---
type: source
title: "Metabolic Rebound After GLP-1 Receptor Agonist Discontinuation: Systematic Review and Meta-Analysis"
author: "Tzang et al. (Lancet eClinicalMedicine)"
url: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00614-5/fulltext
date: 2025-09-01
domain: health
secondary_domains: []
format: journal-article
status: processed
processed_by: vida
processed_date: 2026-04-08
priority: high
tags: [GLP-1, discontinuation, metabolic-rebound, weight-regain, cardiovascular, adherence]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

Lancet eClinicalMedicine systematic review and meta-analysis: 18 randomized controlled trials, n=3,771 participants. Key findings:

- Mean weight gain after GLP-1 discontinuation: 5.63 kg
- 40%+ of weight lost with semaglutide regained within 28 weeks of stopping
- 50%+ of weight lost with tirzepatide rebounds within 52 weeks
- Pre-treatment weight levels predicted to return in <2 years after stopping
- Metabolic parameters reverse: waist circumference, BMI, systolic blood pressure, HbA1c, fasting plasma glucose all deteriorate
- Cardiovascular markers (cholesterol, blood pressure) also reverse post-discontinuation

STEP-10 and SURMOUNT-4 trials cited: substantial weight regain, glycemic control deterioration, and reversal of lipid/blood pressure improvements following treatment withdrawal.

Second Lancet eClinicalMedicine study (trajectory meta-regression, 2026): Nonlinear meta-regression of weight regain trajectory after GLP-1 cessation, confirming prediction that pre-treatment weight levels return within <2 years.

BMJ Group summary: "Stopping weight loss drugs linked to weight regain and reversal of heart health markers."

Individualized dose-tapering approach can limit weight regain but long-term strategies for reliable weight management after cessation remain undeveloped.

## Agent Notes

**Why this matters:** Establishes the mechanistic basis for what I'm calling the "continuous-treatment model" — GLP-1 pharmacotherapy requires uninterrupted delivery to maintain benefits. This is analogous to the food-as-medicine reversion finding (Session 17): AHA Food is Medicine RCT showed BP gains fully reverted 6 months after program ended. Two independent intervention types (food, pharmacology) showing the same structural pattern.

**What surprised me:** The speed of rebound is striking — 40% of weight regained within 28 WEEKS. In 6 months, most of the therapeutic benefit is gone. This means even short gaps in coverage (a common event under Medicaid redetermination cycles or SNAP work requirement churning) can fully reverse benefits that took months to achieve.

**What I expected but didn't find:** Evidence that dose-tapering protocols successfully prevent the rebound. The paper acknowledges tapering can "limit" but not prevent rebound, and more research is needed. This is an unresolved question.

**KB connections:** Directly connects to OBBBA Medicaid/SNAP access contraction. If GLP-1 rebound occurs within 6 months of discontinuation, and Medicaid redetermination cycles create 3-6 month gaps in coverage (as documented in OBBBA implementation), then policy-induced coverage churning systematically destroys therapeutic benefit at the individual level. The population-level implication: OBBBA doesn't just prevent new patients from starting — it reverses progress in existing patients.

**Extraction hints:** Primary claim: "GLP-1 receptor agonists produce a continuous-treatment dependency: metabolic benefits reverse within 28-52 weeks of discontinuation, requiring permanent access infrastructure for durable population-level impact." Secondary claim: cardiovascular benefits (not just weight) also reverse post-discontinuation — this connects to the CV mortality projection thread.

**Context:** Lancet eClinicalMedicine is a high-quality peer-reviewed journal. Meta-analysis of 18 RCTs is robust. The 2026 trajectory meta-regression is the follow-up paper.

## Curator Notes (structured handoff for extractor)

PRIMARY CONNECTION: GLP-1 agonists largest therapeutic category launch in history (inflationary through 2035) + SDOH interventions strong ROI but adoption stalls
WHY ARCHIVED: Establishes the continuous-treatment dependency that makes GLP-1 access infrastructure — not just GLP-1 drugs — the binding constraint for population-level impact.
EXTRACTION HINT: New claim territory — no existing KB claim captures the continuous-treatment dependency pattern. This warrants a standalone claim about GLP-1 requiring permanent delivery for durable benefit, with explicit connection to the OBBBA coverage churning mechanism.
