Stephen A. Smith, Maintenance, and What Happens If You Stop

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GLP-1 medication and metabolic health image for Stephen A. Smith, Maintenance, and What Happens If You Stop

At a glance

  • Public status: Stephen A. Smith has confirmed GLP-1 use on air during ESPN's First Take
  • Drug class: GLP-1 receptor agonists (semaglutide, tirzepatide, and related compounds)
  • Core clinical question: Discontinuation triggers measurable weight regain in most patients within 12 months
  • Key trial: The STEP 1 extension trial showed participants regained roughly two-thirds of prior weight loss after stopping semaglutide 2.4 mg
  • HealthRX Medical Team position: GLP-1 medications function more like blood pressure drugs than antibiotics. Stopping them doesn't "lock in" results for most patients.

What Stephen A. Smith Has Said Publicly

Stephen A. Smith, the veteran ESPN commentator and host of First Take, has openly discussed his use of a GLP-1 receptor agonist on air. His willingness to talk about the medication publicly sets him apart from many celebrities who either deny or sidestep questions about pharmaceutical weight management.

Smith's on-air discussions have touched on how the medication affected his health and physical appearance. He has not, to our knowledge, publicly specified which GLP-1 drug he takes, the dose, or the duration of treatment. Any details beyond what Smith himself has stated on camera remain outside the scope of this article.

What makes his case worth examining is the question it raises for millions of viewers: is this a medication you take temporarily, or is it a permanent commitment?

The Pharmacology of GLP-1 Receptor Agonists

GLP-1 receptor agonists mimic the incretin hormone glucagon-like peptide-1. The drug binds to GLP-1 receptors in the pancreas, gut, and brain. In the pancreas, it stimulates glucose-dependent insulin secretion. In the hypothalamus, it suppresses appetite by acting on satiety centers. In the stomach, it slows gastric emptying, which extends the feeling of fullness after meals.

Semaglutide (marketed as Ozempic for type 2 diabetes and Wegovy for chronic weight management) and tirzepatide (Mounjaro, Zepbound) are the two most widely prescribed agents in this class. Both are administered as weekly subcutaneous injections. Oral semaglutide (Rybelsus) exists but carries lower bioavailability and is FDA-approved only for glycemic control, not weight management as of this writing.

The critical detail: these drugs do not permanently alter metabolism. They work while present in the body. When the drug clears, the biological signals it was suppressing or amplifying return to their prior state.

What the Discontinuation Data Actually Shows

The most cited evidence on GLP-1 cessation comes from the STEP 1 trial extension, published in the journal Diabetes, Obesity and Metabolism. Participants who lost an average of 17.3% of body weight on semaglutide 2.4 mg regained approximately 11.6 percentage points of that loss within 12 months of stopping the drug. They also saw partial reversal of improvements in waist circumference, blood pressure, and lipid profiles.

A similar pattern appeared in the SURMOUNT-4 trial for tirzepatide. Patients who switched from tirzepatide to placebo after 36 weeks regained roughly half of the weight they had lost, while those who continued treatment maintained or extended their losses.

The physiology behind this is not a mystery. Appetite suppression disappears when the drug is withdrawn. Gastric emptying returns to baseline speed. Caloric intake rises. The hypothalamic "set point" that the medication was overriding reasserts itself.

This is not a failure of willpower. It is predictable neurobiology.

The HealthRX Medical Team Framework: Three Discontinuation Scenarios

The HealthRX Medical Team categorizes GLP-1 discontinuation into three clinical scenarios, each with different expected outcomes.

Scenario 1: Full stop, no structured transition. This is the most common real-world pattern and the one with the worst outcomes. Weight regain begins within weeks, and most patients return to within 5-10% of their starting weight by month 14. Metabolic markers (HbA1c, triglycerides, blood pressure) trend back toward pre-treatment levels. The STEP 1 extension data reflects this scenario.

Scenario 2: Dose taper with lifestyle consolidation. Some clinicians taper the dose over 8-16 weeks while the patient reinforces dietary habits and exercise routines established during treatment. Controlled data on this approach is limited. Observational reports suggest modestly better retention of weight loss compared to abrupt cessation, but no large randomized trial has confirmed this.

Scenario 3: Indefinite maintenance at a reduced dose. This mirrors how statins, antihypertensives, and SSRIs are prescribed. The patient stays on the medication, sometimes at a lower dose than the one used for initial weight loss. The American Gastroenterological Association's 2024 guidelines support long-term pharmacotherapy for obesity when clinically appropriate, treating it as a chronic disease rather than a short-term problem.

For a public figure like Stephen A. Smith, whose job involves daily television appearances and a physically visible public profile, the choice between these scenarios carries personal and professional dimensions that only he and his physician can weigh.

Weight Regain Is Not the Only Concern

Discontinuation affects more than the number on the scale. Patients stopping GLP-1 therapy may experience:

Return of glycemic dysregulation. For patients with type 2 diabetes or prediabetes, HbA1c levels tend to rise after cessation. The pancreatic beta-cell support provided by the drug is no longer present, and glucose control deteriorates.

Cardiovascular marker reversal. The SELECT trial demonstrated a 20% reduction in major adverse cardiovascular events with semaglutide 2.4 mg in patients with established cardiovascular disease and obesity. Those benefits are drug-dependent. Stopping the medication means losing the cardioprotective effect.

Gastrointestinal rebound. Some patients report increased hunger, faster gastric emptying, and digestive changes in the weeks following discontinuation. These symptoms are generally self-limiting but can be uncomfortable.

Psychological impact. Regaining weight after a period of successful loss carries well-documented psychological costs, including increased rates of depression and disordered eating patterns. Clinicians should screen for these outcomes during and after GLP-1 withdrawal.

Who Can Successfully Stop?

Not every patient regains all lost weight. A subset of patients, estimated at roughly 15-20% in observational data, maintain a clinically meaningful portion of their weight loss after discontinuation. Common features of this group include:

Patients who adopted sustained dietary changes (particularly increased protein intake and reduced ultra-processed food consumption) during treatment. Those who established a consistent resistance training routine. Individuals whose starting BMI was lower (30-35 range versus >40). And patients who used the medication for longer durations before stopping, allowing more time for behavioral pattern consolidation.

The HealthRX Medical Team emphasizes that none of these factors guarantee success. They shift probabilities. The biological drive to regain weight after pharmacological suppression is strong, and individual variation in metabolic adaptation is wide.

Long-Term Safety of Continued GLP-1 Use

For patients choosing to remain on therapy, the safety profile over multi-year use is increasingly well characterized. The SUSTAIN and STEP trial programs provide data out to two years. Longer-term registries and post-marketing surveillance extend this further.

Common side effects that persist include nausea (typically mild after dose stabilization), constipation, and injection-site reactions. The more serious concerns under ongoing monitoring include:

Pancreatitis. GLP-1 receptor agonists carry an FDA label warning for acute pancreatitis. Population-level data suggests the absolute risk is low (roughly 0.1-0.3% per year), but patients with a history of pancreatitis should not use these drugs.

Thyroid C-cell tumors. Rodent studies showed increased medullary thyroid carcinoma with liraglutide and semaglutide. Human epidemiological data has not confirmed this signal, but the boxed warning remains. Patients with a personal or family history of medullary thyroid carcinoma or MEN2 syndrome are contraindicated.

Gallbladder events. Rapid weight loss from any cause increases gallstone risk. GLP-1 drugs may compound this through effects on gallbladder motility. The STEP trials reported cholelithiasis rates of approximately 2.6% versus 1.2% on placebo.

Muscle mass loss. All caloric-deficit weight loss produces some lean mass reduction. DEXA data from GLP-1 trials show that roughly 30-40% of total weight lost is lean mass. Resistance training and adequate protein intake (1.2-1.6 g/kg/day) are the primary countermeasures, whether on or off the drug.

What This Means for Someone Watching Stephen A. Smith

Smith's public discussion of GLP-1 use reaches an audience of millions. Many viewers are considering these medications themselves, or already taking them and wondering what comes next.

The clinical reality is straightforward. GLP-1 receptor agonists are effective medications for weight management and metabolic health. They are not cure-alls that permanently reset body composition. For most patients, stopping them means losing most of the benefit.

That is not a reason to avoid them. It is a reason to approach them with realistic expectations and a long-term plan. The HealthRX Medical Team views GLP-1 therapy as a tool best used within a comprehensive framework: structured nutrition, progressive resistance training, metabolic monitoring, and an honest conversation with a prescribing physician about duration of therapy.

Smith's openness about his experience contributes to normalizing that conversation. The rest is between each patient and their doctor.

Frequently asked questions

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References

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  • Wilding JPH et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide. Diabetes Obes Metab. 2022. https://pubmed.ncbi.nlm.nih.gov/35441470/
  • Aronne LJ et al. Continued treatment with tirzepatide for maintenance of weight reduction (SURMOUNT-4). JAMA. 2024. https://pubmed.ncbi.nlm.nih.gov/38376001/
  • Lincoff AM et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT). N Engl J Med. 2023. https://www.nejm.org/doi/full/10.1056/NEJMoa2307563
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  • FDA drug label information. https://www.accessdata.fda.gov/drugsatfda_cgi/dru/index.cfm