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How these guides are written and reviewed →
GLP-1 medicines (and the newer dual GIP/GLP-1 medicine) are weekly injections that copy the gut hormones released after a meal. They signal satiety centrally, slow gastric emptying, and improve glycaemic handling — reducing energy intake, prolonging satiety and producing weight loss. They were developed for type 2 diabetes and are now widely used for weight management. They work best as part of a package that includes eating changes, activity and supervised exercise — not on their own.
GLP-1 receptor agonists, and the more recent dual GIP/GLP-1 receptor agonist tirzepatide, have substantially altered the pharmacological management of type 2 diabetes and of obesity. This review covers their mechanism of action, approved indications in Australia, dose escalation, the pivotal trial evidence for weight and cardiometabolic outcomes, renal effects, the adverse-effect profile, and the randomised withdrawal data that bear on discontinuation and maintenance. Agents are referred to by active ingredient throughout. It is written for physiotherapists and allied health professionals who will encounter patients already established on these agents, and it addresses the implications for exercise prescription and the preservation of lean mass. Prescribing, dose selection and deprescribing decisions rest with the treating medical practitioner.
Health professional? Jump to the clinical evidence summary ↓
The agents
| Active ingredient | Class | Approved indication (Australia) | Administration |
|---|---|---|---|
| Semaglutide | GLP-1 receptor agonist | Type 2 diabetes (glycaemic control and cardiovascular risk reduction); and, as a separate higher-dose formulation, chronic weight management in obesity or overweight with a weight-related comorbidity | Weekly subcutaneous injection |
| Tirzepatide | Dual GIP and GLP-1 receptor agonist | Type 2 diabetes and chronic weight management | Weekly subcutaneous injection |
| Liraglutide | GLP-1 receptor agonist | Type 2 diabetes; chronic weight management | Daily subcutaneous injection |
| Dulaglutide | GLP-1 receptor agonist | Type 2 diabetes | Weekly subcutaneous injection |
Two points are worth noting for interpreting the literature. First, semaglutide is marketed in separate formulations at different dose ranges for glycaemic control and for weight management; trial results are not interchangeable between them, and the dose studied must be read with the outcome reported. Second, tirzepatide acts at two incretin receptors rather than one, which is the leading explanation for the larger average weight reduction observed in its pivotal programme.
Substantial off-label prescribing of the glycaemic-control formulation for weight reduction contributed to international supply shortages that affected patients requiring it for type 2 diabetes. This is relevant background when a patient reports an interrupted or substituted regimen, and it is a further reason to record the active ingredient and dose rather than a trade name in clinical notes.
Mechanism of action
Following a meal the gut releases hormones termed incretins — the two main ones are GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide). These medicines are engineered to imitate those hormones but last for about a week instead of minutes. They act in several places at once:
- Brain (appetite centres): they reduce hunger and increase the sensation of satiety, reducing portion size and the frequency of food-related preoccupation — an effect patients commonly describe as a quietening of “food noise”.
- Stomach: gastric emptying is slowed, prolonging gastric residence and extending post-prandial satiety.
- Pancreas: insulin release is potentiated only when blood glucose is elevated (glucose-dependent), and glucagon — improving blood-sugar control with a low risk of hypos on their own.
- Tirzepatide’s additional action: tirzepatide adds GIP-receptor activity on top of GLP-1, which appears to enhance appetite and metabolic effects — the leading explanation for its larger average weight loss.
Beyond weight and glucose, semaglutide has been shown in large trials to reduce the risk of major cardiovascular events in specific groups, with growing evidence of benefit in heart failure with preserved ejection fraction and chronic kidney disease. Obstructive sleep apnoea belongs to tirzepatide rather than semaglutide — tirzepatide is the first medicine approved for moderate-to-severe OSA with obesity, on the strength of the SURMOUNT-OSA trials, and it is the agent to name if a patient asks. CPAP remains first-line therapy for OSA; these medicines treat the obesity driving it and do not replace it — see our obstructive sleep apnoea guide. Between them, these are why interest in the class extends well beyond the scales.
Approved indications and prescribing thresholds in Australia
These are prescription-only (Schedule 4) medicines. Weight-management prescribing in adults is generally considered against the following thresholds, which apply irrespective of sex:
- A BMI of 30 or above (obesity); or
- A BMI of 27 or above with a weight-related health problem — such as type 2 diabetes or pre-diabetes, high blood pressure, high cholesterol, obstructive sleep apnoea or heart disease.
- The lower-dose semaglutide formulation is approved for type 2 diabetes, not for weight management.
BMI thresholds are adjusted for some populations (for example, lower cut-offs are often used for people of South and East Asian background). Prescribers additionally weigh comorbidity, concomitant medicines, reproductive plans and patient preference.
There is no sex restriction; the thresholds above apply equally. One important exception: these medicines are not used in pregnancy or when trying to conceive, and effective contraception is advised while taking them (semaglutide should be stopped well before a planned pregnancy). This should be raised with the prescriber where pregnancy is possible.
Cost and PBS status
For weight management, these medicines are generally not subsidised on the PBS and are paid for privately, which can be a significant ongoing cost. Certain type 2 diabetes indications are PBS-subsidised under specific criteria. Subsidy rules and availability change; the current Schedule should be checked directly.
Administration
Semaglutide, tirzepatide and dulaglutide are administered as a once-weekly subcutaneous injection; liraglutide is administered daily. Injection is into subcutaneous tissue of the abdomen, thigh or upper arm. These are not oral agents and are not administered intravenously.
- Pre-filled pen devices are used — patients, or a carer, self-inject at home following instruction. The needle is short and fine-gauge, and tolerability is generally better than anticipated.
- Same day each week, with or without food, at any time of day — pick a day that's easy to remember.
- Rotate the injection site each week to protect the skin.
- Pens are stored in the fridge before first use; check the product instructions for how long an in-use pen can be kept.
An oral (tablet) form of semaglutide also exists, but the weight-management products in common use are the weekly injectables.
Dose escalation
Escalation is gradual by design: all agents commence at a low dose and step up over weeks to months. This is deliberate: it permits adaptation and substantially reduces nausea and other gastrointestinal effects. Each step is held for approximately four weeks before escalation, settling at the lowest dose achieving an adequate and tolerated response. Typical patterns:
| Agent | Starting dose | Escalation | Usual maintenance range |
|---|---|---|---|
| Semaglutide (weight-management formulation) | 0.25 mg weekly | Stepped up roughly every 4 weeks | Up to 2.4 mg weekly |
| Semaglutide (glycaemic formulation) | 0.25 mg weekly | Stepped up every 4 weeks | 0.5–2.0 mg weekly |
| Tirzepatide | 2.5 mg weekly | Stepped up every 4 weeks | 5–15 mg weekly |
Doses shown are typical adult ranges for orientation only — the prescriber sets and adjusts the dose.
Where adverse effects are troublesome at a given step, the prescriber may extend that step or reduce the dose. Defined catch-up rules apply to a missed weekly dose, varying with the interval elapsed; these are specified in the approved product information.
Weight outcomes in the pivotal trials
Results vary a lot between individuals, but the large clinical trials give a good average picture — when the medicine is combined with reduced-calorie eating and increased activity:
| Agent (trial programme) | Average weight loss | Timeframe |
|---|---|---|
| Semaglutide 2.4 mg (STEP)1 | Around 15% of body weight on average | ~68 weeks |
| Tirzepatide (SURMOUNT)2 | Around 20–22% at the highest dose | ~72 weeks |
For context, that's roughly 15–22 kg for someone starting at 100 kg — weight loss in a range previously only seen with bariatric surgery. Loss is fastest in the first months and then plateaus. Not everyone responds: a minority lose little, and continuation is reviewed where response remains poor after an adequate trial at an adequate dose.
A meaningful share of rapid weight loss can be lean tissue (muscle and bone), not just fat. This is the rationale for supervised progressive resistance and aerobic exercise alongside pharmacotherapy; see the physiotherapy section below.
Renal effects
The renal profile differs meaningfully between agents in this class, and the distinction matters where chronic kidney disease is present.
- None of these medicines is directly toxic to the kidneys. In fact, semaglutide has evidence of renal protection in people with type 2 diabetes and chronic kidney disease — the FLOW trial showed semaglutide slowed kidney disease progression and reduced kidney-related events3. So semaglutide is generally regarded as the most kidney-favourable, and is often the preferred option when kidney protection is a goal.
- The kidney risk with any of them is indirect and preventable: their main side effects — nausea, vomiting and diarrhoea, especially while stepping up the dose — can cause dehydration, and dehydration can cause a temporary drop in kidney function (acute kidney injury). This is avoided by staying well hydrated and by the slow dose escalation.
- Tirzepatide is newer, so its long-term kidney-outcome evidence is less mature than semaglutide's, though early signals are encouraging.
Where renal protection is a priority, semaglutide carries the strongest evidence of kidney benefit. Across the class the practical rule is the same — maintain hydration, especially during dose increases or any illness with vomiting or diarrhoea, with monitoring of renal function. Dose adjustment or extra caution is needed in significant kidney impairment; this is a decision for the prescriber.
Adverse effects and precautions
Most side effects are gastrointestinal and tend to settle with continued exposure. They are broadly similar across the class, reflecting shared GLP-1 receptor activity — the most commonly reported effects for each are:
| Agent | Most common side effects | Notes |
|---|---|---|
| Semaglutide (glycaemic formulation) | Nausea, diarrhoea, vomiting, constipation, abdominal pain, reduced appetite, reflux/burping | Because it's used in diabetes, watch for low blood sugar (hypos) when combined with insulin or sulfonylureas. |
| Semaglutide (weight-management formulation) | Nausea, vomiting, diarrhoea, constipation, headache, fatigue, dizziness, injection-site reactions | Same molecule; the higher weight-management doses can make gut side effects a little more prominent during escalation. |
| Tirzepatide | Nausea, diarrhoea, vomiting, constipation, reduced appetite, indigestion, abdominal pain, injection-site reactions | The dual GIP/GLP-1 action means side effects are broadly comparable to semaglutide; hypo risk again with insulin/sulfonylureas. |
Side effects vary between individuals and are usually worst while stepping the dose up. This is a general summary; the approved Product Information for the specific formulation remains the authority.
Across the class as a whole:
- Common: nausea, vomiting, diarrhoea or constipation, reduced appetite, reflux, burping, and injection-site reactions. Usually mild-to-moderate and worst during dose increases.
- Less common but important: gallstones (partly linked to rapid weight loss), pancreatitis (rare — stop and seek care for severe, persistent abdominal pain), dehydration and its knock-on effects.
- Precautions: not recommended in pregnancy/breastfeeding; caution or avoidance with a personal/family history of medullary thyroid cancer or MEN 2; care with certain other diabetes medicines (risk of hypos). Delayed gastric emptying is relevant to perioperative and anaesthetic planning and should be disclosed to the surgical and anaesthetic team.
Counselling points during dose escalation
- Smaller portions, eaten slowly, stopping at comfortable satiety.
- Blander, lower-fat foods during nausea; limiting high-fat and highly spiced meals.
- Maintained hydration, both for renal protection and to reduce constipation.
- Early review by the prescriber where adverse effects are poorly tolerated; the dose can be held or reduced.
Discontinuation and maintenance
This is the question with the greatest bearing on long-term planning, and the randomised withdrawal data address it directly.
Obesity is understood as a chronic, relapsing condition — much like high blood pressure. These medicines manage it; they don't cure it. When the medicine stops, the biology that drives appetite and weight tends to return.
In the withdrawal studies (for example STEP 4), people who came off semaglutide regained a large share of the weight they had lost — on average around two-thirds within about a year — and much of the metabolic improvement reversed with it. This is not a failure of willpower; it's the underlying condition reasserting itself.
So the realistic picture is:
- For many people, this is a long-term — potentially lifelong — treatment, taken at the lowest effective maintenance dose, much like ongoing medicine for blood pressure or cholesterol.
- Weaning can be appropriate for some — for example after substantial, stable weight loss combined with well-embedded lifestyle changes — but it should be gradual and planned, with monitoring in place and a defined threshold for re-escalation.
- The strongest protector against regain is the lifestyle scaffolding built while on the medicine: sustained exercise (especially resistance training to preserve muscle), eating habits and ongoing support. Medication plus a structured programme gives the best chance of keeping results.
No single answer applies across patients; the decision to continue, reduce or stop is individual and rests with the prescriber.
Implications for physiotherapy
Pharmacotherapy alters appetite and energy balance; it does not build strength or cardiorespiratory fitness, and a meaningful proportion of the mass lost may be lean tissue. This is the point at which supervised exercise bears on outcome rather than acting merely as an adjunct. Our Lifestyle Changes Programme is one delivery model for it.
- Lean mass and bone. Progressive resistance training during weight reduction preserves lean tissue, shifting the composition of loss toward fat mass, with implications for strength, resting metabolic rate and long-term function.
- Cardiorespiratory fitness. Supervised aerobic conditioning improves cardiorespiratory fitness, which remains the outcome most closely associated with prognosis in cardiac and respiratory disease.
- Durability. Exercise and dietary behaviours established during treatment are the principal protection against regain should the agent later be reduced or withdrawn.
- Coordination. Exercise prescription is set alongside the treating medical team so that it fits the pharmacological plan.
Weight-management pharmacotherapy is prescribed and monitored by the treating medical practitioner. Evidence consistently shows that combining pharmacotherapy with supervised exercise and dietary support better preserves lean muscle mass during weight loss than medication alone. Decisions about the appropriateness of any medication rest with the prescriber.
Further reading
This is a rapidly moving evidence base. For the trials cited above and current authoritative sources:
- Therapeutic Goods Administration (TGA)4 — Australian approvals, approvals, safety alerts and supply information for this class.
- New England Journal of Medicine — the STEP (semaglutide), SURMOUNT (tirzepatide), SELECT (cardiovascular) and FLOW (kidney) trial publications.
- NPS MedicineWise / Australian Medicines Handbook5 — plain-language and prescriber medicine information.
Publications and guidelines are updated frequently; verify against the current version before applying any of the above clinically.
A clinician-level synthesis of the randomised withdrawal trials, dose de-escalation strategies, real-world discontinuation data and renal benefit/harm across the class. Prepared 22 July 2026. This is a reference summary, not a treatment protocol.
Terminology: these agents are GLP-1 receptor agonists (GLP-1 RAs) — not inhibitors.
Scope of the class
| Molecule | Administration | Mechanism | Primary indications |
|---|---|---|---|
| Semaglutide | Subcutaneous weekly; an oral formulation also exists | GLP-1 RA | T2D; chronic weight management; CV risk reduction; CKD (FLOW) |
| Tirzepatide | Subcutaneous weekly | Dual GIP/GLP-1 RA | T2D; chronic weight management |
| Liraglutide | Subcutaneous daily | GLP-1 RA | T2D; chronic weight management |
| Dulaglutide | Subcutaneous weekly | GLP-1 RA | T2D |
| Exenatide | Subcutaneous twice daily; extended-release weekly formulation | GLP-1 RA | T2D |
| Orforglipron | Oral, once daily | Oral non-peptide GLP-1 RA | Chronic weight management (approved US, 2026) |
1 · Cessation — randomised withdrawal trials
The findings are consistent across four molecules: stopping produces substantial regain and reversal of cardiometabolic gains.
| Trial | Design | Key result on withdrawal |
|---|---|---|
| STEP 4 semaglutide 2.4 mg Rubino, JAMA 20216 | 803 randomised 2:1 to continue vs placebo for 48 wk after 20-wk run-in | Weeks 20–68: −7.9% (continue) vs +6.9% (placebo); treatment difference −14.8% (p<0.0001) |
| STEP 1 extension semaglutide Wilding, DOM 20227 | 327 followed 1 yr off treatment | 17.3% loss at wk 68 → regained 11.6 pp by wk 120, net −5.6%; cardiometabolic gains reverted |
| SURMOUNT-4 tirzepatide Aronne, JAMA 20248 | 670 at MTD randomised to continue vs placebo through wk 88 | Placebo: mean regain 14%; continuation: additional −6.7% (total −25–26%) |
| SCALE Maintenance liraglutide 3.0 mg Wadden, IJO 20139 | 422 post ≥5% diet run-in, 56 wk | From randomisation: −6.2% vs −0.2% (difference −6.1%) |
West et al., BMJ 202610 (37 studies, 63 arms, 9,341 adults): all medications pooled +0.4 kg/month after cessation (return to baseline ~1.5–2 yr); semaglutide/tirzepatide +0.8 kg/month (~1.5 yr). Return to baseline is faster after drug cessation (1.7 yr) than after behavioural programmes (3.9 yr). Larger initial loss predicts faster regain. Caveat: >12-month post-cessation data for newer agents are sparse.
2 · Real-world discontinuation
- Most patients stop: Rodriguez, JAMA Netw Open 202511 (125,474 initiators) — discontinued within 1 yr in 46.5% (T2D) and 64.8% (no T2D); reinitiated within 1 yr in 47.3% / 36.3%. Persistence, not efficacy, is the dominant real-world failure mode.
- Regain is attenuated vs trials: Cleveland Clinic cohort (Gasoyan, DOM 202612, n=7,938) — obesity indication mean 8.4% loss, only 0.5% regain at 1 yr — largely because patients restart or substitute agents.
- Payer data (non-diabetic): 1-yr persistence ~32%, 2-yr ~15% (highest with semaglutide products).
3 · De-escalation rather than cessation (2026)
Horn et al., Lancet 202613 (NCT06047548). 378 randomised at wk 60 to tirzepatide MTD, reduction to 5 mg, or placebo; assessed to wk 112.
| Arm | Weight change from baseline (wk 112) | Regained ≥50% of loss |
|---|---|---|
| Tirzepatide MTD | −21.9% | 8% |
| Tirzepatide 5 mg | −16.6% | 25% |
| Placebo | −9.9% | 67% |
Treatment differences vs placebo: −12.0% (MTD) and −6.6% (5 mg), both p<0.0001. Continuing at MTD ≈ 7× more likely to maintain than stopping; 5 mg ≈ 4×. ATTAIN-MAINTAIN14 (Aronne, Nat Med in press): switching injectable tirzepatide to oral orforglipron maintained prior loss. Tapering to zero has no RCT support; reduced-frequency dosing rests on case series and PK/PD modelling only. Sub-label dosing is off-label.
4 · The case for indefinite therapy — hard outcomes
- SELECT (obesity + CVD, no diabetes): 20% MACE reduction; secondary composite kidney endpoint HR 0.78 (0.63–0.96), p=0.02.15
- FLOW (T2D + CKD): 24% reduction in major kidney events; 18% MACE; 20% all-cause mortality (detail below).3
- Durability while continued — STEP 5: −15.6% at wk 52 and −15.2% at wk 104 (minimal regain over 2 yr). SURMOUNT-4 continuation produced further loss, not plateau.16
5 · The case for caution — body composition & safety
- Lean mass: network meta-analysis (22 RCTs, 2,258 pts) — ~25% of weight lost was lean mass; tirzepatide and semaglutide were least effective at preserving it; liraglutide preserved lean mass best. Magnitude likened to a decade of ageing — of concern in older adults and sarcopenic obesity.
- Bone: rapid loss reduces BMD via unloading (~2.6% hip, ~2.1% spine over 52 wk); however Liu, JCEM 202617 found GLP-1 groups did not uniformly lose more bone than controls (inter-centre DXA variability a major confounder).
- Other: gallbladder disease; acute pancreatitis (~0.2%, FDA labelling expanded 2025); thyroid C-cell boxed warning (rodent-derived); ileus/obstruction/severe constipation and severe GI reactions added Oct 2025; not recommended in severe gastroparesis.
- Duration of evidence: no randomised data beyond ~4–5 yr for newer agents — "lifelong therapy" is a chronic-disease inference, not a demonstrated finding.
6 · Renal considerations
Benefit — now guideline-grade. FLOW3 (Perkovic, NEJM 2024; 3,533 T2D+CKD, stopped early for efficacy): primary composite HR 0.76 (0.66–0.88), p=0.0003; kidney-specific composite HR 0.79; mean eGFR decline 1.16 mL/min/1.73m²/yr slower; CV death HR 0.71; all-cause mortality −20%; UACR −38%; fewer serious adverse events. Class meta-analysis (Badve, Lancet D&E 2025)18 rates the composite kidney benefit high-certainty. Signals of benefit extend to non-diabetic CKD (SELECT secondary; SMART surrogate-endpoint trial)19 and tirzepatide (SURPASS-4 post hoc, albuminuria-mediated)20.
Anticipate an acute eGFR dip followed by a U-shaped rebound (negligible between-group difference by wk 12), mirroring RAS and SGLT2 inhibitors. An early creatinine rise is not a reason to stop.
Class-wide label update: risk of serious kidney injury from dehydration, including cases requiring haemodialysis.21 Mechanism is pre-renal (volume depletion), not direct nephrotoxicity (rare biopsy-confirmed acute tubular injury / interstitial nephritis exist). Watch the risk-stacking pattern:
amplified by diuretics, ACEi/ARB, NSAIDs · complicated by metformin (lactic acidosis if eGFR falls)
Monitoring implications: titrate slowly and re-titrate after any interruption (never resume at prior dose); check eGFR at initiation, each escalation and during prolonged GI symptoms; counsel explicit sick-day rules (withhold at first sign of dehydration); review concurrent diuretics/RAS inhibitors/NSAIDs/metformin; particular caution in pre-dialysis CKD and transplant. Net position: in CKD the drug is on balance renoprotective, but the acute risk window sits precisely where long-term benefit has not yet accrued.
7 · Bottom line
- Default to indefinite therapy and frame it that way at initiation — every withdrawal trial shows regain plus cardiometabolic reversal (~1.5 yr to baseline for semaglutide/tirzepatide).
- Dose de-escalation is evidence-based; cessation is not. 5 mg tirzepatide beats stopping (25% vs 67% regaining ≥half their loss) but is inferior to MTD (8%). Switching to an oral agent is a second option; tapering to zero is unsupported.
- Real-world regain is slower than trial regain — because patients restart/substitute. Persistence is the dominant failure mode.
- Kidneys: net protective, acutely vulnerable. Expect the early eGFR dip; treat persistent vomiting/diarrhoea as a red flag.
- Lean mass is the clearest allied-health opportunity — resistance training 2–3×/wk, protein 1.2–1.6 g/kg/day, energy deficit ≤500 kcal/day, baseline DXA in high-risk groups.
8 · Principal evidence gaps
- No RCT tests whether a structured multidisciplinary maintenance programme (resistance training + protein + behavioural support) alters the post-cessation regain trajectory — arguably the most important unanswered question, and directly relevant to allied-health practice.
- No RCT of tapering to zero vs abrupt cessation; reduced-frequency dosing rests on case series/modelling.
- No randomised outcome data beyond ~4–5 yr; regain data beyond 12 months post-cessation sparse for newer agents.
- Non-diabetic CKD renal data rest on a 101-patient, 24-week surrogate trial (SMART) and a low-event secondary analysis (SELECT).
- Lean-mass measurement confounded by inter-centre DXA variability; muscle quality poorly captured.
Key trials cited above: STEP 4,6 STEP 1 extension,7 SURMOUNT-4,8 SCALE,9 West meta-analysis,10 SURMOUNT-MAINTAIN,13 FLOW,3 SELECT,15 SMART,19 SURPASS-4,20 Badve meta-analysis.18 Numbered references below; Australian PBS/TGA status changes frequently and should be verified directly.
References & evidence base
- Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med 2021;384(11):989–1002.
- Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1). N Engl J Med 2022;387(3):205–216.
- Perkovic V, Tuttle KR, Rossing P, et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes (FLOW). N Engl J Med 2024;391(2):109–121.
- Therapeutic Goods Administration. Product Information and Consumer Medicine Information database. Canberra: TGA; 2025. Available from: tga.gov.au.
- Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2026.
- Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight-loss maintenance (STEP 4). JAMA 2021;325(14):1414–1425.
- Wilding JPH, Batterham RL, Calanna S, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide (STEP 1 trial extension). Diabetes Obes Metab 2022;24(8):1553–1564.
- Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction (SURMOUNT-4). JAMA 2024;331(1):38–48.
- Wadden TA, Hollander P, Klein S, et al. Weight maintenance and additional weight loss with liraglutide (SCALE Maintenance). Int J Obes 2013;37(11):1443–1451.
- West S, Scragg J, Aveyard P, et al. Weight regain after cessation of medication for weight management: systematic review and meta-analysis. BMJ 2026;392:e085304.
- Rodriguez PJ, Zhang V, Gratzl S, et al. Discontinuation and reinitiation of dual-labelled GLP-1 receptor agonists among US adults with overweight or obesity. JAMA Netw Open 2025;8(1):e2457349.
- Gasoyan H, Pfoh ER, Schulte R, et al. Weight outcomes after discontinuation of injectable semaglutide or tirzepatide. Diabetes Obes Metab 2026.
- Horn DB, Aronne LJ, Wharton S, et al. Tirzepatide for maintenance of bodyweight reduction in people with obesity (SURMOUNT-MAINTAIN). Lancet 2026. doi:10.1016/S0140-6736(26)00656-2.
- Aronne LJ, Horn DB, le Roux CW, et al. Orforglipron for maintenance of body-weight reduction (ATTAIN-MAINTAIN). Nat Med 2026 (in press).
- Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT). N Engl J Med 2023;389(24):2221–2232.
- Garvey WT, Batterham RL, Bhatta M, et al. Two-year effects of semaglutide in adults with overweight or obesity (STEP 5). Nat Med 2022;28:2083–2091.
- Liu J, Zhang Y, Li X, et al. Effects of GLP-1 receptor agonists on bone mineral density: a meta-analysis. J Clin Endocrinol Metab 2026.
- Badve SV, Bilal A, Lee MMY, et al. Effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes: a meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol 2025;13(1):15–28.
- Apperloo EM, Tuttle KR, Pavo I, et al. Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes (SMART). Nat Med 2025;31:278–285.
- Heerspink HJL, Sattar N, Pavo I, et al. Effects of tirzepatide versus insulin glargine on kidney outcomes in type 2 diabetes (SURPASS-4 post hoc). Lancet Diabetes Endocrinol 2022;10(11):774–785.
- United States Food and Drug Administration. GLP-1 receptor agonist class labelling update: risk of acute kidney injury from dehydration. Silver Spring, MD: US FDA; 2025.
References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines and trial evidence in this field are living documents — verify against the latest version and current Australian PBS/TGA status before clinical use. For drug-specific detail, including full product information, consult MedsInfo.
Supervised exercise and practical education, aimed at strength, weight and the everyday function that comes with them.
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