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You stopped your GLP-1 medication… maybe because of cost, side effects, or because things were finally going well and you thought, “I’ve got this now.” But then the weight started creeping back on, you went back on the medication… and now it’s just not working like it did the first time. 

So what changed?

The frustrating truth is, your body isn’t in the same place it was before. Muscle loss, a slower metabolism, weight cycling that increases visceral fat, and chronic stress keeping cortisol elevated… all of this works against you, even when you're doing everything “right”.

In this post, I’ll unpack why this happens, what’s really going on under the surface, and what you can do to get things moving in the right direction again. 

Why people stop medication (and why weight often returns)

People usually have good reasons for stopping medication, like:

• Insurance or cost makes it hard to continue
  
• Side effects become difficult to manage
  
• Pregnancy plans mean stopping is necessary
  
• Or weight loss is going well, and it feels like medication is no longer needed

That last one is especially common. When appetite quiets and weight starts dropping, it’s natural to think, Maybe I can manage this on my own now.

The challenge is that these medications are often treating underlying physiology, not just helping with willpower or habits. When medication stops, the biological drivers of weight regain can come back. Hunger signals increase, cravings return, and weight creeps up again.

So people restart medication expecting the same success as before. But in the meantime, the body has changed. 

Here are the main reasons why results often look different the second time around…

• Muscle loss lowers your metabolic engine

One of the biggest shifts happens with muscle mass, and many people don’t realize it.

During weight loss, some muscle loss almost always happens, especially if strength training and protein intake weren’t prioritized. When weight comes back on, fat returns more easily than muscle.

That means you can end up at a similar weight as before but with a different body composition.

In simple terms:

• Less muscle means a slower metabolism.
  
• A slower metabolism means fewer calories burned at rest.
  
• And fat loss becomes harder the next time around.

So when medication is restarted, it’s not working with the same metabolic setup as before. The engine is running a little slower.

• Weight regain changes how fat is stored

Weight cycling (losing weight, regaining it, and losing it again) tends to increase visceral fat, the fat stored around internal organs.

This type of fat:

• Worsens metabolic health
  
• Makes fat loss more difficult
  
• Raises long-term health risks

So even if the scale shows a familiar number, what’s happening inside the body may be very different. 

• Expectations often stay the same, even when reality changes

A lot of frustration comes from expecting the exact same results as the first time on medication.

People expect the same appetite changes, the same rate of weight loss, the same timeline.

But this time around:

• Muscle mass may be lower.
  
• Fat storage patterns may have shifted.
  
• Stress levels may be higher.
  
• Life circumstances may be different.

So progress may look slower or require different adjustments. That doesn’t mean something is wrong, just that the situation has changed. 

• Other metabolic factors may have developed 

Bodies change over time and new factors can appear that weren’t there before.

Maybe you developed sleep apnea, or a thyroid issue emerged. Maybe something else metabolically shifted that's now impacting how your body responds to medication.

This is why if it's been more than six months to a year since you've had comprehensive lab work done, you need to get reevaluated. 

In my clinic, I see people at minimum once a month, often more frequently. That allows me to catch these shifts early and adjust accordingly. But if you're only seeing your doctor once or twice a year for 15-minute appointments, there’s no way they could possibly dig into all these areas. It’s key to work with someone looking at the full metabolic picture again.

• Stress and the nervous system matter more than you think 

Modern life keeps many people in a constant low-level stress response. Work pressure, finances, parenting, constant notifications, and social media noise keep the nervous system activated.

When stress stays high, cortisol tends to stay elevated. And elevated cortisol can:

• Make fat loss harder
  
• Increase fluid retention
  
• Drive hunger and cravings
  
• Worsen sleep and fatigue
  

Then weight regain happens, and panic kicks in. People start checking the scale constantly, worrying the medication isn’t working, and stressing about every fluctuation.

That stress itself can make fat loss harder, creating a frustrating loop where anxiety feeds the very problem someone is trying to fix.

Stress also changes how decisions get made

When someone feels calm and regulated, they can step back and think clearly. They can look at what needs adjusting and make steady, thoughtful changes.

But under stress, decisions tend to become reactive. People jump between strategies, chase quick results, or constantly change plans instead of sticking with the basics that actually work.

A calmer approach often leads to better long-term results, even though it’s hardest to access when frustration is high.

Sometimes the issue is simpler than expected

Not every stall is complicated physiology. Sometimes the basics quietly slip over time.

Things like:

• Protein intake dropping
  
• Strength training becoming inconsistent
  
• Daily movement decreasing
  
• Sleep getting worse
  
• Water intake falling off
  
• Structure disappearing when life gets busy
  

Medication helps, but it can’t override everything. Long-term success still leans on consistent, simple habits.

So what do you do if this is happening?

Instead of assuming medication stopped working, it helps to step back and look at the bigger picture.

Ask questions like:

• Has muscle mass changed?
  

• Have my habits slipped?
  

• Has stress increased?
  

• Has it been a while since labs or a medical review?
  
• Am I expecting the same results as last time?

Often, progress starts moving again once these areas are addressed. Sometimes that means rebuilding muscle, returning to nutrition basics, improving stress management or making medical adjustments. Usually, it’s a combination.

Moving Forward

If you're facing this situation right now having restarted medication and it's not working like before, please hear this: you haven't done anything wrong.

Your body is complex and this is a chronic condition. The path forward just looks different this time around.

You need:

• Updated metabolic assessment and lab work
• Focus on building (not just preserving) muscle mass
• Realistic expectations about timeline and results
• Serious attention to stress management and nervous system regulation
• Possibly additional support beyond just medication

And if there's any way to avoid stopping medication in the first place—if you can find a way to make it work financially, if you can manage side effects, if you can shift your belief that you "should" be able to do this without medication—I would always choose that route.

Because as frustrating as it is to hear: what I universally see is that when people come back after stopping, they do not have the same results.

This isn't to scare you. It's to help you make informed decisions about your health moving forward.

You deserve support, comprehensive care, and to understand what's really happening in your body so you can move forward with confidence, not panic.

If you’re feeling confused or frustrated about why your GLP-1 medication isn’t working like it did before, check out the full podcast episode. I go deeper into how metabolism, muscle loss, stress, and everyday habits affect your results, and what you can do to support your body so progress starts moving in the right direction again.

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.    

 Welcome back to another episode of the podcast. How are you all doing? I'm recording this on a Saturday, which I normally don't do, but. Something came across my social media feed here. It was actually in a physician group and a person was talking about their experience. But I have seen this so often, not only in my patients and also friends over the past few years that we need to talk about it, which is when you're going on and off of these GLP one medications, how sometimes when you come back to it, it's not effective.

And I wanna give some of my thoughts on that and some of what else might not be working when you're doing that. And again, I know we've talked extensively very recently here about how. It's so unfortunate that financial aspects are a big part here because insurance doesn't cover it a lot of the time.

So, you know all that's involved, but I still think this is a really valid conversation for us to have. Okay. But before we do that, I wanted to just talk real quick. I'm sure I've probably brought this up a bunch. I can't remember sometimes what I've said or not on the podcast, but I've been loving recently this book Slowing down to the Speed of Joy.

It's by Matthew Kelly. I'll make sure to link it in the show notes if you come over to. To my website, renta clinic.com, and you click on podcast. We have for every single episode, we have all of the written notes there links to everything. That's a really good resource, if you're someone that you hear an episode and you're thinking, oh, I wanna go check those things out, or go read that book, whatever it is, you can always come over to my website and it's all there.

There's even a search bar at the bottom of that podcast page, and you can put in. If you remember the name of a person, a book, a Topic, and you can find it. We also have that free podcast roadmap, and again, we'll have all that linked. So it's slowing down to the speed of joy by Matthew Kelly and the subtext is the simple art of taking back your life.

Really what he talks about is when we're busy all the time, we're missing absolutely everything. I just wanna read you just two sentences so far. This is really all within the first 30 pages, and there were, so, I mean, every page or two, I'm highlighting something, but, um, but here we go. He said the faster you go, the less you see, go fast enough and everything becomes a blur.

Does your life ever feel like one big blur? The faster you go, the more likely you are to crash. I talk a lot about in my groups that when you're having challenges with urges and cravings or behavior that isn't serving you, it's often that your life is so fast, you need to slow it down to figure out where you can intervene and how you can do something different.

And a lot of that involves nervous system regulation and. Being able to make pattern interrupts and really learn how our psychology works, so you can do things differently. But the bottom line is when you're going really fast, you cannot come up with solutions. You just can't. Okay, here's the other line though.

That just was massive underlying moment for me. Okay. Busy isn't going to quietly vacate your life. Joyless urgency will remain the status quo unless you decide to wrestle with busy and win. Isn't that incredible? This whole book has just really been resonating. I think that this is one that we will be bringing into that book study that we'll be doing here shortly.

If you're someone that wants to participate in that, I think it's about a four month period. We're gonna do one book per month. We're gonna meet weekly and do calls. I'm gonna do this with Amanda Saer, if you're interested. This is one of the books that I think will really make the list. We're not a hundred percent on what we're gonna do yet, but my suspicion is I think that.

Because we're not just looking at books when we're doing the book study. It's really about how can I actively implement this stuff in my life? Because if you don't do anything with it, there's no point to just reading something and then you continue the same mess in your life that's not working.

This book has really had some. Real ramifications over the past few weeks and how I've been living my life. Okay, but back to the topic at hand. I had a friend tell me this recently, and then again, there's this post where they, in the past, let's say, two years ago, they were having a lot of success.

This person that wrote the Post, they were on semaglutide and they said how they were doing really great. They lost weight, they felt great, and then they thought. Okay, I'm doing so great. I think I can manage this on my own, I'm just gonna go try this without medication. And then they gained back half the weight.

And so they're like, okay, I got it. I need to go back on the medication. Then they go back on what they think is a stronger medication, they go back on Tirzepatide and they're going up and up and up in the dose and they're noticing no weight loss. And now they're saying, what am I doing wrong? And they're wishing that they hadn't come off the med.

My other friend was telling me, this person had actually come off for, uh, sometimes people wanna come off because of, wanting to get pregnant, which makes sense. I mean, it makes sense sometimes to stop the medication, right? But a lot of the times it's a chronic disease and the fact that we think somehow we can like willpower it, like I can just have strong enough habits when we're actually treating something physiologic.

I think that's the actual thought error that occurs. I have seen this just historically that if someone has been doing really great. They have this thought in their mind, it usually comes from a standpoint of they either one, do not believe that they should have to be on medication, which I get it, that's a common belief that people have or it's a financial issue, but it's usually one of the two things.

And so they decide to come off of it. And what I universally see is that when they come back, they do not have the same results. And I don't say this to scare you all. Okay? 'cause that's not everyone. But my point is if there's an option not to quit, I would always pick that route over completely stopping the medication, assuming.

We think you need it for life again, there's always that rare exception of the person that never really struggled with overweight and obesity long term. It's not really a high level of metabolic derangement. The classic example is maybe their whole life they had everything where it wanted to be, and with pregnancy, they gained some weight and.

Then a year after they can't lose the weight and they're really trying to do all the things. Or someone had an episode of massive depression and and they start to come out of that and they just realize I can't get back off the weight that I put on. The body's just not responding the same again because it's a metabolic disease that's happening.

Here's the thing. When the medication worked before and now it's not, there's likely something that is overriding how effective the medication can be. And you hear me talk a lot about all these different buckets, that it's not just nutrition what you're eating, when you're eating it the quality of what you're eating.

It's not just movement, it's also stress. It's muscle mass, it's all those things. What I think is this. Number and these, I'm gonna do this in a numbered order, but this is not in ranked order of how I would see it happen when you initially lost that weight. There's a really good chance that if you were not doing body compositions and really following skeletal muscle mass and making sure that you were doing strength training and eating enough protein, doing all those things, that you lost muscle.

So now you just assume, okay, I'm gonna go back on the medication and it's all gonna work out, but. Your metabolism is a lot lower now because you lost muscle mass. You have lower metabolism, things would need to look very different this time around compared to last time. You see what I'm saying?

Because you're thinking, okay, I just gained back the weight and I'm just gonna do the same things and it comes down. You don't have the same, I always say that the, the metabolic furnace, the power behind it, you don't have that because you lost a lot of muscle. Is everyone following me on that, that the first time you lost weight, yes, you might have been losing muscle as you did it, but you got to where you are, where you were, right?

And you could have just maintained there. But then when you gained back weight, even if we were to take you to where you were at that 50% mark before you had more muscle at that time, so your metabolism was different. I hope everyone's following me on that because that's just like a really good nuance for us to see.

The other thing too, remember we've talked about when you regain weight, when you're doing weight cycling, up and down, up and down, you gain more visceral fat. That's that sick fat that makes it harder for you to achieve health long term. So not only can the muscle mass be down, the engines down, and then also the pattern in which you put it on is not helpful to you.

The other thing that I really see happen is that you have mismanaged expectations because you come back to this and you think, well, I'm gonna have the exact same trajectory that I did the first time.

But again, even if you just think about what we just talked about, it's not the same this time. There's nothing wrong with this, okay? This is part of this being a chronic disease, is that we're always having to get a little bit creative and look at different things and really know what we're doing.

That's fine, but you can't have the same expectation that you did the first time around, that needs to maybe look different. People also get very impatient. You want the results yesterday? Well, guess what? Again, this is a complex disease. We're gonna have to figure out different things. It looks different.

This time around. Rarely you'll see something metabolic pop up, someone developed sleep apnea, someone developed a thyroid problem, that there are other factors at play that is a whole different bucket. This is why I always say that. Let's say it's been more than six months to a year since you've last had your lab work or things really evaluated.

You need to. Go have all that checked. Again, one of the nice things about being in a clinic like mine, I have the metabolic clinic. I see people in Indiana and Illinois. It's that. I know you very closely 'cause I'm talking to you all the time, but if you are not seeing a physician as often as in my clinic, I'm seeing people latest every month, some people more often.

If you're not giving all that feedback to someone, I want you to imagine, unless you have a three hour visit when you go in, how could they dig into all these areas? They can't they're a little bit guessing in the dark you need to realize that. They need to, again, redo lab where kind of reassess things.

Maybe they have another questionnaire that they give you. What are they gonna do so that they can really dig into what is different. We change over time. You're not the same person when you come to me three years later. You are different. I rarely have people that will leave the clinic and then they'll come back.

And I always realize, oh my gosh, I am doing things so much more differently now. But also a lot has changed for them. It's an evolution of what happens over time. We're not just these static people. There's just like such a misconception with that. Again, it's that you did not have your metabolism overall looked at again. This last aspect that I really wanna touch on. How high your stress levels are. I, I, I was joking in this 30, 30 round this January round, I was talking about stress management and nervous system regulation. So much that I just joked at one point, pretty much every single time we talk about this, but it's that important.

I wanna just give a little, example here. I've done a lot of work on this over the past year. And one thing that I've really been loving right now, by the way, this is available for everyone. There's a really great, once a month, it's called The Gathering, and it's run by Jane Pilger I'll put

the link to the information here. I've been going to these, and what she did in one of these here recently is.

She talked about what the nervous system does, it's always trying to say, am I safe? She talked about mapping the nervous system. What's happening when you're regulated and what's happening when you're dysregulated?

And I wanna try to bring her on back on the podcast because I want her to talk about doing that. 'cause I think mapping that is really amazing. She's really skilled at walking you through it. So anyway, I'll put the information for all that. But the point being that there's a lot of work that needs to go into this because just like we talked about in the beginning of this episode with the book, slowing down to the speed of joy.

We live in a world that is bombarding us 24 7. If you're not gonna take some time where you spend some of your day in silence so you can hear what you're thinking, you spend some of your time moving so that those emotions can work through your body. Just think about this for a second.

You give a presentation at work, you do something, before you have all this adrenaline afterward, the cortisol needs to go down. That's an experience, that's an ordeal, we, back in the day, we were meant to, oh my gosh, there's a lion. Go run away. We were always meant to assess what's safe, what's not, what's safe, what's not.

But nowadays we're in very at tame vanilla situations, but our nervous system is still like it was all those years ago, a lot of things have evolved around us, but modern world, ancient brain and body, this is a world that people do not look at enough. We don't live in a supportive world.

It's a lot of social media coming in, a lot,, of, of productivity requirements at work. There's just a lot that's being asked of us 24 7. So it's a very radical, intentional act to say, listen, I'm not gonna live with this stress level. I'm not gonna live my life in this way. And if you love your life and how you feel, this is not a conversation that you need to take on.

But if you're noticing I'm tired all the time, I'm fatigued all the time, I'm unhappy, I'm ungrateful. I mean, you name it, a lot of this has to come back to what's happening in life for you. When you're in that, it is very hard for your body to say, yes. You know what we'd love to do right now, Mateo, we'd love to drop a bunch of fat.

Your body's trying to hold on. It's having to deal with all this. A chemical signaling mess that's occurring when the stress is high, when cortisol's up all the time, you are in fat storage mode, you are in a mode where you're retaining salt and fluid and it's not great. And again, I I always say this online in my videos.

I'm not here to be the cortisol police and fear monger you on it. But it's a massive part. Think about the mental mind space. That this person has to be in where they lost weight, and then they're noticing, oh my gosh, I've gained back half of it. They are panicked. You can tell from the way in which they're writing this message, they are freaked out.

They're panicked, okay? They are going with that energy then onto the medication, and then they're probably like every single day. Look, I'm making stuff up at this point, but you can follow me on the lines, right? They're every day they're looking at the scale. And then they're wondering, it's not working.

It's not working. I'm going higher. Then they're panicking even more as they're going up on the dose, but they're not seeing the results. Can we all see the picture of how that's not gonna work? And I can sit here and explain some of the physiology and the psychology of it, but at the end of the day, you have to decide, is this something that I'm actually gonna work through and I refuse to live my life this way anymore, or am I just gonna continue it?

A lot of what I like that Jane talks about. The thing that just broke my brain when she talked about it is it's not your job to sit there and keep thinking, how can I not overeat? Oh my gosh, I shouldn't overeat. I shouldn't eat these things. It's your job to sit there and figure out how to self-regulate.

That's your work. And a lot of the time, if we can do more of that, the other stuff resolves itself. Hopefully this episode was helpful today. I'm gonna just leave it there for this. These are the kind of things that, the, you know, the topics and insights and things that I like to go through in my programs, because I'm sorry.

It is not just about getting on a medication. It's really not that simple. If it was, you never really had a strong problem to begin with. There's a subset of people that never had a lot of weight to begin with, and I'm so glad that they're getting help with the meds. I'm not negating their experience either, and I don't want disease to get radically outta control before you get help. Definitely not saying that, and I'm very glad they're getting help.

But if you are in the camp, which is usually more who long-term is listening to me where you did lose weight, you are struggling. Times do come when you struggle. This is a chronic thing. And so if we can start to look at, okay, these are all the different players. Which one do I think could be most impacted right now for you, it might not be the stress part, it might just be you just stopped drinking water. there can be very simple. Back to the basics that you can do if you need this. Back to the basics series. I did this in January of 2025.

I think it was three episodes where I went through, listen, like these are the basics and I think I'm gonna redo that coming up here because we just need to be reminded of just. Normal simple basics. But if you are doing those things, 'cause this person's talking about, I'm getting this amount of protein, I'm getting this amount of steps, they're doing all the things.

Okay. If all that stuff isn't working out for you, then if your me, if your medicine workup is completed, then we need to look at other areas like this stress stuff, and we need to figure out how we can get further with you because this is the work long-term that makes it work out. I'm gonna give you one reason why.

Let's say that you get to a place where you are better with knowing when you're triggered. You're knowing when you're not, that's knowing if your nervous system is regulated or dysregulated. There's lots of different terms that we could use for that.

If that's happening, let's say that your weight is going in the wrong direction, these things are happening, you are so calm, you figure out a way. You see if the doctor needs to add another med, you see what you can move. You are creative. You are inspired. You are focused. You have access to the reasoning part of your brain when you are panicked, which that's most of you because you have no concept of managing your mind, managing your stress when that's going on, you are not logical with what you're doing.

You're grasping, you're doing random things. You're constantly seeking novelty. You're constantly seeking high intensity. That does not work out long-term. Alright, I'm gonna leave the episode here. I hope that today's episode was helpful. I would like to ask a big favor here. If you have been loving the podcast and you've been, either you're new or you've been listening along for a while and you've not left a review, can you please do that wherever you're listening?

I know it is such a pain. It really helps for this podcast to be able to get out to more people that need to hear this, that are struggling, that are suffering, and they're getting diet, culture, fat phobia. They're getting not the medical perspective with any compassion, and I want this message to be able to get to them.

If you've been loving it, if you could leave a review, I would be most appreciative. I hope that you have a great rest of the week and I'll see you next week.