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Jump to Key Points Even after careful GLP-1 dose titration, significant weight loss and marked improvement on other health markers, some patients will reach the maximum dose. This milestone is an opportunity to review clinical strategies, reinforce behavior changes, and to lead patients toward continued progress.
Advise Patients to Create a Quality-Focused Nutrition Plan
After weight loss, patients should not “coast,” said Amy Sheer, MD, MPH, an internal medicine and obesity medicine physician at UF Health Internal Medicine in Gainesville, Florida. “They should continue prioritizing protein, vegetables, fiber-rich carbohydrates, and hydration,” she said.
Because GLP-1 therapy suppresses appetite, patients still need sustainable eating habits for long-term protection. Once stable on treatment, nutrition guidance should shift from calorie restriction to calorie quality, with an emphasis on lean proteins, vegetables, whole grains, and hydration, Sheer said. Reducing or stopping medication can increase hunger and food intake, underscoring the importance of this approach.
Keep Patients Focused Moving Forward
Primary care providers should remind patients that strength training helps preserve muscle and support steady metabolism.
- Max GLP-1 dose = maintenance phase; reassess goals, not finish line.
- Shift nutrition counseling → protein, vegetables, fiber-rich carbs, hydration.
- Continue resistance training + adequate protein to preserve lean mass.
- Track weight, appetite, cravings, body composition, A1c; act before regain.
- If inadequate response/intolerance, consider taper, spacing, switch, add meds, or surgery.
“Regular resistance training, not just cardio, is important each week. Combined with adequate protein, exercise helps maintain lean mass during weight loss,” Sheer said.
Sheer also said patients need to be vigilant about their weight. Don’t wait for significant weight regain, she said. Sheer advised patients to track weight, appetite, cravings, body composition if available, and key labs such as A1c — especially if they have diabetes or prediabetes — so clinicians can act early.
Develop a Clinical Plan and Help Guide Patient Expectations
Long-term pharmacotherapy is often necessary in obesity care. Sheer said many patients do best by continuing GLP-1 therapy; when that is not possible, tapering or switching medications may be appropriate.
Review Options and Set Short and Long-Term Wellness Goals
Your patient may wonder ‘what’s next’. Discussions about tapering, dose spacing, lower-cost antiobesity medications, manufacturer or payer appeal pathways, and continued follow-up should be addressed, she said.
Sheer said she treats this phase of treatment as active maintenance, not the finish line. “I schedule a dedicated maintenance visit to discuss the plan and monitor — whether that is continuing, tapering, spacing doses, switching medications, or trialing off therapy,” she said.
Also, she counsels patients to watch for early warning signs like return of “food noise,” increased cravings, or loss of satiety — not just changes on the scale. “Focus on the patients’ goals,” she emphasized.
Taking a Patient-Centric Approach
The assessment of a patient should be dependent on their health profile and stage of obesity.
“If weight does not achieve a healthy range or begins to rebound despite maintaining a healthy lifestyle, consider adding in a second or third obesity medication,” said Jonathan Purnell, MD, professor of medicine, Division of Cardiovascular Medicine, Oregon Health & Science University School of Medicine in Portland, Oregon.
“Even though these outcomes studies have not been performed yet and this advice would not be found in any current guideline statements, this is how we manage other chronic diseases such as hypertension and diabetes when one medication proves insufficient.”
This is especially true for patients at higher obesity classes who have elected to undergo metabolic-bariatric surgery and still have not achieved a healthy weight range, Purnell said. He also recommended routine cardiometabolic, renal, and hepatic monitoring and medication adjustments as needed.
Exploring More Options
Daniel B. Jones, MD, MS, professor and Benjamin F. Rush Jr Chair in Surgery, Department of Surgery, Rutgers New Jersey Medical School in Newark, New Jersey, told Medscape Medical News that when GLP-1 therapy is no longer working, symptoms are no longer tolerable, if patients experience complications, or insurance no longer covers it, patients may want to consider learning more about minimally invasive surgical options like the laparoscopic sleeve gastrectomy.
“Surgery changes your hormones to decrease hunger and increase satiety. You typically go home the same or next day and drop over half of your extra weight,” Jones said. “But many surgeons want their patients to try medical therapy first. And more surgeons are adding GLP-1s after surgery for an additive effect. It’s important to personalize treatment options.”
Sheer and Jones reported having no disclosures.
Purnell reported being an advisory board member for Novo Nordisk, Boehringer-Ingelheim and Zealand Pharmaceuticals. He reported also being a clinical trialist for Novartis and Amgen.
