With more patients using GLP-1 weight-loss medications, physicians are increasingly seeing patients who discontinued therapy because of cost, limited pharmacy availability, intolerable adverse effects, or loss of insurance coverage.

After patients discontinue medication, weight regain is common, and that may affect their mental health, confidence, and willingness to return for follow-up care.

Because the duration of GLP-1 therapy is often uncertain, physicians should begin discussions early so patients understand that long-term nutrition, activity, and behavioral strategies remain central to obesity management. Patients may need counseling about adequate protein intake, the need for resistance training to preserve lean mass, and higher-fiber diets to support satiety and cardiometabolic health.

“It is important to give people realistic expectation about what might or might not happen, including regaining weight after stopping, etc, and that they will not work if not accompanied by an intentional approach to eating,” said Ayman Fanous, MD, chair of the Department of Psychiatry at the University of Arizona College of Medicine – Phoenix.

In addition to nutrition and physical activity counseling, physicians should monitor emotional well-being when patients taper, stop, or lose access to medication, particularly if weight begins to return.

Screening in Primary Care

Primary care physicians (PCPs) should assess mood symptoms and safety when weight relapse is accompanied by sadness, low motivation, excess time in bed, or functional decline.

“As with any increase in depressive symptoms, they should ask about all nine DSM [Diagnostic and Statistical Manual of Mental Disorders] symptoms, get a sense of the individual’s functionality in terms of work and interpersonal relationships and ability to care for themselves, and most importantly suicidality,” said Fanous.

Fanous suggested mentioning their gradual weight gain in a nonjudgmental, open-ended manner.

“The PCP should show them a graph of their weight over time and ask what their activities have been since the last visit rather than ask what they’ve done to stay on the wellness track,” he said.

Patient-centered language is another important clinical tool. Being kind and putting the patient first is also an effective part of the plan, said Ryan Tweet, PsyD, assistant professor of medicine in the Division of Endocrinology, Diabetes and Clinical Nutrition at Oregon Health & Science University School of Medicine in Portland.

For example, Tweet suggested clinicians use this wording:

“Would it be okay if we talk about weight changes and how you are feeling about your health goals?”

After a patient gives permission to discuss weight, the physician can first elicit the patient’s priorities before recommending next steps, said Tweet. “Doing so sets the stage for a partnership rather than a wrestling match,” he said.

Normalize Emotional Responses

Weight regain after sustained effort can trigger shame, sadness, or a sense of failure, especially in patients with long histories of dieting or weight seesawing.

Physicians can reduce stigma by explicitly separating body weight from personal worth and by framing regain as a treatable clinical challenge rather than a personal failure.

Tweet said to validate and separate worth from weight: “Given how hard you worked, it makes sense to feel disappointed. This does not mean you failed.”

Instead, he suggests reframing the course: “Obesity behaves like a chronic condition. When treatment or life circumstances change, regain is common, and change is achievable again. Your prior progress is proof you are not back at zero.”

Close with agency and a plan: Identify one small step for this week, reflect nonscale wins, and schedule a short-interval follow-up to capture early momentum, he said. Clinicians can then set one small weekly goal, note nonscale progress, and schedule follow-up.

Pivot the Focus to Health

A discussion about healthy eating and a commitment to physical activity should be introduced.

“Even if you keep caloric intake and physical activity the same, stopping the medication abruptly will definitely lead to regain,” said Alexa Mieses Malchuk, MD, a family physician in State College, Pennsylvania. “This makes caloric intake and physical activity even more important since those are the few things that you can control, though it’s difficult to control when real life kicks in.”

Malchuk emphasizes focusing on health indicators beyond the scale.

“The most important thing is to focus on actual measures of health, not weight. Weight is not always correlated with health. Instead, focus on things like waist circumference, endurance, and stamina during exercise, blood pressure, cholesterol results, sleep quality, etc,” she told Medscape Medical News.

She also noted the cultural difficulty of this shift: “I understand we live in a diet-obsessed culture, and so it can be really hard to break free from focusing on your weight all the time, but it really is the most important thing for your mental and physical health. There are certain health issues that a higher weight is correlated with, but higher weight doesn’t always cause these health issues in every single person, and there is a lot of variability,” said Malchuk.

Weight may prompt closer evaluation, but it should not be presented as a complete measure of health, she also stated.

When to Refer for Behavioral Health Support

Physicians can frame behavioral health referrals as routine support, not a sign that something is wrong. Acknowledge the patient’s challenges and suggest that talking with someone may help.

Also, keep monitoring mental health markers. Bring in behavioral health when you see depressed mood, avoidance, loss-of-control eating, or high self-criticism, Tweet said.

“Brief CBT [cognitive-behavioral therapy], behavioral activation, or skills-based counseling can reduce symptoms and improve adherence to day-to-day routines,” he said. “And normalize the referral suggestion as standard team care, not a last resort or because you believe they are ‘crazy,’” he continued.

For instance, he said you might say: “What you’re describing sounds exhausting, and you don’t have to be alone in this. Would it help if we added a brief visit with behavioral health to give you more tools while we stay on the medical plan?”

Rebuild Momentum and Treatment Paths

To build patient confidence, clinicians can reinforce progress that the scale does not capture, including energy, sleep quality, stamina, daily steps, food quality, mood, blood pressure, A1c, lipids, or medication de-intensification, Tweet said. “Patients build confidence when you reflect these back and tie them to their values and goals,” he said.

When patients ask whether to restart the weight-loss journey, clinicians can explore whether to resume a previously effective medication, intensify lifestyle strategies, or use a short-term behavioral plan while access issues are addressed.

Moreover, use shared decision-making. “If a medication was helpful and safe, restarting is reasonable while you rebuild simple routines the patient can keep doing if the drug is paused again,” said Tweet. “If cost or access is the issue, set a time-boxed behavioral plan with close follow-up and revisit pharmacotherapy when feasible.”

Tweet further suggests framing weight regain as clinical information to guide the next step, not as a final grade or personal failure. “Collaboratively, explore one or two high-yield, low-lift behaviors such as protein and produce anchor meals, a scheduled walking block, or a consistent sleep window,” he said. “Reduce shame in the room by asking permission, using the patient’s words, and focusing on behaviors over labels, and also schedule a quick follow-up to catch early wins and troubleshoot barriers.”

No disclosures were reported.