By Trace Curry, MD — Medical Director, JourneyLite
Over the past two years, GLP-1 medications (injectable and oral semaglutide/tirzepatide) have helped many patients jump-start weight loss. But a new systematic review and meta-analysis in The British Medical Journal (BMJ) just answered a question that really matters for long-term planning: What happens when you stop the medicine?
TLDR: on average, people regain weight quickly after discontinuing anti-obesity medications, and the improvements in blood pressure, lipids, and glycemic markers tend to slip back, too. That has big implications for both health and total cost of care.
What the BMJ study found (and why it matters)
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- The meta-analysis pooled 37 studies (~9,300 adults) and showed that after stopping anti-obesity meds, people regained ~0.4 kg (≈1 lb) per month on average, returning to baseline weight in under two years. Cardiometabolic gains reverted in roughly 18 months.
- For GLP-1–class drugs specifically (semaglutide, tirzepatide), regain was faster—~0.8 kg (≈1.8 lb) per month—with modeling projecting a return to starting weight in about 1.5 years off therapy.
Takeaway: GLP-1s work very well while you’re on them, but obesity is a chronic, relapsing disease. Stopping the drug commonly leads to rapid regain—faster than what’s seen after ending structured diet/exercise programs.
The cost reality: subscription vs. one-time investment
If the average patient needs ongoing GLP-1 therapy to maintain results, the economics start to look different:
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- Even at “discounted” prices, a GLP-1 plan often nets hundreds of dollars per month (pharmacy pricing varies widely by drug/coverage). Two years of therapy can easily total several thousand dollars; five years can exceed the typical self-pay price of a sleeve gastrectomy.
- By contrast, gastric sleeve is a one-time procedure. At JourneyLite, our transparent self-pay programs are designed to be all-in and predictable. (Insurance benefits, if available, may reduce costs further.)
This isn’t to say medications are “bad.” In fact, we use GLP-1s a lot—as a bridge to surgery, as an adjunct after surgery, or as a primary tool when surgery isn’t appropriate. But if you’re weighing years of monthly pharmacy costs against a single, definitive intervention, surgery often becomes the more cost-effective path to long-term control.
The BMJ data strengthens this point: if stopping meds commonly leads to rapid weight and risk-factor rebound, then the default plan for patients using GLP-1s should be ongoing therapy—and that’s a subscription cost model.
Health durability: what tends to “stick”
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- Surgery (e.g., sleeve, bypass, SADI) changes GI anatomy/hormones in a way that generally produces durable weight loss and metabolic improvements across many years when paired with follow-up and lifestyle care.
- Medications can be highly effective, but the benefits are tightly linked to continued use. When therapy stops, regain is common and cardiometabolic benefits fade—that’s exactly what the BMJ meta-analysis documents.
So which is “better”?
The right tool depends on your medical profile, goals, and resources:
Choose a surgical path if you want:
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- A one-time intervention with the strongest long-term weight and diabetes remission data across populations.
- A solution that’s typically more economical over years compared with continuous GLP-1 therapy.
- Structured follow-up with our surgical bariatric team (nutrition, labs, support groups).
Choose a medication path if you want:
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- A non-surgical start, or if your risk profile makes surgery inappropriate right now.
- A bridge to surgery (pre-op weight loss, NASH improvement), or a maintenance tool after surgery.
- Flexibility to trial response—but budget for ongoing therapy if you want to keep the results.
Often, the best plan is combined and staged: use GLP-1s to stabilize, then proceed to a sleeve when you’re ready—or have surgery first and keep GLP-1s in your back pocket for future tune-ups.
My practice advice (what we do at JourneyLite)
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- Start with a consultation with myself or Dr. Augusta. We’ll map your risks, medications, and goals.
- Model your 2–5 year costs side-by-side (meds vs. surgery), including likely insurance effects.
- Pick the plan that you can stick with—clinically and financially.
- Stay followed. Long-term success comes from routine visits, dietitian support, labs, and having an adjunct (like GLP-1s) ready if needed.
Bottom line
The new BMJ analysis makes one point crystal clear: when GLP-1 therapy stops, weight (and health risks) tend to rebound quickly. That means many patients will either need indefinite medication or should consider a definitive surgical option for durability and value. If you’re comparing paths, surgery is often the more reliable—and ultimately cheaper—way to achieve and maintain meaningful weight loss.
Let’s personalize this to you
If you’re deciding between oral/injectable GLP-1s and sleeve surgery, we’ll run your personalized clinical + cost scenario and build a plan that fits your life.
Request an appointment: https://journeylite.com/appointment-request/
