Maintenance is a taper, not a cliff.

The clinical trial data on stopping GLP-1/GIP therapy without a plan is specific, published, and consistent: most of the benefit is only durable while the plan continues. That’s the entire reason an exit strategy is pillar four, not an afterthought.

What the trial actually measured

The SURMOUNT-4 trial ran 783 adults with obesity through 36 weeks of open-label tirzepatide, then randomized them: half continued on their maximum tolerated dose (10 or 15mg), half were switched to placebo — with neither group knowing which arm they were in. Fifty-two weeks later, the trial measured how much of the week-36 weight loss each group had actually kept.

Source: Aronne LJ, et al. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA. 2024;331(1):38–48. Phase 3 trial, 783 participants: a 36-week open-label tirzepatide lead-in, followed by 52 weeks double-blind on continued tirzepatide vs. placebo. The average difference in total body-weight change between the two groups over that second period was 19.4 percentage points, favoring continued treatment.

What that gap means for your plan

Roughly nine in ten patients who stayed on tirzepatide held onto at least 80% of what they’d lost. In the group switched to placebo, that number was 16.6% — the large majority regained enough to fall well short of that mark. The average difference in total body-weight change between the two groups over that year was 19.4 percentage points. This is the specific, tirzepatide-relevant version of a pattern seen across GLP-1 therapy generally: the medication doesn’t rewrite your physiology permanently on its own. Left untreated, the same appetite and metabolic signals that drove the weight gain in the first place tend to return.

Why Summit doesn’t treat “goal weight” as “done”

Given that data, stopping cold at goal weight is close to the worst-case exit. Summit’s answer is the taper: once you reach your goal, Dr. Miranda reduces your dose slowly and in a controlled fashion — the same deliberate pace as the escalation that got you there, run in reverse — searching for the lowest dose that actually holds your weight rather than removing the medication altogether on a fixed date.

How to read this: this is the mirror image of the escalation chart on Pillar 1 — the same 1mg-per-dose, 8–12-week pace, run backward. It stops at 5mg because that’s the lowest maintenance dose the FDA label actually approves for tirzepatide (2.5mg is a starting dose only, not an approved maintenance level) — a real floor, not an arbitrary one.

Your floor is genuinely your own

That maintenance floor is different patient to patient. For some, it’s a low maintenance dose held indefinitely. For others — particularly those who’ve used the extended runway at lower doses to rebuild real habits around food, protein, and exercise — the floor is genuinely zero. Dr. Miranda doesn’t predict which one you’ll be in advance; the taper itself, done slowly, is how that answer gets found safely rather than guessed at.

Same principle, both directions

Slow going up protects you from side effects and plateaus you don’t need to hit. Slow coming down protects you from exactly the regain the SURMOUNT-4 data shows. It’s the same philosophy, applied at both ends of the same plan — which is the whole point of building the exit in from day one, instead of discovering you need one after the fact.