Dr.EndoEP said:

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

Dr.EndoEP 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.

Dr.PeteFamMed said:

Pregnancy after maintenance dosing weight loss: stopped GLP-1 medication 3 months before TTC as recommended.

This is exactly what I could not find anywhere else. Adding it to my notes with a link back to this thread.

Dr.EndoEP said:

Dr.AddMedPHL 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.

SurmountFan_IN said:

Planning the end of this rather than the middle of it, which nobody around me seems to want to talk about while it is still going well.

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: a couple of off-topic posts removed. Report rather than reply if it drifts again.