Dr.SleepRoch said:

STEP 4 is the study that answers this and it is blunt.

This is exactly what I could not find anywhere else. I will report back once I have actually tried it.

Clinical perspective, offered as context rather than as advice.

Maintenance phase reality on maintenance dosing: reached my goal 8 months ago and now I'm in maintenance. It's a different mental game.

During weight loss, the scale going down is constant positive reinforcement. In maintenance, the scale staying the same is... just... nothing. It's anticlimactic. The dopamine hit is gone.

What keeps me going: lab improvements, physical capabilities, how I feel, fitting in clothes I love, and the knowledge that regain happens when people stop being intentional. I'm staying intentional.

Dr.EM_Chicago said:

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

STEP 5 long-term data on maintenance dosing: the 104-week (2-year) extension showed sustained weight loss of -15.2% with continued semaglutide vs weight regain in the discontinuation group[1].

Key insight: weight loss continued to accrue between weeks 68 and 104 in many patients, suggesting the nadir may not occur until year 2+. The 68-week primary endpoint in most trials may underestimate maximal efficacy.

This supports long-term, open-ended treatment rather than fixed-duration "courses" of therapy.

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.

The concept of "metabolic set point" and its relevance to maintenance dosing: the body actively defends a weight set point through hormonal feedback (leptin, ghrelin, insulin, GLP-1). After weight loss, these signals shift to promote weight regain[1].

GLP-1 agonists may work in part by resetting this set point — or at least overriding the counter-regulatory signals that drive regain. This would explain why continued treatment maintains weight loss while discontinuation leads to regain.

Understanding maintenance dosing through this lens reframes the drug from "weight loss tool" to "metabolic set point modulator."

Moderator note: the sourcing question belongs in the vendor section and has been split out. Tagging this one for the weekly digest.