The best thing to do after stopping a GLP-1 depends on what you want to keep, and a new Cleveland Clinic study gives you real numbers to compare. Over two years, patients who had weight-loss surgery lost the most, 28% of body weight. Patients who stopped with no further treatment lost the least, 4%. The hospital’s own release says patients should talk with their provider before stopping semaglutide or tirzepatide, so take these numbers to that conversation. Here is what the study found, how it differs from the clinic’s earlier study, and the questions that settle your next step.
What did the new Cleveland Clinic study find?
This is Cleveland Clinic’s own newsroom release about its own study, dated November 14, 2026. The Cleveland Clinic’s November 2026 release says the study looked at electronic health records of 20,486 patients who took semaglutide or tirzepatide for at least three months between 2021 and 2023. Researchers compared five paths over two years: staying on the initial drug, switching between semaglutide and tirzepatide, switching to another obesity medicine, weight-loss surgery, and stopping with no further treatment. The release names eClinicalMedicine as the journal.
Here is two-year weight loss on each path, as the release lists it.
| Path after stopping or switching | Weight loss at two years |
|---|---|
| Bariatric (weight-loss) surgery | 28% of body weight |
| Switching between semaglutide and tirzepatide | About 16% |
| Staying on the original drug | Nearly 11% |
| Switching to another obesity medication | Average 8% |
| Stopping with no further treatment | 4% |
The release adds a few more results. Switching from semaglutide to tirzepatide beat staying on semaglutide. Among patients who started on tirzepatide, staying on it beat switching to semaglutide. For type 2 diabetes, weight-loss surgery gave the largest improvement in A1C, a blood sugar test, at one year. For high blood pressure, continued treatment brought bigger drops than stopping did.
Hamlet Gasoyan, Ph.D., the lead author, says obesity is a complex chronic disease that needs more than a one-size-fits-all approach. Ali Aminian, M.D., director of the Cleveland Clinic Bariatric and Metabolic Institute, says patients who stopped all treatment had the least weight loss and the smallest metabolic benefit. Gasoyan is scheduled to present the work at ObesityWeek 2026 on Sunday, Nov. 15, in National Harbor, Maryland.
Quick facts as of 2026-11-14
| Fact | Detail |
|---|---|
| Source | Cleveland Clinic newsroom release, Nov. 14, 2026 (the hospital’s own release about its own study) |
| Design | Retrospective, based on electronic health records |
| Patients | 20,486 Cleveland Clinic patients |
| Medicines | Semaglutide or tirzepatide, taken at least three months, between 2021 and 2023 |
| Paths compared | Five |
| Follow-up | Two years |
| Journal | eClinicalMedicine |
| Presentation | ObesityWeek 2026, Sunday, Nov. 15, National Harbor, Maryland |
How is this different from the March 2026 study?
Cleveland Clinic published an earlier study in March. The Cleveland Clinic’s March 2026 release describes it. It is a separate study with different numbers, so the two should not be mixed.
| Feature | March 12, 2026 study | November 14, 2026 study |
|---|---|---|
| Patients | 7,938 adults in Ohio and Florida | 20,486 patients |
| Who was included | Adults who started injectable semaglutide or tirzepatide for obesity or type 2 diabetes and stopped within 3 to 12 months | Patients who took semaglutide or tirzepatide for at least three months between 2021 and 2023 |
| Follow-up | One year | Two years |
| Journal | Diabetes, Obesity and Metabolism | eClinicalMedicine |
The March release reports how weight changed for each group. It says these patients lost weight before they stopped, and what happened after.
| Group | Before stopping | A year later | Gained weight | Kept losing or stayed the same |
|---|---|---|---|---|
| Obesity | Lost 8.4% | Regained an average of 0.5% | 55% | 45% |
| Type 2 diabetes | Lost 4.4% | Lost another 1.3% | 44% | 56% |
Within 12 months, the March release says 27% of these patients switched medication, 20% restarted the original drug, and 14% joined lifestyle programs with clinicians. Under 1% had surgery. Cost or insurance was the leading reason for stopping, followed by side effects.
Common mix-ups to avoid
- Two studies, two sets of numbers. The March study followed 7,938 people for one year. The November study followed 20,486 for two years.
- “45% keep weight off” is not what it sounds like. The March release’s headline uses the phrase “45% keep weight off,” and the text defines it as patients who kept losing or stayed the same.
- The 28% is a share of body weight. It is not a number of pounds.
- Surgery is not a medicine switch. It is one of the five paths, and its figure applies to surgery.
- Blood sugar and blood pressure results measure different things than weight. Read them as separate findings.
What does the NIH guidance say about stopping?
The NIDDK guidance on weight-loss medicine from the National Institute of Diabetes and Digestive and Kidney Diseases says you will probably regain some weight after stopping. If less than 5% of your starting weight is lost after 12 weeks at full dose, a clinician will probably advise stopping. The page was last reviewed in June 2024.
NIDDK also says regular physical activity and healthy eating may reduce regain. It names 150 minutes a week of moderate activity, plus muscle-strengthening on two or more days, and says more may be needed for maintenance. After one year, medicine plus lifestyle gave about 3% to 12% more weight loss than lifestyle alone, with most of that loss in the first six months.
Both sources point the same way. The Cleveland Clinic November study found stopping with no further care gave the smallest two-year loss, and NIDDK expects some weight to come back after stopping.
Who does this affect?
The release cites Gallup’s 2026 figures for context. Gallup says U.S. adults using GLP-1s for weight loss rose to 11% in 2026, from 3% in 2024. The release also says cost, insurance limits and side effects are common reasons people stop.
If you have type 2 diabetes or high blood pressure, the diabetes and blood-pressure findings above are the ones to raise with your prescriber.
Is any research still underway?
The ClinicalTrials.gov tirzepatide pause study, listed by the U.S. National Library of Medicine, is recruiting adults ages 18 to 70 who take tirzepatide. It plans 40 participants. The study looks at how a 3 to 4 week pause, followed by a restart of 6 to 8 weeks, affects hunger, mood, sleep and brain activity. The total study duration is about 13 weeks.
What this study can tell you
This is an observational study, so it shows what happened to groups of patients, not what one person should choose. If you want to understand why that matters, our understanding clinical study design (our research library) guide explains the difference between study types.
Questions that settle your next step
The hospital’s release says to talk with your provider before stopping semaglutide or tirzepatide. Bring these questions to that visit.
- Why am I stopping? If cost, insurance or side effects are the reason, say so. Those are the most common reasons the release names.
- Does staying on my current medicine, switching, or stopping fit my goals? Ask which of the five paths makes sense for me.
- Is weight-loss surgery an option for me? Ask a bariatric surgeon or your prescriber.
- If I restart, which dose and schedule should I use? Ask your prescriber or pharmacist. For surgery patients, ask your surgeon how soon a restart is appropriate.
- Which numbers should we track? Our weight loss treatment tracker shows what to record.
If surgery is on your list, our guide to the weight loss surgery diabetes remission study answers common questions about that research. For changes to medicine rules and coverage, check our weight loss medication updates before you decide.
Key dates
- 2021 to 2023: the period in which the November study’s patients took semaglutide or tirzepatide for at least three months.
- March 12, 2026: Cleveland Clinic’s earlier release on the 7,938-patient study.
- November 14, 2026: Cleveland Clinic’s release on the 20,486-patient study.
- Sunday, November 15, 2026: lead author presentation at ObesityWeek 2026, National Harbor, Maryland.
By the Primary Care Evidence Guide Team
This article is for general information purposes only and does not constitute medical advice. Consult your doctor or qualified healthcare provider before making changes to your health routine.