The downside of semaglutides
GLP-1-based therapies for obesity have been transformational. The benefits are undeniable, and the risks for most people are negligible. These drugs belong in the class with anti-hypertensives and statins. Who could complain?
Here’s one doc who was an initial enthusiast, but who has cooled:
“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.”
OK, so this isn’t the fault of the drug. The single biggest variable in therapy is patient compliance. Stop taking the drug, stop doing the PT exercises, fall off the wagon, and you lose the benefits.
I understand and share the impulse to minimize my intake of pharmacy. But largely owing to the fact that I won the genetics lottery, I don’t have the sorts of conditions that require chronic drug use*. And if the drugs have side effects, there’s a trade-off.
But with GLP-1-based pharmacologies, the side effects of use are minimal. The side effects of stopping are significant. Stick with the program, peeps.
*I recently started eye drops for glaucoma, which I need to take once a day for the rest of my life if I don’t want to go blind from excess intraocular pressure. I’m happy to accept this minor inconvenience for the profound benefit.
Risk of stopping GLP-1-based therapy
Here’s one doc who was an initial enthusiast, but who has cooled:
“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.”
OK, so this isn’t the fault of the drug. The single biggest variable in therapy is patient compliance. Stop taking the drug, stop doing the PT exercises, fall off the wagon, and you lose the benefits.
I understand and share the impulse to minimize my intake of pharmacy. But largely owing to the fact that I won the genetics lottery, I don’t have the sorts of conditions that require chronic drug use*. And if the drugs have side effects, there’s a trade-off.
But with GLP-1-based pharmacologies, the side effects of use are minimal. The side effects of stopping are significant. Stick with the program, peeps.
*I recently started eye drops for glaucoma, which I need to take once a day for the rest of my life if I don’t want to go blind from excess intraocular pressure. I’m happy to accept this minor inconvenience for the profound benefit.
Risk of stopping GLP-1-based therapy
Joel, I might have misread this, but a “side effect” of GLP-1 for many patients seems to be high financial pressure on family budgets. In many cases discontinuing the use of these drugs is nothing at all like not doing your PT home exercises because not doing PT doesn’t save the family money but stopping Wegovy saves a lot of stress for a lot of families even if the food budget goes up. If we go back and restudy much of the material Bill put up on ACA premiums, we see that these drugs are highlighted as one of the major causes for 2026 gross premium increases, so even insurance coverage for them is generating serious financial pressure. I am not minimizing your glaucoma, but It isn’t that good of an analogy here. It’s clear that going blind has a big potential for enormous quality of life and financial impact due to both costs and loss of income. I feel pretty confident that nearly all the people who discontinue GLP -1 would not discontinue eyedrops to prevent going blind. There are differences between the two experiences that create incentives for different choices. I’d highlight the presence or absence of dependent kids as a serious influence on all kinds of decisions. If it’s a pretty hefty cost, the opportunity cost for your kids gets to be a big factor.
@Eric,
The point of the glaucoma analogy is that the eye drops, like semaglutides, must be taken for life or the symptoms return. It is a good analogy to make that point and that’s why I used it. I know the drops cost less and I well understand the difference between glaucoma and obesity. I don’t see the point of your misdirection here.
The article I linked to explicitly mentions cost as a factor for discontinuing. My quote from the article mentions cost. I encourage you to click and actually read the link written by a practicing physician who treats patients on these drugs. Stipulating that cost is a significant factor for some, the fact remains that stopping will, like discontinuing PT, lead to a return of the problem.
Hope that helps.