Dr.ObesityMed said:

One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.

Pregnancy after maintenance dosing weight loss: stopped GLP-1 medication 4 months before TTC as recommended. Was terrified of regaining weight during pregnancy.

Worked closely with my OB and MFM. Gained 28 lbs during pregnancy (within recommended range). Baby is healthy. The metabolic improvements from pre-pregnancy weight loss gave both of us a healthier pregnancy.

If you're planning pregnancy, discuss the medication discontinuation timeline with your OB. GLP-1 agonists are NOT safe during pregnancy.

One thing that is still open after Dr.SleepRoch’s answer:

Whether extending the interval works as well as reducing the dose, since they are not the same intervention pharmacologically?

PeptideChemSF said:

Pregnancy after maintenance dosing weight loss: stopped GLP-1 medication 4 months before TTC as recommended.

PeptideChemSF said:

...I stopped maintenance dosing and regained all the weight...

This is a really important data point and I appreciate your honesty. The STEP 1 extension data showed ~2/3 of weight regain within 12 months of discontinuation.

This doesn't mean the drug "doesn't work" — it means obesity is a chronic disease requiring ongoing treatment, just like hypertension or diabetes. We don't criticize blood pressure meds for "not working" when BP rises after stopping them.

The framing matters. maintenance dosing is a treatment, not a cure. And that's okay.

Reporting back.

I went to a lower dose rather than a longer interval on the strength of the trough argument in this thread, and the difference in how even it feels is obvious.

Dr.EM_Chicago said:

PeptideChemSF said: ...I stopped maintenance dosing and regained all the weight...

Dr.EM_Chicago said:

...the STEP extension data on maintenance dosing is concerning...

Let me offer a different interpretation of the same data. Yes, 2/3 of weight was regained after discontinuation. But consider:

• This is consistent with EVERY chronic disease medication ever studied
• 1/3 of patients maintained significant weight loss — who are they and why?
• The metabolic improvements partially persisted even with weight regain
• The data supports long-term treatment, not a "course" of therapy

The takeaway isn't "the drug fails when you stop" — it's "chronic diseases require ongoing treatment." We've always known this.