Frequently Asked Questions

This concern has been thoroughly investigated. A large real-world retrospective cohort study of 107,910 patients published in Nature Medicine (2024) found that patients taking semaglutide had a significantly lower risk of suicidal ideation and self-harm compared to those using other weight-loss or diabetes medications: not a higher risk. The study found a 49–73% lower risk of suicidal ideation in the semaglutide group. The European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA) have both reviewed available evidence and concluded that no causal link between GLP-1 medications and suicidal ideation has been established. That said, significant weight loss and changes in eating behaviour can bring up complex emotions: which is why Élan's programme includes psychological preparation and ongoing check-ins throughout treatment.

Most patients do not experience negative mental health effects from GLP-1 medications, and some studies suggest improvements in mood and quality of life alongside weight loss. However, any significant change in body and behaviour: including reduced appetite and shifting food habits: can surface emotional reactions that deserve attention. Élan's clinical team is trained to monitor for these changes and will ask about your wellbeing at every appointment. If you have a pre-existing mental health condition, we discuss this during your initial assessment to ensure treatment is appropriate and well-supported.

Yes: and you're not alone in feeling this way. Many patients describe a sense of loss or grief around food when appetite changes dramatically: social meals feel different, old comfort foods lose their appeal, and the emotional role food played in daily life is suddenly disrupted. This phenomenon, sometimes called "food grief," is a recognised psychological response to the changes GLP-1 treatment brings. Élan prepares patients for this shift before treatment begins, and our team is available to help you build a new, healthier relationship with food: one that doesn't require mourning what you've left behind.

GLP-1 medications work by reducing appetite signals and slowing gastric emptying, which fundamentally changes how hunger and food satisfaction feel: at least while you're on treatment. For many patients, this creates an opportunity to establish new eating patterns without the constant pull of cravings. Whether those changes persist after stopping treatment depends on whether new habits have been consolidated. At Élan, nutritional behavioural coaching is part of the programme specifically to help you use this window to build lasting habits, not just temporary restriction.

The honest answer: most people regain a significant portion of lost weight after stopping GLP-1 medication without a structured maintenance plan. A major clinical trial extension (STEP 1 extension, Wilding et al., Diabetes, Obesity and Metabolism 2022) showed that participants who discontinued semaglutide regained approximately two-thirds of their lost weight within one year. This is not a failure of willpower: it reflects the chronic nature of obesity as a metabolic condition. GLP-1 medications treat the condition while you take them; stopping without transition support removes that treatment effect. Élan's Regain Shield programme is specifically designed to bridge the gap: combining dose tapering, habit consolidation, and ongoing monitoring to protect your results as long-term as possible.

GLP-1 medications do not cause physical dependence in the way some other drugs do, so abrupt discontinuation does not typically produce withdrawal symptoms. However, stopping suddenly: without a tapering plan or lifestyle support in place: significantly increases the likelihood of rapid weight regain and the return of metabolic risk factors such as elevated blood sugar and blood pressure. Élan strongly recommends a planned, supervised transition off medication rather than stopping cold. If circumstances require stopping sooner than planned, we will discuss strategies to minimise the impact on your results.

Weight plateaus are a normal and expected part of GLP-1 treatment: not a sign that the medication has stopped working or that you've done something wrong. As body weight decreases, the body adapts by reducing its resting metabolic rate (adaptive thermogenesis), meaning fewer calories are needed to maintain the new lower weight. Research shows this metabolic adaptation can persist even after the plateau resolves. Options to address a plateau include dose adjustment under medical supervision, increasing dietary protein intake to preserve lean mass, and incorporating resistance training to stimulate metabolic activity. Élan's clinical team will review your individual trajectory at regular intervals and recommend adjustments accordingly.

There is no fixed duration: plateaus can last anywhere from a few weeks to several months, and their length varies significantly between individuals. A plateau does not necessarily indicate treatment failure; it may simply reflect the body reaching a temporary equilibrium point before further loss resumes. In some cases, a plateau signals that the current dose has reached its ceiling effect and a dose adjustment is warranted. Rather than interpreting a plateau as a setback, Élan's approach treats it as a data point that informs the next step of your personalised plan.

This is a legitimate concern. Studies: including a body composition sub-analysis of the STEP 1 clinical trial using DEXA scanning: have shown that without proper nutrition and exercise support, up to 26–40% of total weight lost during GLP-1 treatment can come from lean mass (muscle), rather than fat alone. Muscle loss has long-term implications for metabolic health, physical function, and the sustainability of weight maintenance. Élan's protocol specifically addresses this through personalised protein intake targets (typically 1.2–1.6 g per kg of body weight per day) and a structured exercise prescription that includes resistance training. These are not optional add-ons: they are core components of the programme.

Yes: with appropriate support, many patients not only preserve muscle but improve body composition by losing fat while maintaining or even modestly increasing lean mass. This requires adequate protein intake, consistent resistance training, and sufficient caloric intake to support muscle protein synthesis (which can be challenging when appetite is suppressed). Your Élan treatment plan includes exercise guidance tailored to your current fitness level and a protein strategy aligned with your dietary preferences. Body composition: not just the number on the scale: is something we track throughout your programme.

Oral GLP-1 receptor agonists exist and are an active area of development. Oral semaglutide (Rybelsus) has been available for type 2 diabetes management, and higher-dose oral formulations for weight management were in clinical trials or awaiting regulatory review as of early 2025: this landscape is changing rapidly and may have evolved since publication. Oral GLP-1 medications present different pharmacokinetic characteristics compared to injectables: they are generally absorbed less predictably and require specific dosing instructions (taken on an empty stomach with minimal water). At present, the injectable forms remain the most studied and most effective options for weight management. Élan monitors regulatory developments and will offer new formulations as they become appropriately approved and available.

Injectable GLP-1 medications (administered once weekly for most formulations) offer more consistent and well-studied bioavailability, meaning the dose delivered to the body is reliable and predictable. The clinical evidence base: including long-term cardiovascular outcome trials: is substantially larger for injectables. Oral formulations offer the advantage of avoiding injections, which matters to some patients, but require careful adherence to dosing conditions and may deliver lower effective doses per administration. Neither format is universally superior; the choice depends on patient preference, medical history, and what is currently authorised for weight management indication in Estonia. This is something we discuss with each patient individually at Élan.

GLP-1 receptor agonists are generally considered appropriate for adults with a BMI of 30 or above, or BMI of 27 or above in the presence of weight-related health conditions such as type 2 diabetes, hypertension, or obstructive sleep apnoea. However, eligibility is determined on an individual basis: there are medical contraindications (including personal or family history of certain thyroid conditions or pancreatitis) that need to be screened for. An initial consultation at Élan includes a structured medical assessment, review of your health history, and a discussion of all available treatment options, so you can make an informed decision together with your doctor.