The Three Phases of Treatment: A Plan to Take This Medication in Order to Stop It

One of the biggest problems we see with how GLP-1 medications are currently being used is that people treat them as a short term fix. They start the medication, reach their goal weight, and stop. Inevitably, they then start to put weight back on. This pattern has led many to believe that these medications must be taken for life. But there's another way, a structured approach that maximises your chances of maintaining weight loss after you stop.

We recommend thinking about treatment in three phases. Phase 1 is the weight loss phase. This is when you're actively losing weight on the medication, typically lasting around 12 months, though this varies depending on how much weight you need to lose. During this phase, you gradually increase your dose as tolerated and work through the psychological programme to address your relationship with food.

Phase 2 is the maintenance phase, and this is where many current treatment approaches fall short. Once you've reached your goal weight, we recommend staying on a maintenance dose for about another 12 months. This might seem like a long time, but there are crucial reasons for it. During this phase, you're not trying to lose more weight. Instead, you're allowing your body and brain to adjust to the new weight.

Spending time on this maintenance dose allows the body's 'set point' to adjust to a lower weight, so that your body starts to accept the lower weight as the new normal. It also allows the brain's reward pathways time to recalibrate, meaning that people find they are drawn less to high calorie and sweet foods once they stop. Crucially, this maintenance phase gives you time to really put into practice what you've learned in the psychological programme, without being totally overwhelmed and distracted by food noise.

Phase 3 is life after medication. This is when you've stopped the medication entirely and are maintaining your weight through the habits, skills, and psychological changes you've developed during Phases 1 and 2. If you've done the work during the first two phases, you should find that maintaining your weight feels much more manageable than it ever did before.

Part of the problem is that the media have presented these medications as a quick fix to lose weight, when in fact the medication needs to be taken over a longer period of time to allow the body to adjust and for new behaviours and habits around food to become established. You'll see that this means someone who has spent a year losing weight will need another year on a maintenance phase, a total of around 24 months.

These numbers aren't set in stone and you should be guided by how you feel and how you progress with the psychological programme. There is often an understandable wish to just stop altogether once you reach your goal weight. However, taking the time to complete all three phases properly is an investment in your long term health and freedom from the constant battle with your weight. With the right approach, you can use these medications as a bridge to a healthier future, not a crutch you'll need forever.