Discontinuations Drive Poor Real World Outcomes with GLP-1s
Honestly, we cannot figure out why this basic fact of obesity treatment seems so hard for so many people to grasp. New, advanced medicines for obesity don’t work well when a person doesn’t take them. A new study in Obesity drives this point home. Hamlet Gasoyan and colleagues found that discontinuations and sub-optimal dosing of GLP-1s explain real world outcomes in obesity that are poor by comparison to the results in clinical trials:
“Our findings indicate that treatment discontinuation and use of lower maintenance dosages might reduce the likelihood of achieving clinically meaningful weight reduction in patients who initiate obesity pharmacotherapy with semaglutide or tirzepatide.”
Disappointing Outcomes
When people persisted with these therapies, their average real-world weight loss was 12%. But for those who discontinued the medicines within three months of starting them, that number went down to four percent. The number was slightly better, seven percent, if they discontinued therapy later.
Though this was not a study of patients with diabetes, some of the patients had prediabetes. For them, researchers found similarly disappointing outcomes with glycemic control. Discontinuing therapy resulted in little improvement in A1c levels, while patients who persisted saw substantial improvements.
Systematic Pressure to Discontinue
It is no secret that the pressure to discontinue these therapies is intense. Out-of-pocket costs are high and some insurers are making them even higher. Cost and insurance coverage changes, along with side effects, are among the most common reasons for discontinuing therapy. One of the study’s authors, Scott Butsch, told us:
“Not surprisingly, one’s ability to stay on these medications is influenced by real world factors – classic barriers like insurance coverage and high costs.”
Then there is the resistance to thinking of obesity as a chronic condition requiring ongoing treatment. Patients and healthcare professionals alike are misled by talk about obesity that focuses on “weight loss” and calls these medicines “weight loss drugs.”
So many patients default to thinking that once they lose the weight, they ought to be able to keep it off without these medicines. Insurers and wellness companies are selling hard the idea of an “off-ramp” from GLP-1s. Such self-serving programs would be laughed out of town for any other chronic disease. For obesity, they find acceptance because people implicitly blame themselves for their condition.
Slowly, we expect, these systematic pressures will ease. Costs will come down and the reality of the need for chronic care in obesity will become undeniable. Until then, people will suffer needlessly from poor health outcomes that come from inadequate or sporadic obesity care.
Click here for the study and here for more about it from the Cleveland Clinic. For perspective on the pressure to discontinue therapy from insurers, click here.
Le Lecteur (The Reader), painting by Louis Marcoussis / Birmingham Museums Trust
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June 11, 2025
June 11, 2025 at 7:08 am, Sarah Mueller said:
This article really resonates with me—thank you for shedding light on the deeper issues surrounding obesity and access to GLP-1 medications. As someone who responded well to a GLP-1 and saw real, sustained changes while on it, I was incredibly disappointed when my insurance stopped covering it. I’ve noticed a significant return of hunger, and despite my best efforts, I’m regaining weight and struggling to fit into clothes that once felt comfortable.
What’s even more frustrating is that I’m a registered dietitian—and yet, one of the requirements my insurance imposed was that I meet with a registered dietitian regularly to maintain coverage. It felt incredibly patronizing, as if my expertise and understanding of nutrition didn’t count. The standards they set for qualifying are nearly impossible and ignore the fact that obesity is a chronic disease, not a character flaw.
GLP-1s weren’t a quick fix for me; they gave me the space to form healthier habits and feel in control of my appetite for the first time in years.
On a more positive note, I’m slowly rediscovering the joy of grocery shopping and meal planning for my family—something I had lost interest in while on the medication. It’s a small silver lining, but it reminds me that managing obesity is about more than the number on the scale—it’s also about quality of life.
Thanks again for helping to shift the narrative. We need more honest conversations like this.