Long-term success: how people maintain weight loss for three years with Mounjaro

For many struggling with obesity, finding treatments that provide lasting results has been challenging. Most weight loss methods show diminishing returns over time, with many people regaining lost weight. Mounjaro (tirzepatide) offers promising evidence for long-term Mounjaro use and sustained weight management. Understanding how this medication supports sustainable weight loss over multiple years can help set realistic expectations and proper planning for those considering this treatment option.

What the SURMOUNT-4 Trial Revealed About Mounjaro’s Long-term Effects

The groundbreaking SURMOUNT-4 trial provided critical insights into Mounjaro 3-year results by using a unique study design. Participants first completed a 36-week lead-in phase where everyone received Mounjaro, achieving impressive weight reduction. Following this initial period, researchers randomly assigned participants to either continue Mounjaro or switch to a placebo for an additional 52 weeks.

The results were striking: those who continued Mounjaro maintained their weight loss and even lost a bit more, while those switched to placebo regained over half of their lost weight within a year. During the lead-in phase, participants achieved an average weight loss of approximately 20.9% of their starting weight. Those who continued tirzepatide lost an additional 5.5% of their weight during the withdrawal phase, while those who switched to placebo regained about 14% of their weight.

This study demonstrates that Mounjaro maintenance requires ongoing treatment, much like other chronic conditions such as high blood pressure or diabetes that require continuous management.

Why Mounjaro May Support Weight Loss Better Over Time

Mounjaro’s effectiveness for long-term weight management stems from its unique dual-action mechanism targeting both GLP-1 and GIP receptors. Unlike earlier weight loss medications that may lose effectiveness over time, Mounjaro’s impact on multiple hormonal pathways helps regulate hunger, enhance feelings of fullness, slow gastric emptying, and improve insulin sensitivity.

With sustained use, many patients report that their relationship with food fundamentally changes. The constant thoughts about eating, cravings, and emotional eating patterns that previously dominated their lives often diminish significantly. This creates a window of opportunity to establish healthier eating patterns that can support weight maintenance.

Dr. Ania Jastreboff, a leading obesity medicine specialist, explains that medications like Mounjaro work by countering the body’s biological defense mechanisms against weight loss. When we lose weight, our bodies typically respond by increasing hunger hormones, decreasing satiety signals, and lowering metabolic rate—all designed to regain the lost weight. Mounjaro helps override these powerful biological responses, making long-term weight management possible.

What the Three-Year Journey Looked Like for Patients

The weight loss journey with long-term Mounjaro use typically follows a characteristic pattern. During the first 6-9 months, patients experience the most rapid weight reduction as their bodies respond to the medication and reduced caloric intake. This initial phase often yields the most dramatic results.

In the second year, weight loss typically continues but at a slower pace. Many participants reached their maximum weight loss around 18-24 months into treatment. The third year generally focused on weight maintenance rather than further significant losses, though some patients continued to lose weight gradually throughout the entire study period.

Beyond just taking the medication, successful participants engaged in supportive lifestyle modifications. While the SURMOUNT trials didn’t require strict diets, participants received basic counseling on healthy eating and moderate physical activity. Many reported that the reduced hunger and cravings from Mounjaro made it easier to follow these lifestyle recommendations without the intense struggle typically associated with dieting.

How Long Do People Stay on Mounjaro?

The evidence increasingly suggests that Mounjaro maintenance requires ongoing treatment for most people. In the SURMOUNT trials, participants who achieved the best results remained on the medication throughout the study period, highlighting the importance of continuous treatment.

This reality is shifting the medical community’s approach to obesity treatment from a short-term intervention to a long-term management strategy. Just as we don’t expect someone with high blood pressure to take medication for a few months and then maintain normal readings without treatment, the medical community is recognizing that weight management often requires sustained support.

This long-term approach raises important questions about affordability, insurance coverage, and commitment. Currently, many insurance plans limit coverage for weight management medications or impose strict requirements for continued coverage. Patients considering Mounjaro should understand the potential financial commitment and advocate for appropriate coverage of this medically necessary treatment.

Is Long-term Mounjaro Use Safe?

Safety remains a primary concern for any long-term medication use. The good news is that the safety profile for extended long-term Mounjaro use appears consistent with shorter studies. Gastrointestinal side effects—including nausea, vomiting, and diarrhea—remain the most commonly reported issues, though these typically decrease in intensity over time as the body adjusts to the medication.

Serious adverse events were relatively rare in the long-term studies. The most commonly monitored concerns include:

Potential effects on the pancreas
Gallbladder issues
Thyroid C-cell tumors (based on animal studies)
Kidney function impacts

Importantly, no major new safety concerns emerged during the extended treatment periods. However, researchers continue to monitor long-term users, and future studies will provide more data on safety beyond three years of use.

Can You Keep the Weight Off If You Stop Mounjaro?

The SURMOUNT-4 results clearly show that most patients experience significant weight regain after discontinuing Mounjaro. This pattern of Mounjaro weight regain reinforces the understanding that obesity is a chronic metabolic condition rather than simply a lifestyle issue that can be “fixed” permanently.

When treatment stops, the body’s powerful biological mechanisms to defend and restore weight typically reassert themselves. Hunger increases, metabolic rate decreases, and the brain’s reward system once again becomes more responsive to food cues.

Some individuals may be able to maintain a portion of their weight loss through intensive lifestyle management after discontinuing medication, particularly if they’ve established strong habits during treatment. However, most people will require some form of ongoing support—whether medication, continued behavioral therapy, or both—to maintain significant weight reductions long-term.

What This Study Means for the Future of Obesity Treatment

The Mounjaro 3-year results represent a significant advancement in understanding obesity as a chronic medical condition requiring long-term management. These findings challenge outdated perspectives that view obesity as simply a failure of willpower or a temporary problem to “solve.”

Medical guidelines are already evolving to reflect this understanding, with major organizations now recommending continued medication use for maintaining weight loss. Insurance policies and healthcare systems will likely need to adapt to this reality, providing coverage for ongoing treatment rather than imposing arbitrary time limits.

For individuals, these tirzepatide success stories offer hope that sustainable weight management is possible with appropriate medical support. By combining effective medications like Mounjaro with personalized lifestyle modifications, we’re entering an era where long-term weight management becomes an achievable goal rather than an endless struggle.

Schedule a consultation with Heally today to discuss whether Mounjaro might be appropriate for your long-term weight management journey and to develop a comprehensive plan that addresses both the medical and lifestyle aspects of sustainable weight control.