The 30-second summary
- Stopping usually brings weight back. In trials, people who stopped semaglutide or tirzepatide regained much of what they had lost within a year.
- A lower dose is a middle path, now with trial data. In SURMOUNT-MAINTAIN, dropping tirzepatide to 5 mg for a year kept people 16.6% below their starting weight, against 21.9% on their full dose and 9.9% on placebo.
- Microdosing below the licensed doses has not been tested. The trial used 5 mg, a licensed dose. Everything below that is still unknown.
The question most people reach eventually
Once the weight has come off, the same question comes up again and again: do I stay on this dose for good, step down, or stop? It is a reasonable question. The medicine costs money, some side effects linger, and many people would rather take less of anything if less will do.
For a long time the only hard evidence was about stopping. Now there is a trial about stepping down.
What stopping does
Three large trials looked at what happens when people who have lost weight on a GLP-1 medicine stop taking it.
- Semaglutide, STEP 4. After 20 weeks on semaglutide, people who carried on with 2.4 mg lost a further 7.9% of their body weight over the next 48 weeks. Those switched to placebo regained 6.9%.
- Semaglutide, STEP 1 extension. People had lost 17.3% of their body weight over 68 weeks. A year after stopping, they had regained about two-thirds of it, leaving them 5.6% below where they started.
- Tirzepatide, SURMOUNT-4. People had lost 20.9% over 36 weeks. Over the next year, those who carried on lost a further 5.5%, while those switched to placebo regained 14.0%.
The STEP 1 extension authors put it plainly: the findings confirm that obesity is a chronic condition, and suggest ongoing treatment is needed to keep the improvements in weight and health. (See what happens when you stop a GLP-1.)
What SURMOUNT-MAINTAIN tested
SURMOUNT-MAINTAIN was published in The Lancet in June 2026. It was funded by Eli Lilly, which makes tirzepatide, and run at 20 sites in the United States.
- 441 adults with obesity first took tirzepatide at the highest dose they could tolerate, 10 mg or 15 mg, for 60 weeks.
- 378 of them were then randomly assigned to one of three groups for another 52 weeks: stay on their dose, drop to 5 mg, or switch to placebo.
- From week 84, anyone who had regained more than half of the weight they had lost could be given their tirzepatide back as a "rescue" treatment.
At the start, the average participant weighed 113.8 kg with a BMI of 40.1. Almost two-thirds were women, and the average age was 46.6.
What it found
| Group, for the final year | Change in body weight from the very start, at week 112 | Given rescue treatment for regaining more than half |
|---|---|---|
| Stayed on 10 or 15 mg | 21.9% lower | 8% |
| Dropped to 5 mg | 16.6% lower | 25% |
| Switched to placebo | 9.9% lower | 67% |
Three things stand out.
The lower dose kept a good share of the weight off. People on 5 mg ended well below those who stopped, a difference of 6.6 percentage points.
It kept off less than the full dose did. People who stayed on their higher dose ended 5.3 points lower again.
Responses varied. A quarter of people on 5 mg regained more than half of what they had lost and were given rescue tirzepatide. The authors themselves say a lower dose "might provide a valuable alternative to discontinuation", and add that individuals' responses might vary.
The most common side effects of tirzepatide were stomach-related, mostly mild to moderate, and mostly during the dose increases.
What the trial does not tell you
- Nothing about doses below 5 mg. The trial tested the lowest licensed maintenance dose, not a microdose.
- Nothing about semaglutide. We could find no equivalent trial of stepping Wegovy or Ozempic down to a lower dose to keep weight off.
- Only one year at the lower dose. What happens over several years is not known.
- A particular group of people. Adults in the United States with an average BMI of 40, on 10 or 15 mg, in a trial funded by the manufacturer.
What about microdosing?
"Microdosing" means different things to different people online. Usually it means taking less than the licensed doses, either from compounded vials or by counting clicks on a branded pen to deliver part of a dose. We could find no randomised trial of it on PubMed. What has been published so far is commentary: a 2026 report for nurse practitioners, for example, describes dosing errors and safety risks from manipulating pens, using compounded vials and sharing medicines, and people buying illicit "research-grade" peptides online.
The licensed pens are not designed for it. Mounjaro's prescribing information says each KwikPen contains 4 doses of 0.6 ml, that any solution left over after those should be thrown away, and that its instructions must be followed carefully. Its lowest dose, 2.5 mg, is the starting dose; the licensed maintenance doses are 5, 10 and 15 mg.
Compounded versions add a separate set of risks, because they are not the licensed product and are not checked the same way. (See compounded semaglutide and tirzepatide and the FDA's action on compounded GLP-1s.) If you are drawn to microdosing, the honest position is that it is an experiment without data, and one to discuss openly with a prescriber rather than work out from a forum. (See GLP-1 microdosing.)
Can you stay on 1 mg of Wegovy?
Wegovy's UK prescribing information names 2.4 mg as the maintenance dose, and now allows adults with obesity to go up to 7.2 mg if needed. The steps before that, including 1 mg, are part of the climb. The label does give prescribers room: if stomach side effects are significant, they can delay the next increase or go back to the previous dose until symptoms improve. The 2025 joint advisory from four US nutrition and obesity medicine societies notes that some of its authors keep people at the lowest effective dose and increase it only when weight loss stops. There is simply no trial yet showing how well a lower semaglutide dose keeps weight off over the long run. (See pausing a dose increase.)
Making a lower dose work
If you and your prescriber decide to step down, a few things give it the best chance.
- Agree a plan before you change anything. SURMOUNT-MAINTAIN built one in: if weight came back past a set point, the higher dose came back too. Deciding that in advance takes the guesswork out later.
- Weigh yourself regularly and watch the trend, not single days.
- Keep protein and strength training going. A 2025 joint advisory from four US nutrition and obesity medicine societies says structured strength training is well established to help preserve lean mass during weight loss, and that enough protein should be a priority. (See keeping muscle on a GLP-1 and strength training on a GLP-1.)
- Be ready for some appetite to return. In trials, how much less people ate rose with the dose, so a lower dose may mean a louder appetite. (See when food noise comes back.)
What to do with this
When you reach your goal, your calorie target changes too. If you enter a goal weight at or below your current weight, the calculator gives you a maintenance target rather than a deficit, along with a protein floor, so you can see what keeping the weight off actually asks of you.
Sources
- Horn DB, et al. Tirzepatide for maintenance of bodyweight reduction in people with obesity in the USA (SURMOUNT-MAINTAIN): a multicentre, double-blind, randomised, placebo-controlled trial. Lancet 2026. PubMed
- Aronne LJ, et al. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA 2024. PubMed
- Rubino D, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA 2021. PubMed
- Wilding JPH, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab 2022. PubMed
- Mounjaro KwikPen solution for injection in pre-filled pen: Summary of Product Characteristics. electronic medicines compendium. emc
- Wegovy 2.4 mg FlexTouch solution for injection in pre-filled pen: Summary of Product Characteristics. electronic medicines compendium. emc
- Trainer N. The "microdosing" dilemma: Balancing patient anecdotes with clinical safety amid GLP-1 compounding restrictions. J Am Assoc Nurse Pract 2026. PubMed
- Mozaffarian D, 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 Pillars 2025. PubMed
Medical disclaimer: Articles in the foodose research library are educational, not medical advice. Never change your dose without talking to your prescriber. See our full medical disclaimer.