Cosmos Study

Two Years After Stopping GLP-1s, Most Patients Sustain at Least Some Weight Loss

September 9, 2025

Team A:Kersten Bartelt, RNJoe Deckert, PhD

Team B:Blaine Franklin, PT, DPTEric Barkley

Key Findings

At 24 months post-cessation, 56% of semaglutide, 52% of liraglutide, and 55% of tirzepatide patients kept the weight off or lost additional weight.
Complete weight regain occurred in 23% of semaglutide, 21% of tirzepatide, and 27% of liraglutide users at 24 months.
Weight trajectories stabilized after 12 months, with only small variations in the distribution of weight outcomes through year two.

GLP-1 medications, including semaglutide, liraglutide, and tirzepatide, are increasingly used for weight loss. While effective during treatment, their long-term benefit hinges on whether weight loss persists after discontinuation. We previously showed promising one-year outcomes,¹ but questions remain about longer-term trends.

To understand the durability and stability of weight outcomes after stopping GLP-1s, we studied 188,722 patients who stopped using a GLP-1 medication after being on it for at least 90 days and who lost at least 5 pounds while on it. Patients were grouped based on whether they regained weight, maintained their weight loss, or experienced further weight reduction.

Two years after stopping GLP-1 treatment, most patients had sustained at least some of their weight loss. For semaglutide, 25.9% doubled their weight loss, 15.6% had some additional weight loss, and 14.6% maintained their initial loss, totaling 56.1% in the sustained or improved categories.

Figure 1

Proportion of Patients by Weight Change After Stopping Semaglutide

Figure 1. The proportion of patients by amount of weight regained or lost after stopping semaglutide.

For liraglutide, 21.8% of patients doubled their weight loss, 15.9% lost some additional weight, and 14.2% maintained their loss, with 51.9% in total maintaining or losing more weight.

Figure 2

Proportion of Patients by Weight Change After Stopping Liraglutide

Figure 2. The proportion of patients by amount of weight regained or lost after stopping liraglutide.

Among patients who stopped taking tirzepatide, 31.0% doubled their weight loss after two years, 15.2% lost some additional weight, and 9.0% maintained their initial loss, with 55.2% in total maintaining or losing more weight.

Figure 3

Proportion of Patients by Weight Change After Stopping Tirzepatide

Figure 3. The proportion of patients by amount of weight regained or lost after stopping tirzepatide.

Across all groups, proportions in each weight category stabilized after 12 months, with small variations between months 12 and 24, suggesting long-term weight trajectories are largely set by one-year post-cessation. Stratification by patient sex and age showed similar distributions.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,700 hospitals and more than 40,000 clinics from all 50 U.S. states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

References

Bartelt K, Mast C, Deckert J, Gracianette M, Joyce B. Many Patients Maintain Weight Loss a Year After Stopping Semaglutide and Liraglutide. Epic Research. https://epicresearch.org/articles/many-patients-maintain-weight-loss-a-year-after-stopping-semaglutide-and-liraglutide. Accessed on August 4, 2025.

Data Definitions

Study period: 1/1/2017 to 7/1/2025

Study population: inclusion: Patients with
A GLP-1 prescription for at least 90 days
At least five pounds of weight loss while on the GLP-1
A weight reading between 30 days prior through 3 days after starting the GLP-1
A weight reading within 30 days of stopping the GLP-1
At least one weight reading 1 to 24 months following end of the GLP-1

Study population: exclusion: Thyroid conditions (ever): ICD-10-CM E03*or E05*
Eating disorders (ever): ICD-10-CM F50*
Pregnancy within a year before GLP-1 start through GLP-1 stop

Censoring: Other weight loss medication or restart of GLP-1
Amputation
Bariatric surgery
Pregnancy that started in period after GLP-1 was stopped

Outcomes: Percent of weight change relative to initial weight loss after end of GLP-1 treatment

GLP-1: A medication with a simple generic of semaglutide, liraglutide, or tirzepatide.

Other weight loss medications: Orders with one of the following pharmaceutical classes and not associated with any GLP-1 simple generics:
ANTI-OBESITY SEROTONIN 2C RECEPTOR AGONISTS
ANTI-OBESITY-OPIOID ANTAG-NOREPI,DOPAMINE RU INHIB
ANTI-OBESITY – ANOREXIC AGENTS
ANTI-OBESITY – MELANOCORTIN 4 RECEPTOR AGONISTS

End of GLP-1 treatment: Calculate the date following the last end date of GLP-1 agonist drug represented by the end date calculated based on the number of refills as (refills + 1) * 28 after the treatment start date.

Amputation: A diagnosis with ICD-10-CM code Z89.2*, Z89.6*, S78.011A, S98.011A, S78.012A, S98.012A, S78.019A, S98.019A, S78.021A, S98.021A, S78.022A, S98.022A, S78.029A, S98.029A, S78.111A, S98.111A, S78.112A, S98.112A, S78.119A, S98.119A, S78.121A, S98.121A, S78.122A, S98.122A, S78.129A, S98.129A, S78.911A, S98.131A, S78.912A, S98.132A, S78.919A, S98.139A, S78.921A, S98.141A, S78.922A, S98.142A, S78.929A, S98.149A, S88.011A, S98.211A, S88.012A, S98.212A, S88.019A, S98.219A, S88.021A, S98.221A, S88.022A, S98.222A, S88.029A, S98.229A, S88.111A, S98.311A, S88.112A, S98.312A, S88.119A, S98.319A, S88.121A, S98.321A, S88.122A, S98.322A, S88.129A, S98.329A, S88.911A, S98.911A, S88.912A, S98.912A, S88.919A, S98.919A, S88.921A, S98.921A, S88.922A, S98.922A, S88.929A, S98.929A or a procedure with ICD-10-PCS code 0Y6[23478CDFGHJ]* or 0X6[012389BCDF]*

Pregnancy: A diagnosis with ICD-10-CM code O*, a pregnancy episode, or a birth record

Bariatric surgery: A procedure with CPT code 43644, 43645, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43845, 43846, 43847, 43848, 43886, 43887, 43888, 43842, or 43843

Limitations: We allow a patient to be included in each month, using their highest weight in that month. Patients who have repeated weight measurements might be the extremes of weight change.