Starting Your GLP-1 Journey
Last year you decided you were going to finally get rid of those last 15 lbs with the help from a GLP-1 (semaglutide) that seemingly everyone around you was talking about. Or maybe a semaglutide like Ozempic, Wegovy, Mounjaro, or another GLP-1 helped you lose 20, 40, 60, or 100 lbs. The thought process was simple: I will take this medication, lose the weight, feel my best in years, and then stop taking it and live happily ever after. Besides, you knew that you would feel so much more confident about yourself if you could drop the extra weight.
So, new year, and new you, and it is time to come off the GLP-1. This should be a piece of cake, pun intended, right? But just as you are about to fully commit, you begin to worry. What if the weight comes back? What happens if I eat more than before and have to go back up a size? Coincidentally, you happen to look down at your leg resting on a chair and you swear it looks bigger than yesterday. It is at this time that you realize that rather than having the dread of trying to lose weight that you are now focused on not gaining the weight back.
Getting Off Of GLP-1s
You continue onward and discontinue your GLP-1. A few days go by and you are feeling good about your progress as you check your weight daily to make sure nothing is changing. But then you begin to feel that triggering feeling, hunger, and it is coming back stronger by the day. You know that you used to eat when you were hungry, but you also remember how much time you would spend thinking about what and how much to eat. Then, like a pile of bricks, it hits you, that you are overthinking everything you are eating again like you did before you started your GLP-1. You are focused on your timing between meals, calories, meal size, cravings, and most of all, how do I keep the weight off? Food noise, a familiar foe, has reemerged but in a different way.
As you try to fight off the food noise you begin to become very aware of your body. You start weighing yourself twice daily, pinching your stomach, contorting your body in the mirror, and trying on your clothes to make sure there are no changes. You spend extra time in the mirror looking for differences, or even worse, you begin to avoid the mirror because you can tell your body is changing and you don’t want to see it. The issue we swore would get better, our body image, is now also back with a vengeance.
And just like that you are stuck between a semaglutide and a snack. You may think I don’t want to take this medication forever but I am also deathly scared of what will happen to my weight and mental health when I come off the GLP-1. Luckily, there are therapists specifically trained around the impacts of getting off a semaglutide that can help you navigate this difficult experience.
Common Experiences When Coming Off of GLP-1s
For many people, coming off a GLP-1 brings up a new and unexpected fear: Was the medication the only thing keeping me in control? When the inevitable hunger cues return, it can feel like proof that your body is “broken” or there is something wrong with you and that the medication is now essential. You may wonder whether you can trust your appetite at all, or whether responding to hunger will inevitably lead to weight gain.
Another common concern is the pressure to maintain the exact number on the scale. Even small, normal fluctuations can feel catastrophic after weight loss, especially when your identity, confidence, or sense of self becomes tied to this lower weight. People notice that their mood, self-esteem, and daily mental energy begin to revolve around preventing regaining weight. What was supposed to feel freeing can quietly turn into constant monitoring.
There is also a grief that can surface when coming off GLP-1s. Grief for the sense of ease around eating, or for knowing your weight would be fairly constant. This grief is rarely talked about, yet it is deeply valid. When food noise returns, it can feel like a personal failure rather than a predictable physiological response to stopping a medication that altered hunger and satiety signaling. Without support from a therapist, people often respond by blaming themselves instead of recognizing a normal bodily response.
How Therapy Helps When You Get Off GLP-1s
Therapy can be especially helpful during the transition off a semaglutide. A therapist trained in food and body image concerns can help you distinguish between biological hunger and psychological hunger, reduce compulsive checking behaviors like frequent weighing or body checking, and rebuild trust in your body’s signals. Therapy also helps you loosen rules around food so that eating becomes more intuitive and less emotionally charged, even when hunger feels louder than it did on the medication. Therapy can actually teach you tools to quiet the food noise!
Therapy for coming off GLP-1’s can also address the identity shift that often comes with weight loss and regain fears. If your confidence improved on a GLP-1, coming off it can stir up old insecurities or beliefs about your worth and appearance. Working through these patterns allows your self-esteem to become less dependent on a number, a clothing size, or a medication, and more grounded in who you are as a whole person.
Specific Ways Therapy Helps When Getting Off a GLP-1
Getting off a GLP-1 includes a physical, psychological, and emotional transition. These medications significantly reduce hunger, cravings, and food-related thoughts. When discontinued, the return of appetite and food noise can feel abrupt and overwhelming. Therapy helps by addressing all aspects of this transition. Some of these aspects are listed below:
- Rebuilding trust in hunger and fullness cues – While on a GLP-1, your body’s appetite signaling was suppressed. When hunger returns, it can be interpreted as danger rather than information. Therapy helps you retrain how you recognize and respond to hunger in a helpful manner. This reduces the urge to micromanage eating and supports more stable and sustainable patterns over time.
- Reducing food noise and obsessive thinking- For many people, the most distressing part of stopping a GLP-1 is the worry of constant mental chatter about food. Therapy helps interrupt cycles of worrying, calorie tracking, and meal timing anxiety. This helps reduce the intensity and frequency of food thoughts so they don’t dominate your day.
- Addressing fear of weight gain without reinforcing diet culture – Fear of regaining weight is common. Therapy does not dismiss this fear, nor does it push someone to blindly accept it. Instead, it helps you challenge catastrophic thinking, tolerate uncertainty, and make decisions based on health and values rather than fear. This often prevents the pendulum swing between restriction and overeating that actually increases weight gain risk.
- Interrupting body-checking and avoidance behaviors – Weighing multiple times per day, mirror checking, pinching skin, or avoiding mirrors altogether are signs of anxiety. Therapy helps reduce these patterns, which are strongly linked to body dissatisfaction and eating disorder risk. As these behaviors decrease, body image distress often reduces as well.
- Supporting identity shifts after weight loss – Weight loss, especially rapid and/or significant, can change how you see yourself and how others respond to you. Coming off a GLP-1 may trigger fears of “losing” that version of yourself or returning to an old identity you worked hard to escape. Therapy provides space to process this shift and build self-worth that is not contingent on weight, medication, or appearance.
- Addressing body dysmorphia – Alternatively, you may have lost a significant amount of weight and still see yourself in the same body size you used to be. This can lead to a desire to lose even more weight by going back on your GLP-1 or engaging in disordered eating behaviors. This feels very real to you despite others around you telling you that you look smaller and lighter. This is body dysmorphia and a skilled therapist can help you challenge a distorted body image.
- Preventing disordered eating patterns during the transition – Stopping GLP-1s can increase vulnerability to restrictive eating, binge-restrict cycles, purging, emotional eating, or relapse into past eating disorder behaviors. Therapists trained in eating and body image concerns are skilled at recognizing early warning signs and helping you course-correct before patterns become longer lasting.
- Aligning behavior change with values – Therapy helps you clarify what kind of life you want after GLP-1s often including energy, flexibility, mental peace, social connection, and physical health. Therapy supports behavior changes that serve those goals.
What therapist can help me after getting off A GLP-1?
A therapist who has specific training and experience in working with clients on weight loss medication can help you. Dr. Vincent Fitch is one of the psychologists in Atlanta at Best Within You Therapy & Wellness that specialize in food and body image concerns. Dr. Fitch has extensive experience helping people with concerns related to eating including eating disorders, bariatric surgery, disordered eating, weight loss medication, and trying to lose weight. He is sensitive to the challenges you may experience and can help by helping you adjust your thinking related to food and negative body image. Additionally, he can help you target desired behavior change by aligning your goals with your values. He takes a person-centered approach while using evidence-based treatments to help you become the best version of yourself.
If you would like assistance as you think about getting off a GLP-1 or are getting off a glp-1 please complete an appointment form on our website. In addition to therapy, at Best Within You Therapy & Wellness we also offer meal plan support from a registered dietitian if you feel that would benefit you in this new journey.
This blog was written by Dr. Vincent Fitch, licensed psychologist. It was clinically reviewed by Dr. Rebecca Leslie, licensed psychologist.
