic does not cure anything, it merely manipulates the endocrine system in a way that can provide favorable metabolic conditions for some patients. When the medication disappears from the body, the endocrine system will begin to revert towards its baseline, including its problematic aspects that caused trouble in the first place.

Described below are some of the less-desirable effects one might look for when discontinuing Ozempic:

Reappearance of cravings and appetite

Many patients who take Ozempic for weight management initially became overweight by eating excessive amounts of calories for extended periods of time. Those individuals who realized weight-loss success with Ozempic likely did due to its ability to suppress appetite by manipulating the body’s endocrine system allowed them to change these eating habits. As the drug takes effect, many patients report that they lose the constant urge to eat, and no longer have to battle cravings or flex their willpower in a losing struggle against temptation.

Unfortunately, without Ozempic, the relief it provides from cravings and an oversized appetite will almost surely return. Patients may once again find themselves locked in a mental struggle to ignore or resist the strong messages from their bodies to consume more food. And, since any behavioral habits or force-of-will they developed pre-Ozempic have most likely atrophied from a lack of necessity throughout their treatment, they may even have a more difficult time with their appetite than before.

Weight gain

Based on the expected return of one’s appetite post-Ozempic, one could intuitively predict that a sharp increase in weight would likely closely follow. Hard data on this is limited, but at least one study supports this hypothesis. The study checked in on former Ozempic patients and found that two-thirds of them had regained any weight they had lost since discontinuing.

However, none of this is inevitable. If the prospect of weight gain causes you distress, there may be other strategies you can put in place to help you regulate your eating and weight once you stop taking the medication.

Blood sugar spikes

We must not forget that weight loss is not the only reason why people might be taking Ozempic, nor is it even the original purpose for the medication. From its origins, Ozempic was developed and marketed as an anti-diabetic medication for the treatment of type 2 diabetes in adults. It is still effective as such for many adults with type 2 diabetes and has come to form a vital part of their overall diabetes management plan.

The unfortunate reality for these patients is that, like patients taking Ozempic for weight management, discontinuing it will cease any further therapeutic benefits. This means that diabetics may notice a sudden dysregulation in their blood sugar and a tendency for their blood sugar levels to spike dramatically where they would normally be more stable.

Careful monitoring and supervision from a doctor should accompany any patient’s discontinuation of a medication, but this is especially salient for type 2 diabetics discontinuing Ozempic. Strategies should be in place prior to discontinuation to mitigate the potentially harmful impacts of dysregulated blood sugar.

Mitigating the Negatives

Ozempic may have been a very helpful tool in helping you achieve the results you wanted regarding weight loss, but it is not the only tool at your disposal. There are many other tried-and-tested strategies that may prove effective for individuals absent Ozempic. As always, the best course of action, and the only one we recommend, is to speak to your healthcare provider to strategize around how you will handle ceasing Ozempic. However, you may wish to discuss some of the following items with your healthcare provider when doing so.

Dietary changes

At the risk of over-simplification, most weight loss and weight gain can roughly be boiled down to a net calorie deficit or surplus, respectively. For Ozempic patients who used the drug for its appetite-suppressing effects, careful control over the amount of food one consumes post-Ozempic can be a major source of success in limiting rebound weight gain. For many, this is easier said than done, and we acknowledge that being told to simply eat less when you have a chronic weight struggle can sound patronizing and dismissive. However, there are highly effective resources, such as professional advice from a dietitian, regarding how to build a dietary approach that can work for your needs. For some patients, simply learning more about the caloric contents of their favorite foods and on how certain macronutrient balances can impact satiety or energy levels throughout the day can be enough to make a difference on the scale.

For diabetic patients, dietary changes can also be a helpful mitigation plan, but the specifics might not look the same. The focus for diabetics will probably be more aligned with controlling the intake of carbohydrates in order to achieve smooth and sustained blood sugar levels throughout the day. Consult a dietitian or your doctor for more advice on how best to suit your diet to your diabetes – this applies even to diabetic patients not worrying about Ozempic.

Physical activity

In the net calorie equation (calories consumed minus calories burned), physical activity can largely dictate the value of calories burned throughout the day. Granted, even a comatose patient will burn some number of calories simply keeping their basic bodily functions active (respiration, digestion, and circulation all consume energy, for example) – this is referred to as the basal metabolic rate (BMR) and it is not particularly high. However, physical activity can significantly boost the number of calories a person’s body burns throughout the day, often doubling the overall value from the BMR alone.

The takeaway, then, is that increasing your physical activity levels can drastically affect the net calorie balance. For most people struggling with weight, this can significantly impact how quickly they regain their weight after discontinuing Ozempic. However, we must give a few caveats to this.

First, you cannot outrun a bad diet. The amount of energy needed to burn off a couple slices of pizza is equivalent to the amount burned by walking roughly 10,000 steps – more than many people take in an entire day. Betting on exercise as a way to counter overeating is therefore almost destined to fail. Exercise is still important, and has many non-weight related health benefits, but its potential must be seen realistically.

Second, exercise can cause problems of its own. It can be tempting when starting a new training routine to go all out right from the start, but this can be a recipe for injury, particularly if we are starting out of shape or significantly overweight. Remember to take things slow and steady and consult with a healthcare professional about how to exercise safely.

Other lifestyle factors

Stress and sleep are two often overlooked factors that can profoundly affect your health in almost every other area of life. Diabetes management and weight loss are not exceptions to this.

Make sure you are not sacrificing a sound night’s sleep, as insufficient sleep can lead to cortisol spikes, appetite de-regulation, and a lack of energy needed to be physically active.

Stress too can elicit strong increases in cortisol levels, leading to emotional eating and blood sugar dysregulation. Be sure you are identifying stressors in your life and adopting strategies to mitigate or cope with these elements.

Medical alternatives

A well-balanced lifestyle is an indispensable core to a healthy life, but it doesn’t have to be the only tool at your disposal. If you are contemplating discontinuing Ozempic for any reason, consider speaking to your healthcare provider to explore alternative medical treatments for whichever underlying condition you were taking it for. Other anti-diabetic medications and weight loss aids may be available that your doctor might feel are appropriate for your needs such as Trulicity, Mounjaro, Victoza and Saxenda.

In fact, we should stress that discontinuing Ozempic without a doctor’s clearance and supervision is strongly discouraged. The effects of suddenly discontinuing a medication can be drastic and should be managed by a medical expert.