# What Happens When You Stop Tirzepatide? SURMOUNT-4 Says 14% Comes Back In SURMOUNT-4, people who stopped tirzepatide regained 14.0% over a year while those who continued lost a further 5.5%. What returned depended on how much weight came back. Publisher: This GLP Editorial Team Canonical: https://thisglp.com/research/what-happens-when-you-stop-tirzepatide Updated: 2026-10-26 Published: 2026-09-17 [← Research](https://thisglp.com/research) Evidence # What Happens When You Stop Tirzepatide? SURMOUNT-4 Says 14% Comes Back The trial randomized 670 people to keep taking it or stop. Over the following year the ones who stopped regained 14.0%, and how much each person regained decided how much of the benefit they kept. [This GLP Editorial Team](https://thisglp.com/about)September 20268 min read Waist gained after stopping, by share of loss regained · +0.8 · <25% · +5.4 · 25–50% · +10.1 · 50–75% · +14.7 · 75%+ · Centimeters, week 36 to 88. Everyone shown had stopped. **Research, not medical advice.** This GLP is independent and educational. Nothing here is a substitute for individualized care from a licensed clinician, and reading it creates no doctor–patient relationship. Talk to your own provider before starting, stopping, or changing any medication, peptide, or therapy. See our [methodology](https://thisglp.com/methodology) and [terms](https://thisglp.com/terms). ## Key takeaways - In SURMOUNT-4, everyone spent 36 weeks on tirzepatide and lost 20.9% on average, then half were switched to placebo for a year. - Over that year the placebo group regained 14.0% of their week-36 weight while those who stayed on the drug lost a further 5.5% — a difference of 19.4 percentage points. - Regaining is not all-or-nothing: sorted by how much came back, waist circumference rose 0.8, 5.4, 10.1 and 14.7 cm across four bands. - Blood pressure rose in every band, including among people who held nearly all of their loss. The weight comes back gradually, and how much of it comes back varies enormously between one person and the next. The amount you keep off appears to decide how much of the health benefit you keep with it. SURMOUNT-4 is the trial that measured this, and it was built for the purpose rather than stumbling on it afterwards [\[1\]](https://thisglp.com/research/what-happens-when-you-stop-tirzepatide#ref-1). Everyone in the trial took tirzepatide for the first 36 weeks, openly and without a placebo group, which is how 783 people came to lose an average of 20.9% of their body weight before the real experiment began. At that point 670 of them were randomly assigned either to carry on with the drug or to switch to a placebo injection for another 52 weeks. Neither they nor their doctors knew which they had been given. That is a withdrawal design, set against the observational stopping this site examined in — a withdrawal design rather than the observational stopping this site examined in [what happens in ordinary care](https://thisglp.com/research/glp1-weight-loss-in-ordinary-care). ## What the scale did over the following year The group that stayed on tirzepatide lost a further 5.5% on top of everything they had already lost, while the group switched to placebo gained 14.0% back. That leaves a gap of 19.4 percentage points between the two arms, with a confidence interval running from 21.2 to 17.7 [\[1\]](https://thisglp.com/research/what-happens-when-you-stop-tirzepatide#ref-1). Regaining 14% is not the same as ending up where you started Somebody who had lost 20.9% and then regained 14.0% of their week-36 weight is still a long way below the weight they walked in at, because the second percentage is measured against the lighter body they had become rather than against their original one. The trial does not show that stopping undoes everything, and a page telling you it does is either misreading the arithmetic or hoping you will not check it. ## Why two people who both stop can end up in very different places A later analysis took the 308 people from the placebo arm who had lost at least 10% during the lead-in and sorted them by how much of that loss had returned by the end. That turns a single average into something far more useful for anyone actually deciding whether to stop [\[2\]](https://thisglp.com/research/what-happens-when-you-stop-tirzepatide#ref-2). The bands are shares of the weight each person had lost, so somebody in the largest band had regained three quarters or more of their own result rather than three quarters of their body weight. Change from week 36 to week 88 among people who stopped tirzepatide. | Share of lost weight regained | Waist gained | Systolic blood pressure | | --- | --- | --- | | Under 25% | +0.8 cm (95% CI −1.0 to 2.6) | +6.8 mm Hg | | 25% to under 50% | +5.4 cm | +7.3 mm Hg | | 50% to under 75% | +10.1 cm | +9.6 mm Hg | | 75% or more | +14.7 cm | +10.4 mm Hg | Change from week 36 to week 88 among people who stopped tirzepatide. Post hoc analysis of the SURMOUNT-4 placebo arm, 308 participants The people who held on to most of their loss showed no measurable change in waist circumference at all, since 0.8 cm carries an interval running from minus 1.0 to 2.6. The people who regained the most put 14.7 cm back on. [Non-HDL cholesterol](https://thisglp.com/research/does-ozempic-lower-cholesterol) behaved the same way, staying flat in the two smaller bands and rising 8.4% and 10.8% in the two larger ones. ## The exception that is worth knowing about before you stop Blood pressure did not follow that pattern. Systolic pressure rose in every single band, from 6.8 mm Hg among the people who barely regained anything to 10.4 mm Hg among those who regained the most. It came back even for the people who did best on the scale. Whatever the drug was doing to blood pressure, holding on to the weight loss did not preserve it. One limit governs how hard any of this can be pushed, and it is worth being plain about: nobody was randomly assigned to a regain band. Everyone in that analysis received placebo, and which band a person landed in was an outcome rather than an allocation. So people who regained little may differ from people who regained a lot in ways that have nothing to do with the drug — the same problem this site set out in [what happens when the control group never started treatment](https://thisglp.com/research/do-glp1-drugs-cause-depression). ## Is this specific to tirzepatide? No, and the semaglutide evidence points the same way. When the STEP 1 extension followed people who had come off semaglutide, weight and the cardiometabolic markers both moved back toward where they had started. That is the pattern this site went through in [the withdrawal evidence](https://thisglp.com/research/stopping-glp1-and-weight-regain) and again, across drug classes, in [what comes back besides the weight](https://thisglp.com/research/what-else-comes-back-when-you-stop-a-glp1) [\[3\]](https://thisglp.com/research/what-happens-when-you-stop-tirzepatide#ref-3). What none of these trials can tell you is what happens to somebody who stops deliberately and carefully, with a plan, rather than because a prescription lapsed or a trial protocol switched them to saline. That trial has not been run, which is worth remembering the next time a page promises you a safe way off. — and the composition question underneath it, of what exactly is lost and what exactly returns, is in [what is lost and what returns](https://thisglp.com/research/do-you-lose-muscle-on-a-glp1). Continuity is a practical question to ask before treatment, not a promise of a successful exit. [PlushCare](https://thisglp.com/reviews/plushcare) describes ongoing weight management and the ability to keep the same doctor on its [website](https://plushcare.com/). Ask how follow-up would work if medication becomes unaffordable or must be discontinued; the withdrawal trials do not evaluate that service. ## Frequently asked What happens when you stop taking tirzepatide? In SURMOUNT-4, people switched to placebo regained 14.0% of their week-36 weight over the following year, while those who stayed on the drug lost a further 5.5%. Do you regain all the weight? Not in this trial. Participants had lost 20.9% before the withdrawal period began, and the 14.0% regained is measured against that lighter weight, so the group remained well below where they started. Does it matter how much weight comes back? It appears to. Sorted into four bands by how much of their loss returned, waist circumference rose 0.8, 5.4, 10.1 and 14.7 cm, and non-HDL cholesterol only rose once regain passed about half. Does anything come back even if you keep the weight off? Systolic blood pressure rose in every band, from 6.8 to 10.4 mm Hg, including among people who regained less than a quarter of what they had lost. Is semaglutide any different? The pattern looks the same. The STEP 1 trial extension found weight and cardiometabolic markers moved back toward baseline after semaglutide was withdrawn. ## Sources 1. \[1\] Aronne LJ, Sattar N, Horn DB, Bays HE, Wharton S, Lin WY (2024). Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial JAMA. [PMID 38078870](https://pubmed.ncbi.nlm.nih.gov/38078870/) 2. \[2\] Horn DB, Linetzky B, Davies MJ, Laffin LJ, Wang H, Murphy MA (2026). Cardiometabolic Parameter Change by Weight Regain on Tirzepatide Withdrawal in Adults With Obesity: A Post Hoc Analysis of the SURMOUNT-4 Trial JAMA Internal Medicine. [PMID 41284285](https://pubmed.ncbi.nlm.nih.gov/41284285/) 3. \[3\] Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension Diabetes, Obesity and Metabolism. 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