Coming Off a GLP-1 Is a Lot Like Coming Off a Diet: Notes From a Dietitian

I spoke with someone recently whose story stuck with me. She’d been on and off several different GLP-1s. The first time was awful: disorienting, dissociating, very emotional, so she stopped after a week. The following year, still frustrated with how she was eating, she tried again. This time it was more tolerable, and she lost weight. But she always knew she didn’t want to stay on it long-term. Never being excited about a meal was its own kind of depressing. So she came off again. And that was the scariest part: her appetite and binge eating came back stronger than they’d ever been. And that’s when she reached out to me.

If eating feels out of control again or food thoughts and appetite have come with a vengeance after you stopped a GLP-1, or you’re scared they will, this post can give you some hope and a bit of a plan about what to do during this transition. I’m also going to share a bit about how this whole GLP-1 era has been feeling to me, as someone who helps people with their relationships with food. I hope you find it helpful.

Why Non-Diet Dietitians Understand This Transition Well

As a dietitian who has worked with people with chronic dieting and disordered eating for a decade now (wait, what?!), I have seen countless versions of folks ending cycles of food restriction. It’s basically my whole schtick.

Over the past few years, as GLP-1 drugs like semaglutide (Ozempic, Wegovy), tirzepatide (Zepbound, Mounjaro), and others, have become part of that landscape, I’ve been doing my best to help the people I see who are looking for support, and ideally to help folks who are unlikely to get nuanced care from their prescriber. (that is a whole different conversation though)

A dietitian can help at many stages of this experience: deciding whether to start one in the first place, figuring out how to eat enough while your appetite is barely there; building habits that’ll actually stick once your weight starts changing; to name a few.

I hope you’re getting support with all of that. Our profession is good at it.

But this one specific experience, coming off the medication, is one that eating disorder and intuitive eating dietitians are especially suited to help with. That’s because we have lots of experience supporting folks through the transition of learning to listen to their body and trust their hunger again, and know precisely how emotionally and physically complex this is.

How Many People Decide To Stop Taking a GLP-1?

It turns out the population on these medications really is split, which makes sense to me. A JAMA Network Open study tracking over 125,000 adults found that within a year, nearly 47% of people using these medications for type 2 diabetes had stopped, and almost 65% for people using them for weight loss.

The reasons vary. Side effects are the main cause: nausea, vomiting, and other GI issues affect somewhere between 40 and 70% of people on these medications. Cost and insurance coverage are also limiting. And some people just don’t like the idea of being on an appetite suppressant forever, or don’t like how it makes them feel. I’ve heard all kinds of stories about side effects, everything from losing the joy in life to being nauseous every day, to just not liking the emotional experience of it all.

Coming off GLP-1s now can feel like stepping into a world that got even more obsessed with thin bodies. What happens if you gain some weight back in this new environment? How will that feel?

I’ll be honest. Yes, this could be difficult. Absolutely. But even though we’re seeing less of them, the body-positive and body-neutral spaces aren’t gone. They’re just being drowned out by the weight loss conversations. Some past voices in the body positive space have fled the scene or are trying to navigate it just like you and me and all of us.

Why Binge Eating Might Come Back After Stopping a GLP-1

Binge eating is a complex phenomenon, and no single explanation covers every reason it happens. Trauma, emotional regulation, neurodivergence, genetics can all play a role, but the most common reason is diets and restrictive eating.

Glucagon-like peptide–inhibitors work, in large part, by dramatically reducing appetite and slowing digestion. For a lot of people, this means that worrying about eating “too much” also eases up. You simply don’t care about eating as much as you used to.

But reducing your appetite isn’t the same thing as changing your relationship with food. If nothing about how you relate to food, your body, or your hunger actually shifted while you were on the medication, the drug was managing a symptom, not treating what’s underneath it. That’s often why, once it wears off, things either settle back where they started, or as I feared, can get worse.

I hope to help you feel better about coming off them, not worse, so stay with me. I’m not trying to scare you.

The drug reduces your hunger signals, so it becomes very easy to eat less than your body actually needs without ever deciding to restrict anything. But just like forgetting to eat because of your ADHD medication, your body doesn’t know the difference between a diet and an appetite-suppressing medication. It just knows it’s been underfed, and once the tool keeping your appetite suppressed is no longer in your system, your body will respond in a predictable way. It could feel like taking a big gulp of air after being held under water by your mean big brother for a long time. It’s not a gentle inhale – it feels intense and dramatic. You need more air, faster, and urgently.

A lot of the intensity of this rebound comes down to plain old undereating — the same restrict-rebound mechanism behind every restrict-binge cycle, just by a medication instead of sheer will.

Research on people coming off GLP-1s shows ghrelin, the hormone that drives hunger signaling, goes up, while leptin and PYY, which help you feel full and satisfied, stay low. The body also burns fewer calories at rest than it did before, fewer than a smaller size alone would predict. That’s metabolic adaptation. It means you need fewer calories to maintain the lower weight than you used to, the same pattern researchers found when they followed up with Biggest Loser contestants six years out.

The best available research shows about 60% of what folks lose on GLP-1s typically comes back in the first year. Nobody has tracked people beyond a year off the medication, so we really don’t know what will happen. But if we assume what happens is the same as what happens when you stop another severe period of calorie restriction, we can assume that roughly ⅔ of folks will end up gaining back more than they lost, and the rest will likely end up at a set-point weight.

Why There’s No Clear Protocol for Coming Off a GLP-1 Yet

Despite being a few years in, we are still in the wild west clinically here. We never had adequate research about long-term use of these medications to begin with. So even though I say anti-diet dietitians and other weight-neutral professionals are skilled at this, we are also navigating this complicated space alongside you.

It’s not easy, either. Weight-neutral clinicians are constantly arguing with doctors and the public about why weight loss interventions backfire, even while doing our best to hold space for people newer to this work than we are. I’ve built up a real intolerance for weight loss marketing over the years, but that doesn’t mean I’ve got this era figured out any more than you do.

There isn’t research yet on what happens to people who cycle on and off these medications more than once, because this is genuinely new territory. My guess is each round erodes trust in your own signals a little further, consistent with what we already know about weight cycling generally: it’s harder on a person than staying at one weight the whole time. I expect the research will catch up eventually.

Your specific body, your specific history, your specific mind – they’re different from anyone else’s, and individualized nutrition therapy could genuinely make a difference for you. What I can tell you, honestly, is this: coming off a GLP-1 looks a lot like coming off a diet. Your body will likely be extremely hungry for a while. The job — mine, if we work together, or yours if you’re doing this on your own — is to make that process as calm and safe as possible while it’s happening.

It’s not always going to be easy. I can’t promise exactly what your body will do once appetite comes all the way back. But if what you actually want is to heal what’s underneath this, and to not be on these medications forever, I believe you can do it.

Interested in joining a newsletter that can help you reject dieting all together and heal your relationship with food? Check out Lunch & Liberation, my weekly ode to eating well and loving every minute of it.

Can You Practice Intuitive Eating on a GLP-1 So You Can Transition Off More Easily?

I don’t believe you can fully practice intuitive eating while you’re on a GLP-1. The medication is altering the physiological signals of hunger and fullness, the ones that intuitive eating asks you to attune to. These are your body’s ways of communicating its needs with you and if you’re going to use your body as your guide, you kinda need them.

That doesn’t mean you can’t do any work on your relationship with food while you’re still on the medication. I believe you can, and it’s worth doing! Think of it as doing the foundational work, the theory, the mindset, and the emotional work. You can unlearn your internalized anti-fat bias (yes, certainly complicated while on a weight loss medication, some may say too counter-intuitive to even try, but I think you can start).

You can work on your ability to be kind to yourself, to trust your decision-making, to build real meal planning skills. You could check out my Intuitive Eating Meal Planning Guide if you want support with that one.

You can also learn how to feed yourself food that you enjoy and that feels good in your body unconditionally. This means rejecting the notion that just because you’re not “thin enough” that you don’t deserve to eat good food. It is important not to under-eat on these meds. Check out my post about how to make sure you’re not undereating on a GLP-1.

The Fear of Regaining Weight in A Thin-Obsessed World

If you’ve lost weight on these medications and now you fear regaining it, that is probably not just vanity. It’s possible you’ve lost and gained weight enough in your life to know this lesson well. People are nicer to thin folks. Let’s not pretend otherwise.

It can be genuinely hard to lose the social ease that came with a smaller body. Family members were nicer, started complimenting you again, or just stopped side-eyeing your plate. Coworkers were nicer. Clothes were easier to find and buy. And even if you know intellectually, politically, and in your bones, that none of that should have been true in the first place, that you shouldn’t have had to shrink to be treated with basic decency, losing that ease is still a real loss. You’re allowed to have big feelings about it. Pretending you don’t feel that loss can make accepting your body and treating it well more difficult.

If You Believe in Intuitive Eating But Still Took a GLP-1

As I’ve said, I think at least half of the people who end up on one of these medications never intended to stay on it forever. I also think that for many people, on some level, starting one sorta felt like abandoning everything they used to believe about diets and bodies.

But it didn’t. Humans are complicated. You can know, deeply, that intentional weight loss rarely lasts, and still watch everyone around you get smaller while it feels like the whole body-positive shift got disappeared overnight, and decide to try anyway, hoping for the best.

If you’ve done work on your relationship with food already, and you still ended up on one of these medications, I don’t think that’s a contradiction.

Some of you probably did the very rewarding work of building a real, functioning relationship with food and your body. And then, over years, your weight crept up anyway, because of age, hormones, life circumstances, health diagnoses, genetics, or any number of things that have nothing to do with whether the work you did was legit. Bodies change. They were always going to.

How to Come Off a GLP-1 Without Falling Back Into Binge Eating

I do think this is hard to list in a static blog post, but I’m going to try anyway. So here are some things I think will be helpful if you find yourself in this space, wanting to stop, or already stopped, and are sorta freaking out.

• Let go of black-and-white thinking about food. No more “good” days and “bad” days, on-plan and off. Whatever you do, do not have “cheat weekends”. This is what turns a normal appetite increase into a binge or a shame spiral. Go for the grey. Let yourself enjoy pancakes at brunch, and a salad with dinner. Research on thought suppression shows trying not to think about food only makes you think about it more.
• Keep exercise in your life, but hold it loosely. Movement can genuinely help you feel more connected to your body, and now may be a super important time for you to feel good. Make sure you’re not letting it feel punishing, or do it in a way to make up for the food you ate. Just find a very gentle routine that you can live with, and stick to it. Twice a week is great.
• Eat enough during the day, even if you’re still overeating at night. Undereating during the day is often what fuels nighttime eating that feels out of control. Fixing the daytime under-eating first tends to soften the night-time overeating.
• Give yourself an outrageous amount of self-compassion. More than feels reasonable. I promise, there is no downside to being loving to yourself.
• Eat plenty of protein. Try a palm-size amount three times per day.
• Surround yourself, on purpose, with people who love you for who you are, not your body size. If someone comments on your body, your weight coming back, you eating more, you’re allowed to say something like, “I’d rather not talk about my body, but I’d love to catch up,” and leave it there. You don’t owe anyone an explanation for your body doing what bodies do.
• Keep meeting your other needs. Play, satisfaction, connection, pleasure. Food obsession has a way of swallowing all the space in your life meant for these things. Don’t let it.

You can’t simulate hunger while it’s still pharmacologically quieted down. So even if you do everything on this list, when your appetite comes all the way back, it might still feel shockingly sudden and intense. That’s not a sign you did any of this wrong, just a natural reaction to appetite suppression.

A safety note: everything above assumes what you’re dealing with is a hard, uncomfortable, but survivable rebound, not a full relapse putting your health or safety at risk. If it feels dangerous, if you can’t stop once you start, if it’s affecting your physical health, or if you’re having thoughts of harming yourself, please reach out for a higher level of care right away. The National Alliance for Eating Disorders runs a free helpline staffed by licensed therapists at 866-662-1235 (9am–7pm EST, M–F), and they can help you find the right level of support.

If you’re not sure whether what’s happening counts as bingeing versus something else entirely, I’ve written more about how to tell the difference here.

What I’d Actually Recommend, Step by Step

First of all, this is not meant as medical advice, but for educational purposes, but if you asked me to sit across from you and just tell you what to do, here’s roughly what I’d say.

First, talk to your prescriber about a slower taper instead of stopping cold. If you can taper off over a longer stretch, it may feel a lot calmer. A lot of prescribers won’t offer this unless you ask directly.

Second, before your appetite fully comes back, start rebuilding the structure around eating. Eat regular meals and snacks, food you actually like and can available in your house. Build relatively balanced meals, but don’t deprive yourself of things you love. Try and eat three meals and maybe snacks, and don’t go longer than 4 hours without eating.

Third, get support lined up now, not after things feel like they’ve fallen apart. Whether that’s me, another dietitian who works this way, a therapist, or a program.

Fourth, expect things might feel a little chaotic. Some days your appetite will feel manageable, other days it might feel ravenous. There is a level of normal in that. We are hungrier on some days for all sorts of reasons, so if you can try and just listen to your hunger instead of making it a “big deal” you might have a smoother time.

And last, give yourself permission to not have this figured out yet. You’re allowed to believe deeply in food freedom and still be, right now, in the middle of a genuinely hard transition.

If you’re reading this and thinking, this is exactly where I am, and I don’t want to keep doing this alone, I’d love to help. You could be a great fit for the Love Food Again program. It’s my 6-month group program for people who are done with the cycle and ready to actually heal their relationship with food, with real support instead of white-knuckling it solo. Learn more about that and my other offerings here.

About Emily

Emily Van Eck, MS, RDN specializes in Intuitive Eating, eating disorders, body image, women’s reproductive health, and healing from years of weight-bias and disordered eating. She helps people find balance, consistency, and peace with their eating habits so they can feel confident to get outta their heads and into their bodies. Emily is a registered dietitian and certified Intuitive Eating counselor with a master’s degree in nutrition science. Read more about her practice, values, and experience here.