Most of what gets written about stopping GLP-1 drug therapy is about the weight. The trial data suggests the weight is the least of it.
Semaglutide won approval for weight loss in 2021 on the strength of four trials. The largest put 1,961 adults with obesity and no diabetes on either the drug or a placebo for 68 weeks. Researchers then followed 327 of them for another year with no drug and no diet program. That group had lost an average of 17.3 percent of their body weight, and regained 11.6 percentage points of it, about two-thirds. That part surprised no one.
This part did. The improvements in blood pressure, cholesterol and blood sugar that came with the weight loss drifted back toward where they started, according to findings published in Diabetes, Obesity and Metabolism. The researchers concluded that obesity behaves like a chronic condition, and that keeping the health gains means staying on it.
Tirzepatide follows the same curve. In a separate trial, people moved to a placebo after 36 weeks regained substantial weight while those who stayed on kept losing.
The reason is less about old habits than about biology: appetite returns when the drug stops, into a smaller body that now burns fewer calories than before.
What the trials cannot show is that stopping is usually not a decision. Analyses of insurance claims and medical records find that between half and two-thirds of adults without diabetes who start one of these drugs are off it within a year. Even among the well insured it runs 30 to 50 percent, pointing to side effects and treatment fatigue as much as cost.
Anyone counting on the Medicare GLP-1 Bridge should mark a date. It covers eligible Part D enrollees at a 50 dollar monthly copay through December 31, 2027, and the program meant to follow it has been delayed indefinitely.
Rick Good spent ten years in the newspaper business, including with The News & Observer (Raleigh, NC) and The Greenville News (Greenville, SC). He co-wrote, with Melinda Coleman, Rutledge to Riley: Governors of South Carolina, 1776–Present (Published by The Greenville News), and is the author of Mind Games Trivia #1 (Amazon). He has recently spent 15 years creating original trivia content through Sounds Good Mobile Entertainment and continues that with his new company, SGME Software. He edits The Smart Reader’s money, real estate, and business coverage.
