Getting lean has two phases: the deficit that takes fat off, then everything that holds the result, built while the deficit is still running. When semaglutide was stopped overnight in the STEP 1 extension, about two-thirds of the lost weight returned within a year (Wilding 2022); individual results vary. Book your consult: Dr Quek plans your taper through the GetLean GLP-1 Taper Plan, where clinically appropriate.
Maintenance: in the research literature, intentionally losing at least 10% of initial body weight and keeping it off for at least a year (Wing and Hill 2001). It is defined as an outcome held over time, not as a target reached once.
What is phase one actually for?
Removing fat — and doing it in a way that leaves the body better composed at the end, not just smaller.
That distinction is the whole reason phase one deserves any planning at all. Every kilogram lost is a mixture. In the SURMOUNT-1 body-composition sub-study of 160 people, approximately 75% of the weight lost was fat and 25% was lean mass — and the split was the same in the placebo arm, which was diet alone (Look 2025). Substantial weight loss costs lean tissue regardless of how the deficit is produced.
Two inputs change that arithmetic, and both belong in phase one rather than being saved for later.
Resistance training. In people with overweight and obesity, lean mass was statistically unchanged in the trials where resistance training accompanied caloric restriction (Lopez 2022).
Protein. Intakes of 1.2 to 1.6 g per kg of body weight per day during energy restriction improve appetite, body-weight management and lean-mass preservation compared with lower-protein diets (Leidy 2015). Note the denominator: that range is per kilogram of body weight, not of fat-free mass, and the two are routinely mixed up.
A phase one that ends with less muscle than it needed to hands phase two a harder job.
Why does phase two exist at all?
Because holding a lower weight is a different job from reaching it. Two separate pressures act on it, and phase two is built to answer both.
The first is metabolic. Maintaining a body weight at least 10% below usual weight reduces total energy expenditure by more than the change in body mass alone predicts — and that was seen in people who had never had obesity as well as in people who had (Leibel 1995). The reduced body runs on less than its new size would suggest.
How long that persists is less certain than the internet suggests. The most-quoted evidence is a follow-up of 14 people from a televised weight-loss competition, in whom resting metabolic rate was still several hundred kcal a day below what body composition predicted six years later (Fothergill 2016). That was a mean loss of 58 kg under competition conditions in 14 people. It should not be read as a description of ordinary or medically supervised weight loss, and the authors' own word for the adaptation is "incomplete" rather than permanent.
The second is behavioural, and it is the one that actually decides most outcomes: the conditions that produced phase one stop applying. The deficit ends and attention moves on. Phase two is what takes their place.
What does the evidence say holds a result?
Two kinds of evidence answer this: a registry of people who have kept large losses off for years, and a randomised trial that followed people for a year after GLP-1 treatment ended.
The National Weight Control Registry follows people who had already kept a large loss off. Entry required having lost at least 13.6 kg and kept it off for at least a year. Its first large description covered 784 members who had lost a mean of 30 kg, and who reported a low-fat diet and a high level of physical activity, in the region of an hour a day (Klem 1997). It describes what long-term maintainers report doing, and three of its findings are worth having.
Time held matters. In a one-year prospective follow-up of registry members, 35% gained weight over the year and 59% maintained. Risk factors for regaining included more recent weight losses — under two years versus two years or more — larger losses relative to maximum weight, and higher levels of depression, dietary disinhibition and binge eating (McGuire 1999). A review of the same literature reports that once a loss has been held for two to five years, the chance of longer-term success rises substantially (Wing and Hill 2001).
Self-monitoring tracks with holding. Among 3,003 registry members followed for a year, those who reduced how often they weighed themselves regained a mean of 4.0 kg, against 1.8 kg in those whose frequency was unchanged and 1.1 kg in those who increased it (Butryn 2007). Observational, in a self-selected group — but the association held independently of the other factors measured.
Activity volume is high in maintainers. The ACSM position stand associates more than 250 minutes a week of physical activity with improved maintenance after weight loss (Donnelly 2009).
The trial evidence points the same way. In a Copenhagen randomised trial that followed adults for a year after treatment ended, those who had combined a GLP-1 medication with supervised exercise were more likely than those who had taken the medication alone to still hold a loss of at least 10% of their starting weight (Jensen 2024). The medication was liraglutide, an earlier GLP-1 medicine, and the initial loss came from a low-calorie diet.
We go through this evidence in more detail in habits that predict keeping it off.
In phase two the dose comes down
For patients on medication, phase two includes bringing the dose down, and how that is done matters. The withdrawal trials took the medication away, by stopping it or by switching people to placebo. In the STEP 1 extension, where semaglutide and the trial's lifestyle support both stopped at week 68, adults regained roughly two-thirds of what they had lost within a year, though a year on the group was still 5.6% below its starting weight (Wilding 2022).
The reason is biology, not a lack of willpower. The medication quiets appetite while it is taken; stopped overnight, that effect fades over the following weeks, and the habits in place by then are what is left.
Stepping down is a different picture. In SURMOUNT-MAINTAIN, adults who stepped down to a lower dose of tirzepatide after 60 weeks were still 16.6% below their starting weight a year later (Horn 2026).
At GetLean the exit is planned from the first consultation. Dr Quek brings the dose down at the monthly reviews, towards the lowest effective dose, rather than stopping it overnight, so appetite adjusts step by step while the habits built in phase one take over. The pace is set for each patient as the response comes in, not fixed on day one. Never stop or change a prescribed medicine on your own. The step-down is set out in tapering off GLP-1 medication.
What does a phase two actually look like?
Concretely, five things, none of which is new — they are phase one's inputs, continued at maintenance energy intake.
- Resistance training, unchanged. The stimulus that protected lean mass in the deficit is the same stimulus that holds it afterwards (Lopez 2022).
- Protein, kept up. The 1.2–1.6 g per kg of body weight range was derived for energy restriction (Leidy 2015) and no source here sets a maintenance target — but dropping protein the week the deficit ends removes an input while the training load stays.
- Activity volume you can actually sustain, with the 250-minutes-a-week association as a reference point rather than a rule (Donnelly 2009).
- A measurement you keep taking. Weight, waist, or both — the registry association is with continuing to measure, not with any particular number (Butryn 2007).
- A decision about medication, made with your prescriber, rather than by default when a supply runs out.
At GetLean, the programme is designed to end: our philosophy is that GLP-1 medication should act as a catalyst — not something to depend on indefinitely. The plan for coming off is the GetLean GLP-1 Taper Plan: after hitting your goal weight with the right nutrition and exercise habits built, the dose is stepped down at Dr Quek's monthly reviews towards your lowest effective dose and, where clinically appropriate, off the medication. That means phase two is part of the plan from the first consultation, not a conversation that starts when phase one ends. Individual results vary, and clinical-trial figures describe the populations that were studied. If you are considering treatment, book your consult and speak to a doctor about whether it is suitable for you.
Common questions
What are the two phases of getting lean?
Phase one is the energy deficit that removes fat. Phase two is everything that holds the result — maintenance eating, continued resistance training, protein, self-monitoring, and for patients on medication the planned taper. Phase one is finite; phase two is built during it, so the habits that hold the result are already in place when the deficit ends.
How long does phase two last?
The habits carry on, and the odds improve with time held. Registry follow-up found that having already maintained a loss for two years or more was associated with a lower chance of regaining over the next year (McGuire 1999), and a review of the same literature reports that once a loss has been held two to five years, the chance of longer-term success rises substantially (Wing and Hill 2001).
Do you regain the weight after stopping GLP-1 medication?
In the STEP 1 extension, where semaglutide and the trial's lifestyle support were both stopped overnight after 68 weeks, with no taper, adults regained about two-thirds of their loss within a year (Wilding 2022). At GetLean the exit is built around that: the habits are in place before the dose moves, and Dr Quek steps the dose down at the monthly reviews rather than stopping it overnight. Never stop or change a prescribed medicine on your own; speak to your prescriber first.
What does the National Weight Control Registry show people doing?
It records what people who kept a large loss off report doing. Its first large description covered 784 members who had each lost at least 13.6 kg and kept it off five years on average, and who reported a low-fat diet and a high level of physical activity, around an hour a day (Klem 1997). Later registry follow-up found that those who kept weighing themselves regularly regained less over a year than those who weighed less often (Butryn 2007).
How much activity does maintenance take?
The ACSM position stand associates more than 250 minutes a week of physical activity with better maintenance after weight loss (Donnelly 2009). That figure comes from cross-sectional and prospective data.