Adapted from BMJ 18 -25 April 2026
Kengo Miyoshi, Assistant Professor, Tokyo states that to avoid weight regain with GLP-1 drugs, Japanese patients enter a programme of structured support to maximise the effectiveness of the intervention.
The drugs are regulated and are only given where there are obesity related co-morbidities and functional impairment. The drugs are only started after six months of lifestyle modification which includes dietary, exercise, psychological and behavioural modifications. These should be continued lifelong. At the six month point, GLP-1 drugs are prescribed but for a maximum of 68-72 weeks. The exit criteria is established at the outset. The continued support mitigates the “weight regain” effect.
Randomised controlled trials have shown that exercise makes a big difference to the effects of the drugs during and after GLP-1s are stopped. While on the drugs, exercise promotes greater fat loss, preservation of lean muscle mass, improved insulin sensitivity, increased cardiorespiratory fitness, and physical functioning. When the drugs are stopped, the preserved lean muscle mass, higher exercise expenditure and sustained physical activity lead to less fat regain. The metabolic improvements need to be supported by structured care long term. Obesity is after all a long term condition and needs to be supported as such.
Diabetes Diet 