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If you've got to a stage where you're considering coming off the medication, it shows the positive steps that you've already made on your weight-loss journey so far, but it doesn't end here.
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We know that weight loss is only one part of the journey, and the next step is maintaining that weight loss in the long term.
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Having been on the Second Nature programme, you've focused on developing a healthier lifestyle that will inherently support weight loss maintenance through improved eating habits, physical movement, and other healthy habits like good sleep hygiene.

After being on the medication for a while, you might be concerned about whether you could manage your hunger levels and eating habits without it.
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Fortunately, promising research shows the benefit of combining habit change with gradual medication titration.
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Titration is a process of slowly reducing the dose of the medication over several months to allow the body time to adapt to the lower doses and, eventually, to no medication.
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Recent research has suggested that titrating, or tapering, off of GLP-1 medications slowly helped patients maintain the weight they'd lost 6 months after coming off of the medication.
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This approach was combined with a programme similar to Second Nature that supported members develop healthy habits such as eating a healthier diet, improving sleep hygiene, and being more physically active.
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If you want to come off of the medication but reduce the chance that you'll regain the weight you've lost, then tapering off of the medication slowly could be a great option,

and it's something we can work with you to achieve.
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However, as titrating off GLP-1 medications hasn't been extensively researched, there are many unknowns. So, we've written this guide to highlight some things you should be aware of before you decide to titrate off of your medication over time.
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When coming off of the medication, some residual medication (Wegovy or Mounjaro) may remain in your system, and you may continue to experience lower hunger levels.

However, as the medication slowly leaves your system, your healthy habits and food choices will play a much larger role in managing your hunger levels and helping you maintain the weight you've lost.
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For example, it will be important to eat in a way that naturally increases GLP-1 levels in your body, such as following the Second Nature balanced plate model, which focuses on eating enough protein, fibre, and fat from whole foods.
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Additionally, exercise and physical activity will help to maintain weight loss in the long term. This doesn't you mean you need to start running marathons, but the more you can keep your body moving regularly, the better.
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We also introduced many psychological tools in the programme to help manage cravings unrelated to physical hunger, like the urge surfing technique. Drawing on these strategies in the future will be helpful in managing your eating habits.
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So, if you're confident you've cemented your healthy habits, then now might be the right time to titrate down. If not, maintaining your current dose might be the better option while you continue to work with your health coach to cement your habits.
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Everyone's response to GLP-1 medications and their underlying biology is unique. By titrating slowly off the medication alongside a healthy lifestyle, it's possible that you may not notice your hunger levels returning to what they were before taking the medication.

On the other hand, it's possible that, due to genetic differences in how the body releases and responds to the hormones that manage hunger, you may see your hunger levels return as you titrate off GLP-1 medications.
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The only way to know for sure is by lowering your dose and seeing how your body responds.

You might experience some of the same side effects common with GLP-1 medications, such as nausea and tiredness, but we expect these to ease as you move down to the lower doses.

You can rest assured that your health coach and the clinical team will support you throughout the process.

Feeling hungry and having an appetite is a completely normal human experience.

It's not uncommon to experience some fear around hunger, but it's also important to recognise that feeling hungry is part of being human, and we can learn to respond to this in a way that supports our goals.

This is why we promote healthy habits and a diet based on whole foods rich in protein, fibre, complex carbohydrates, and fat from whole foods.

If you decide to stop taking the medication, we recommend using tools we've shared throughout the programme, like the urge surfing technique and mindfulness, to manage cravings or a desire to eat that isn't due to physical hunger.

The tools we've shared throughout the program will also help you determine what's driving your hunger, which could be physical, emotional, or situational cues.

Once you've identified these, you can work with your coach to find alternative ways to manage these cues aside from food intake.

Additionally, GLP-1 medications will have supported your loss of excess body fat over time, as you'll have likely been eating in a calorie deficit (eating fewer calories than the body burns).

However, we don't recommend eating in a calorie deficit forever, as this will eventually lead to the loss of lean tissues like muscle and bone.

If your appetite returns when you come off the medication, it may help you eat at a more sustainable calorie intake that will nourish your body and maintain your muscle mass long-term.

When you started your medication, you would have followed a set dosing schedule with the dose increasing each month until you reached the maximum maintenance dose.

When you titrate off of the medication, you won't have to follow a set dosing schedule and will be able to maintain on lower doses for as long as you like before dropping down.

Here's an example of how you might titrate off of Wegovy:

Here's an example of how you might titrate off of Mounjaro:

If you decide to explore titrating down, you'll first need to discuss this with the clinical team so they can advise on how best to do this. They'll consider your specific health context, progress, and goals to tailor the best course forward.

To set this up, in your next check-in form, please select the option, "I'd like to discuss my options with the clinical team", when you get to the question about your next dose.

Our health coaches are registered dietitians and nutritionists who are trained to support you through this journey.

If you experience any challenges during this time (as would be expected), your health coach is there to support you every step of the way. You're not going through this alone; they're there with you.