80% of People Gain the Weight Back After Retatrutide— Here's Why | Weekly Q&A

Somebody hits their goal weight on Retatrutide and the first question is always the same one. Should I stop, lower my dose, or stay on it? What I can tell you, man, is in my experience working with people who have gone on some type of diet or even a, you know, GLP-1 type medication is nearly 80% of the time, and the stats back this up, they gain the weight back within the first year.

And most of the reason, in my opinion, is because they use the diet or the GLP-1 or the tool or whatever the case may be to get them the results rather than building the foundations beneath it.

So before we get into the taper, you need the full picture of what the drug is actually doing for you, because there are three separate jobs it is handling at once, and when you stop, all three of them stop at the same time.

Appetite is the first piece, and it works because Retatrutide hits the GLP-1 receptor, which slows how fast food leaves your stomach and turns down the hunger signaling in your brain, and this is the part most people notice. Slowed gastric emptying is well documented with these medications and it is also why the gastrointestinal side effects show up so often [Gentinetta 2024].

Your metabolic rate is the second job, and here's why that matters: the glucagon agonist inside of Retta is actually turning your liver into a furnace where it's burning fat on overdrive 24-7. I have to be straight with you on the mechanism here: I cannot point you to a study that has confirmed a resting metabolic rate increase in humans from the glucagon arm specifically, so treat that as the working explanation, not settled science.

The third job is where your food goes after you eat it, and that is the GIP piece. The term for this is something called nutrient partitioning, which just means whether the calories you eat get used for energy or parked into fat tissue. From what I have seen, that is the part clients feel the least and miss the most once it is gone, and the data is not there yet on the GIP arm improving partitioning in humans.

People who have metabolic dysfunction, insulin resistance, type two diabetes, their body's basically storing this food by default, which is why it's so hard for those types of people to lose weight.

So you take all three away at once and you have someone who is hungrier than they have been in months, with a slightly lower burn rate, and food that now goes back to being stored the way it always was. Three systems shift in the same week, all at once, and calling that a willpower problem misses what's actually happening in the body.

So how do we solve this? Well, the first thing that we do is you need to make sure that you have your habits built, your foundations are built, you're consistently going into the gym, you're tracking your food, you're weighing it, you know your macros, like this is important because that's what's gonna help you keep on track when your hunger comes back and you're also staying consistent with your sleep.

Then you taper down at the same rate you titrated up. Maybe I started at two milligrams, at week five I went to four, at week 10 I went to eight or six and so forth and so on.

Reverse the climb instead, dropping from eight to six and holding there until your weight is stable for a couple weeks, then four, then two, and you can go down to one or even half a milligram before you stop. You are hand holding yourself into doing it alone instead of going cold turkey.

Five months in is when the second situation tends to show up: weight loss stalls, and the immediate assumption is the peptide stopped working so the dose needs to go up. That's like the immediate knee jerk reaction and the reason why they think that is, in my opinion, because they've grown accustomed to relying on this drug or medication to get them the result.

Your body reached a new state of homeostasis. The drug never changed the mechanism of fat loss, it only made the calorie deficit easier to hold, and a deficit that fit you at 295 pounds does not fit you at 225.

Go back to a TDEE calculator and run the numbers again. Somebody 5'8 or 5'9, 225 pounds, 38 years old, lands around 3,000 calories as a starting point. If I lose 30 pounds, I go back into that TDE calculator, the number of calories that that thing is gonna recommend for me at 295 pounds versus 225 is gonna be significantly less.

Look at protein next, since one gram per pound of your goal body weight is the number I commonly use, but for the purpose of getting as accurate as possible, we wanna do at least 0.8 to one gram per pound of your lean body weight.

And so in order for me to actually get the accurate calculation using this strategy, I need to know my body fat within about plus or minus 2%.

So if you know your body fat, let's say as an example, you're 200 pounds, you're 20% body fat, that means you have about 40 pounds of fat, ignoring the idea of organs and bones and all that. That leaves 160 pounds of lean mass, so 160 grams of protein. That would be the one gram mark, right? And then whatever 80% of that is, it's like 144 grams per day or something like that.

The third thing to check is how long you have been pushing the deficit, because the stall may not be a calorie problem at all.

I had a client come in after six months of keto. Lost roughly 20% body fat, which is real progress, but the labs told a different story. Cortisol was high, estradiol was very low, testosterone had started to crash, TSH was through the roof and T4 conversion was very low, and the whole panel read like a body pushing back against the deficit rather than adapting to it.

In this case, I would definitely recommend if you've been on an extreme deficit for more than 12 to 16 weeks and you're having a hard time making progress, to reverse diet back up to maintenance and sit there for a few weeks to help your body normalize. Four to six weeks at maintenance is the window I use.

As long as you incrementally increase your food back up to maintenance, and the way that we know we're at maintenance is if we eat and we're not gaining weight, right? You may see a little bit of residual water weight gain, especially as you increase your carbs, working your way back up to maintenance, but most of the time that's just glycogen replenishing into your muscles because you're so flat and depleted.

Your goal should be to kind of find that maintenance, which means one to two weeks of not seeing any movement on the scale.

When you drop back into a deficit after that, the deficit can be much less aggressive and the last bit of body fat comes off easier because the resistance is gone.

None of this works without real data, and this is where most people quietly sabotage themselves. Meaning if your goal is to get down to sub 10% body fat, I can tell you right now, you're probably not going to be able to do that without measuring your food on a scale built for the job, not an AI app guessing calories off a photo you took, not eyeballing macros.

Fat loss follows a curve, and the early results come fast while the last stretch fights you the whole way. Going from 25 to 15% body fat is a completely different game than going from 15 to five.

And then based upon the running average of your weight and the progress that you see over a 14 day period, making informed data driven decisions about how you optimize your food intake so that you can achieve your goal.

Sleep and stress belong in the same conversation as calories, because chronically high cortisol tells your body to hold onto fat while it simultaneously drags on thyroid conversion and sex hormone production. This creates a downward spiral effect hormonally that's going to make it 10 times harder to get to the goal that you're trying to accomplish.

Research: Gentinetta S, Sottotetti F, Manuelli M et al. Dietary Recommendations for the Management of Gastrointestinal Symptoms in Patients Treated with GLP-1 Receptor Agonist, published in Diabetes Metab Syndr Obes back in 2024.

References:

Howard MD, Allen SE. The use of GLP-1: receptor agonist medications for benign gynecology. Curr Opin Obstet Gynecol. 2025. https://pubmed.ncbi.nlm.nih.gov/40183300/

Gentinetta S, Sottotetti F, Manuelli M et al.. Dietary Recommendations for the Management of Gastrointestinal Symptoms in Patients Treated with GLP-1 Receptor Agonist. Diabetes Metab Syndr Obes. 2024. https://pubmed.ncbi.nlm.nih.gov/39722834/