Today’s Dietitian
Vol. 27 No. 8 P. 20
The newest generation of antiobesity medications (AOMs)—GLP-1 (glucagon-like peptide-1), GIP (glucose-dependent insulinotropic polypeptide), dual action GLP-1/GIP combinations, triple action injectables, and emerging injectable and oral medications—have changed the landscape for weight management, bringing weight loss success to many for whom weight maintenance had previously not been possible. But these drugs are not for everyone. They have side effects, cost can be prohibitive, insurance coverage can change, and medication fatigue can set in. Additionally, long-term studies are limited and the effects of taking them for extended periods of time are not yet fully known. What happens when AOMs are stopped, and what strategies can dietetics professionals use to help people maintain their weight loss success?
A Brief Overview of AOMs
The first generation of AOMs include the injectable semaglutide medications, Ozempic and Wegovy, both produced by NovoNordisk. Ozempic is FDA-approved for blood glucose management—off-label use includes weight loss—and Wegovy is FDA-approved specifically for weight management. Semaglutide drugs target the incretin system. Incretins are hormones released by the enteroendocrine L-cells of the gastrointestinal tract in response to food intake. Incretins like GLP-1 stimulate insulin release, suppress glucagon, slow gastric emptying, and enhance satiety, among other actions. This helps reduce consumption in part by suppressing appetite. Dulaglutide (brand name Trulicity) is another similar derivative.1
Next generation AOMs include tirzepatide (Mounjaro and Zepbound), a combination of GLP-1 and GIP—another incretin, that offers similar benefits to semaglutides with potentially less nausea, fewer side effects, and greater weight loss.2 Mounjaro and Zepbound have similar label specifications regarding diabetes management vs weight loss compared with Ozempic and Wegovy, respectively. The combination of GLP-1 and GIP may also support heart health.3
“The best candidates for GLP-1 medications are those with overweight and at least one weight-related health complication such as obesity, type 2 diabetes, established CVD, obstructive sleep apnea, or chronic kidney disease,” explains Katherine H. Saunders, MD, DABOM, cofounder of FlyteHealth, and obesity specialist physician at Weill Cornell Medicine, New York. “It’s important to note, however, that not all individuals who are eligible need a GLP-1 medication. These medications can be expensive. Also, we generally avoid GLP-1 medications in patients with a history of pancreatitis, those at high risk of pancreatitis, and those with gastroparesis.”
Evidence suggests that individuals with diabetes may be more motivated to stay on AOMs. A study published in JAMA Network Open showed that individuals with type 2 diabetes were less likely to discontinue AOMs than were those on AOMs for weight loss alone.4
Not Right for Everyone
According to Colleen Dawkins, FNP-C, RDN, CSOWM, owner and provider of individualized virtual care at Big Sky Medical Wellness, “antiobesity medications may not be right for people with contraindications, including a personal history of medullary thyroid carcinoma, or a personal or family history of multiple endocrine neoplasm syndrome type 2 (MEN2). A risk-vs-benefit conversation is necessary for patients who are pregnant or may become pregnant because there is not enough data supporting safety during pregnancy, or breastfeeding. Other reasons include fear of needles, side effects, and noncompliance.” Of course, medication cost is a consideration, especially as prescription managers redefine coverage and copays.
“Many people don’t want to take AOMs long term,” observes James O. Hill, PhD, coauthor of the upcoming book, Losing the Weight Loss Meds: A 10-Week Playbook for Stopping GLP-1 Medications Without Regaining the Weight (December 2025). Hill is a professor in the Department of Nutrition Sciences and director of the Nutrition Obesity Research Center at University of Alabama at Birmingham. “There’s no doubt that these highly effective medications may not be practical or desirable for some people because of personal, medical, side effects, or financial factors. Also, some individuals get tired of them and just want to try something else. Data on long-term use is not available. However, the reality is that most people who go off these medications—some pharmacy drug managers suggest that over half of those on prescriptions stop them within a year—regain substantial weight over time.”
Four US organizations recently published an evidence-based advisory regarding support for patients and clients on AOMs.5 The advisory recommendations focus on improving treatment outcomes, compliance, health benefits, and weight maintenance in the face of gastrointestinal side effects, risk of nutrient inadequacies, muscle and bone loss, and other concerns. Care priorities outlined in the advisory include patient-centered therapy, nutritional assessment, management of digestive side effects, personalized diet, prevention of micronutrient deficiencies, and positive lifestyle changes. The recommended diet features nutrient-dense choices, foods with minimal processing,
and adequate protein.
Changing the Post-AOM Trajectory
In his upcoming book, Hill provides three key reasons why people regain weight after stopping AOMs: appetite control, changes in metabolism, and state of mind. “The appetite regulation system can drive some people to think about food all the time, experience constant food noise, and need larger portions to satisfy their appetite. Psychosocial stressors and emotional challenges can derail people whose eating habits are affected by their mood and emotions. That is why people need a very different set of strategies and skills for maintaining weight loss. The weight management journey has two distinct phases—losing weight and maintaining weight.”
Dawkins tailors her approach to the individual, considering the reasons why AOMs were stopped in each case. “It is important to remember that we are treating a health condition, not a number on the scale. We do have other options for treating obesity that can influence metabolic markers, physical health, mental health, and overall quality of life. A layered approach may be needed and must include strategies to help reset expectations and reframe changes in therapies.”
Can AOM Action Be Replicated Without Drugs?
AOMs profoundly influence hunger and appetite, and that effect is hard to replicate. Su-Nui Escobar, DCN, RDN, FAND, whose New York-based practice helps individuals optimize their weight loss journey, says that while a high-protein, high-fiber diet with adequate healthy fats can mimic drug action by helping regulate hunger and appetite, including slowing down the digestion and absorption of food, effects typically last only a few hours, compared with days of lingering effect from medications. The order of magnitude of the effect on GLP-1 and GIP also is much lower with diet than with medication.
Several ingredient manufacturers are innovating around functional ingredients that may help replicate the beneficial actions of incretins like GLP-1 and GIP. Germany-based Beneo produces prebiotic chicory root fibers; a low glycemic carbohydrate, Palatinose™ (isomaltulose); and plant-based proteins that can impact weight management-related issues like satiety, blood glucose homeostasis, muscle health, and gut health. Chicory root fibers can enhance satiety. Isomaltulose releases sugar slowly into the bloodstream and has been shown to stimulate GLP-1 production and enhance GIP release.6
Rousselot, a subsidiary of Texas-based Darling Ingredients, positions its Nextida GC collagen peptide as promoting GLP-1 secretion lowering postmeal glucose spikes. Florencia Moreno Torres, global marketing manager at Rousselot, describes a clinical study on Nextida GC in healthy individuals that reduced postprandial blood glucose and encouraged release of GLP-1.7
Ingredient manufacturer ADM (Archer Daniels Midland) offers a comprehensive portfolio of ingredients to address the nutrition needs of current and former AOM users. Its Bifidobacterium longum CECT7347 (ES1) probiotic and postbiotic has been shown to benefit gut health in IBS,8 and these benefits could be applicable to other digestive disorders. The company also promotes its prebiotic dietary fiber, Fibersol, for gut health, as well as postprandial blood glucose management and enhancement of GLP-1 production.9 ADM identifies two consumer moments and sets of needs in the AOM journey: during use of AOMs and while ramping down or discontinuing AOMs.
The supplement Calocurb features its trademarked Amarasate, an extract of New Zealand hops that is promoted to boost the body’s natural release of GLP-1. Bitter compounds in the hop extract have been shown to activate GLP-1 release and reduce levels of the hunger hormone ghrelin by interacting with taste 2 receptors in the intestinal tract in vitro10 and in a randomized controlled trial in 19 healthy-weight men.11
Oregon-based Icon Foods specializes in combinations of sweeteners and fibers. Cofounder and chief innovation officer Thom King comments that while sugar alcohols such as erythritol and xylitol can stimulate GLP-1 and GIP, no ingredients can match the efficacy of the agonist drugs in duration or magnitude.
Long-Term Approaches to Weight Management
Escobar observes that “no research to date clearly identifies the best diet for maintaining weight loss after stopping antiobesity medications. However, we do know that the most effective diet for long-term weight maintenance is one that can be sustained—and that looks different for everyone. Common diet elements include adequate protein, fiber, and hydration; more vegetables; less fat and sugar; and access to healthy food choices.” Escobar begins working with clients on weight maintenance while they are still taking AOMs, noting that it is the ideal time to build new habits while food noise is reduced and sustainable eating patterns are easier to establish. She also stresses the importance of a more physically active daily routine, including one that incorporates strength training.
“The number and types of medications available for treatment are expected to continue to increase over the next 6 to 10 years,” Dawkins says. “However, what I find most important is that the person understands that I will continue to help find workable solutions involving lifestyle and medicine. It may take more time, but we have a lot of tools at our disposal to help our patients. People can be successful with existing drugs and shiny new drugs are not always the best treatment option. I have seen successful weight loss and other health benefits in cost-conscious individuals who reduce their dose and increase the time between injections.” Dawkins points out that since there is no single right answer, dietetics professionals can compassionately offer guidance, share evidence when available, consider goals, and problem-solve with the individual.
Julie Schwartz, MS, RDN, CSOWM, NBC-HWC, a Florida-based health and wellness coach for employer-sponsored weight loss plans through FlyteHealth, describes her work as combining the best in metabolic science with a cutting-edge digital treatment platform and delivering care with equal parts expertise, compassion, and equanimity.
“Our goal is to improve life, lifestyle, and comorbidities,” Schwartz explains. “Individuals need to get enough protein and fiber-rich foods for appetite regulation. It’s important to look beyond the scale and encourage eating in a way that also lowers cholesterol and manages glucose. Sometimes we need to try more affordable, better tolerated first generation weight loss medications to manage side effects. We look for ways to reduce food noise, partly by helping people recognize hunger and fullness. Then we have to be open to making adjustments on the path to healthier living and eating. Keep in mind that AOMs can promote weight loss but maybe not weight loss maintenance and management of long-term disease.”
In his book, Hill notes that maintenance requires a different state of mind, new food and physical activity strategies, a deeper level of commitment, and a brand-new lifestyle. Individuals need to establish a baseline weight and track it consistently in order to spot weight change trends and make adjustments. They also need to assess quality of life since overall well-being plays a key role in long-term weight maintenance. Weight loss maintenance hinges on creating habits and routines that are sustainable, realistic, and easy. It’s about aligning goals with core values, identity, and the life the individual wants to live; integrating weight, health, and overall fulfillment.
— Mindy Hermann, MBA, RDN, is a food and nutrition writer, communications consultant, and market researcher in metro New York.
Helpful Resources
• Academy of Nutrition and Dietetics. “Obesity Medication and the Role of Lifestyle Interventions Delivered by RDNs.” https://www.eatrightpro.org/obesity-medication.
• Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight by David A. Kessler, MD.
• Society of Behavioral Medicine. “What Are GLP-1 Medications? 9 Common Questions.” https://www.sbm.org/healthy-living/what-are-glp-1-medications-9-common-questions.
• Losing the Weight Loss Meds: A 10-Week Playbook for Stopping GLP-1 Medications Without Regaining the Weight by Holly R. Wyatt, MD, and James O. Hill, PhD.
References
1. Kommu S, Whitfield P. Semaglutide. [Updated 2024 Feb 11]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2025 Jan-. https://www.ncbi.nlm.nih.gov/sites/books/NBK603723/. Accessed July 31, 2025.
2. Farzam K, Patel P. Tirzepatide. [Updated 2024 Feb 20]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2025 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK585056/. Accessed July 31, 2025.
3. Rizvi AA, Rizzo M. The emerging role of dual GLP-1 and GIP receptor agonists in glycemic management and cardiovascular risk reduction. Diabetes Metab Syndr Obes. 2022;15:1023-1030.
4. Rodriguez PJ, Zhang V, Gratzl S, et al. Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists among US adults with overweight or obesity. JAMA Network Open. 2025;8(1):e2457349.
5. Mozaffarian D, Agarwal M, Aggarwal M, et al. Nutritional priorities to support GLP-1 therapy for obesity: a joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society. Obesity (Silver Spring). 2025;33(8):1475-1503.
6. Zhang J, Sonnenburg D, Tricò D, et al. Isomaltulose enhances GLP-1 and PYY secretion to a mixed meal in people with or without type 2 diabetes as compared to saccharose. Mol Nutr Food Res. 2024;68(4):e2300086.
7. Grasset E, Briand F, Virgilio N, et al. A specific collagen hydrolysate improves postprandial glucose tolerance in normoglycemic and prediabetic mice and in a first proof of concept study in healthy, normoglycemic and prediabetic humans. Food Sci Nutr. 2024;12(11):9607-9620.
8. Srivastava S, Basak U, Naghibi M, et al. A randomized double-blind, placebo-controlled trial to evaluate the safety and efficacy of live Bifidobacterium longum CECT 7347 (ES1) and heat-treated Bifidobacterium longum CECT 7347 (HT-ES1) in participants with diarrhea-predominant irritable bowel syndrome. Gut Microbes. 2024;16(1):2338322.
9. Ye Z, Arumugam V, Haugabrooks E, Williamson P, Hendrich S. Soluble dietary fiber (Fibersol-2) decreased hunger and increased satiety hormones in humans when ingested with a meal. Nutr Res. 2015;35(5):393-400.
10. Lela L, Carlucci V, Kioussi C, et al. Humulus lupulus L.: Evaluation of phytochemical profile and activation of bitter taste receptors to regulate appetite and satiety in intestinal secretin tumor cell line (STC-1 Cells). Mol Nutr Food Res. 2024;68(21):e2400559.
11. Walker EG, Lo KR, Pahl MC, et al. An extract of hops (Humulus lupulus L.) modulates gut peptide hormone secretion and reduces energy intake in healthy-weight men: a randomized, crossover clinical trial. Am J Clin Nutr. 2022;115(3):925-940.
