Taking semaglutide? Stick with the program
Personally, I’ve never had a weight problem. Always had a BMI under 24. But I’ve known plenty of people who were overweight or obese. For the ones who started taking semaglutides, the results have been transformative and the risks for most have been negligible. But don’t take my word for it. Here’s Dr. McGowan, a gastroenterologist and obesity medicine specialist:
“As a practicing obesity medicine specialist, I was an early and vocal advocate for GLP-1 therapy — speaking publicly and often about their unprecedented efficacy against obesity. I shared the excitement around these medications and fought alongside my patients to obtain them despite well-documented barriers: high costs, limited insurance coverage, prematurely terminated coupon programs, and supply shortages.”
But McGowan has recently soured on GLP-1 therapy. Not because it doesn’t work when taken as prescribed, but because of what happens when his patients *stop* taking it:
“The benefits of these drugs cannot be denied when they are taken as intended — meaning indefinitely. But what happens to the body and mind when these medications are discontinued? This is where the problem lies.
“The truth is, most patients don’t stay on anti-obesity medications — I see it in my practice every day. Research shows that three-quarters of patients stop GLP-1 medications within 2 years, many within months. Reasons for discontinuation include cost, side effects, and supply shortages. But one of the most common reasons is that patients simply don’t want to take a weight loss medication indefinitely. Many believe they can “beat the system,” use them briefly, change their lifestyle, and stop taking them without regaining weight.
“Unfortunately, they can’t. Clinical trials of semaglutide and tirzepatide show that the average patient regains two-thirds of the weight lost (and similar changes in cardiometabolic variables) within the first year of discontinuation. For some, the return of weight feels almost instantaneous, and they often regain more than they initially lost. My patients describe feeling ravenous and overwhelmed by the resurgence of food noise.”
So why not just get back on the drugs?
“The adverse effects of stopping these medications extend beyond the scale, as evidence suggests certain risks are associated with weight cycling. Take body composition: while on treatment, patients lose lean muscle along with fat, and studies suggest much of that muscle loss is never recovered. Upon discontinuation and subsequent weight regain, the regained weight is primarily fat, not muscle. This can leave patients worse off — with less lean mass, a lower basal metabolic rate, and greater difficulty achieving future weight loss. Health consequences include diminished strength, reduced bone density, and a higher risk of fractures.”
The benefits of these drugs for many people are undeniable. The danger is not the drug, it’s cycling off and on. As with most therapies, the single biggest variable is patient compliance.
GLP-1 therapy: stick with the program
“As a practicing obesity medicine specialist, I was an early and vocal advocate for GLP-1 therapy — speaking publicly and often about their unprecedented efficacy against obesity. I shared the excitement around these medications and fought alongside my patients to obtain them despite well-documented barriers: high costs, limited insurance coverage, prematurely terminated coupon programs, and supply shortages.”
But McGowan has recently soured on GLP-1 therapy. Not because it doesn’t work when taken as prescribed, but because of what happens when his patients *stop* taking it:
“The benefits of these drugs cannot be denied when they are taken as intended — meaning indefinitely. But what happens to the body and mind when these medications are discontinued? This is where the problem lies.
“The truth is, most patients don’t stay on anti-obesity medications — I see it in my practice every day. Research shows that three-quarters of patients stop GLP-1 medications within 2 years, many within months. Reasons for discontinuation include cost, side effects, and supply shortages. But one of the most common reasons is that patients simply don’t want to take a weight loss medication indefinitely. Many believe they can “beat the system,” use them briefly, change their lifestyle, and stop taking them without regaining weight.
“Unfortunately, they can’t. Clinical trials of semaglutide and tirzepatide show that the average patient regains two-thirds of the weight lost (and similar changes in cardiometabolic variables) within the first year of discontinuation. For some, the return of weight feels almost instantaneous, and they often regain more than they initially lost. My patients describe feeling ravenous and overwhelmed by the resurgence of food noise.”
So why not just get back on the drugs?
“The adverse effects of stopping these medications extend beyond the scale, as evidence suggests certain risks are associated with weight cycling. Take body composition: while on treatment, patients lose lean muscle along with fat, and studies suggest much of that muscle loss is never recovered. Upon discontinuation and subsequent weight regain, the regained weight is primarily fat, not muscle. This can leave patients worse off — with less lean mass, a lower basal metabolic rate, and greater difficulty achieving future weight loss. Health consequences include diminished strength, reduced bone density, and a higher risk of fractures.”
The benefits of these drugs for many people are undeniable. The danger is not the drug, it’s cycling off and on. As with most therapies, the single biggest variable is patient compliance.
GLP-1 therapy: stick with the program