Deborah Beck Busis, LCSW, Director, Cognitive Behavioral Wellness Coaching Program
New research shows that most people who discontinue a GLP-1 gain back all the weight they had lost within two years. This is so discouraging for anyone who doesn’t want to or can’t be on a GLP-1 forever. But the good news is that there are specific CBT skills you can learn to help you stay on track while still taking this medication and especially when tapering off and stopping it. CBT skills help people on GLP-1 medications manage unhelpful thoughts, habits, and emotional eating—areas that appetite suppression alone doesn’t address.
If you’re currently taking a GLP-1, there’s a good chance eating feels different right now: your food noise is probably quieter, it feels easier to limit your portions, and you’re likely just not struggling very much with limiting your eating. While this can feel like a huge relief, it’s only part of the picture. GLP-1s support your physiology, but don’t address unhelpful thinking that can lead you to overeat. Learning and practicing specific CBT skills allows you to change your thinking, your eating behavior, and your desire to soothe yourself with food when you’re upset. Changes in your appetite don’t automatically change your habits, your beliefs, and your coping mechanisms. CBT ensures that your progress isn’t solely dependent on appetite suppression.
How Do CBT Skills Support Weight Management on GLP-1s?
The urge to emotionally eat doesn’t magically disappear when you’re on a GLP-1. You may still have thoughts about turning to food when you’re feeling stressed, upset, bored, or tired, or when you’re in need of comfort. CBT helps you identify the triggers and the sabotaging thoughts you’re likely to have in those situations. With this information, CBT helps you come up with a plan for what to say to yourself and what to do to cope with negative emotion without eating.
CBT also helps you figure out how, when, and what to eat in a way that works for your lifestyle. You need to learn to anticipate the challenges you might have and do a lot of troubleshooting in advance. CBT also helps you learn to accept inevitable mistakes and instead of judging yourself harshly, recognize all-or-nothing thinking (e.g., “Since I made a mistake, I’ve blown it for the day”) and recover immediately. These skills ensure that you don’t have to rely on appetite suppression alone to lose weight and keep it off.
What Happens When You Taper Off a GLP-1—and How Can CBT Help?
CBT becomes essential once you start the process of reducing or discontinuing a GLP-1 entirely. Hunger and food noise are likely to come back, which can be disheartening if you’re not prepared for it. CBT helps to normalize this experience and offers you strategies to predict problems and create workable solutions, so you’ll be prepared to deal effectively with unhelpful thoughts, hunger, and craving. Problem-solving in advance, accepting mistakes, and recovering from them immediately will help you stay on track, even when following a plan feels difficult.
CBT also helps you distinguish thoughts from facts. When discontinuing a GLP-1, you may have thoughts like, “This is too hard,” or “I’m gaining back weight. What’s the point in trying?” Instead of buying into these thoughts, CBT helps you recognize that while it is difficult, that doesn’t mean you can’t do it. You just need to learn how. Even if you do gain back some weight, that certainly doesn’t mean all progress is lost! You can still practice the CBT skills and continue to move forward.
GLP-1 medications can undoubtedly be incredibly helpful tools, but they’re not the only ones that matter. CBT skills help ensure that progress isn’t dependent on appetite suppression alone. Learning CBT skills will help you make and maintain progress, whether you remain on medication or eventually transition off.
Reference:
West, S., Scragg, J., Aveyard, P., Oke, J. L., Willis, L., Haffner, S. J., … & Koutoukidis, D. A. (2026). Weight regain after cessation of medication for weight management: systematic review and meta-analysis. bmj, 392.
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