Discontinuing semaglutide after weight loss: strategy for weight maintenance and a possible new side effect.
Level 4 - case-series / case-control
Single-patient case report
PubMed 38587178 · doi:10.1139/cjpp-2023-0464
What was done
A case report documented the clinical course of a 35-year-old male with new-onset obesity treated with oral semaglutide. The report tracks weight changes and adverse gastrointestinal symptoms across initial dose escalation to 14 mg daily, dose reduction to 7 mg daily, re-escalation back to 14 mg daily, and eventual complete discontinuation alongside lifestyle modifications (strength training and diet).
What was found
The patient lost 22.7 kg over 120 days on oral semaglutide (14 mg/day). Dose reduction to 7 mg/day led to weight regain, but re-escalation to 14 mg/day restored weight loss within 1 month, which remained stable for 1 year. After full discontinuation, the 22.7 kg weight loss was maintained for 6 months. During semaglutide therapy, pre-existing lactose intolerance worsened and new gluten intolerance developed (celiac and food allergy testing were negative); neither intolerance resolved after drug cessation. Six months post-discontinuation, the patient was diagnosed with small intestinal bacterial overgrowth (SIBO).
Why it matters
Weight regain is common after stopping GLP-1 receptor agonists, and this report illustrates that structured lifestyle modification may support post-cessation weight maintenance in select individuals while highlighting potential persistent gastrointestinal complications like SIBO.
Limits
Findings come from a single patient (n = 1), preventing any generalization. Causality between semaglutide use and SIBO or food intolerances cannot be established, and unmeasured confounders may account for the sustained weight maintenance.
Cited by
- supports Recent studies and clinical data show that GLP-1 receptor agonist use can lead to small intestinal bacterial overgrowth (SIBO).