What happens after the six months of RCOMP end?

RCOMP runs for six months, and the six months are the easier half. What follows is maintenance, which is a different physiological problem from losing weight and is the point at which most weight programs quietly fail. If a GLP-1 was part of the plan, the exit strategy written at the start is what gets executed: a maintenance dose or a structured reduction, a protein target, resistance training that continues, and a monitoring schedule with real dates on it.

What the withdrawal data show

The evidence on stopping is consistent. In the STEP 1 trial extension, participants who came off semaglutide 2.4 mg regained a mean of 11.6 percentage points of body weight over the following year, roughly two thirds of what they had lost. Blood pressure in that extension returned to baseline levels by week 120. In SURMOUNT-4, among participants switched from tirzepatide to placebo for 52 weeks, 82 percent regained more than a quarter of the weight they had lost, and waist circumference, systolic blood pressure, non-HDL cholesterol and HbA1c all worsened in step with the amount regained.

What maintenance actually involves

Maintenance is a set of specific commitments rather than a state of mind. Resistance training at least twice a week, because muscle lost during rapid weight loss is not regained automatically. A protein intake high enough to support that training. Sleep, because short sleep raises appetite. Weight checked at a fixed interval with a threshold agreed in advance that triggers a review instead of a wait. And where medication continues, the lowest dose that holds the result rather than the highest dose tolerated.

What keeps being monitored

The monitoring plan depends on what was found in the first place. Someone whose prediabetes resolved still needs an HbA1c at a set interval, because the Diabetes Prevention Program showed progression to type 2 diabetes being reduced rather than abolished. Someone started on levothyroxine during the program needs thyroid function rechecked, since a large weight change can alter the dose requirement. Someone continuing a GLP-1 follows the usual label monitoring. Someone whose sleep apnea was treated needs it reassessed rather than assumed to have gone.

The last weeks of the program are where the next phase gets decided, and that decision belongs in the appointment rather than on this page, because it depends on what you are still taking, what still needs watching, and which local physician can carry it. Raise it at month five rather than month six. The question to put on the table is who is watching what, and at what interval, from here.