Few medications have had such a meteoric rise as semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound), the GLP-1-based treatments for obesity that have captivated society and quickly become household names. These drugs represent a significant advancement in obesity medicine — for a good reason. Until semaglutide’s 2021 FDA approval for chronic weight management, the most effective medication was arguably phentermine (Adipex), first approved in 1959. After more than six decades with questionable progress, it’s no surprise that patients and doctors saw the GLP-1s as a long-awaited breakthrough.
Until recently, I was one of those doctors, too.
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.
However, years later, my perspective has shifted based on real-world experience — and I’m now deeply concerned about how GLP-1 medications are being used.
Don’t get me wrong — from an efficacy standpoint, these drugs “work.” Those who can afford, tolerate, and sustain GLP-1 use absolutely lose weight. I’ve seen first-hand how reducing hunger, quieting food noise, and increasing satiety can transform a person’s ability to lose weight. And the benefits extend beyond weight loss: studies have confirmed reductions in cardiovascular events and improvement in conditions like congestive heart failure, kidney disease, obstructive sleep apnea, and osteoarthritis.
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.
The science behind these drugs explains why: they do not cause permanent changes. These medications are exogenous, synthetic agonists of the glucagon-like-peptide-1 receptor. While in use, they saturate those receptors — particularly in the brain and stomach — mimicking the effects of endogenous GLP-1 at sky-high, sustained levels. Once the medication is stopped, that effect evaporates within 2-4 weeks. The receptors are no longer bathed in hunger-calming peptides. Hunger returns — with a vengeance. And the weight quickly follows.
The result? Many patients cycle on and off treatment, and in the end, the only thing they’ve lost is money — upwards of $12,000 per year (if their insurance doesn’t cover it, and most plans don’t).
This vicious cycle may have profound long-term implications for the physical, mental, and economic health of our nation — and the millions struggling with obesity. What happens to society when we expose millions of people to short-term GLP-1 use? Are we ultimately violating medicine’s most basic rule: do no harm?
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.
Psychologically, weight regain reinforces myths and stigmas surrounding obesity. Patients feel blame and shame for yet another “failed” attempt, often leading to depression and declining self-confidence.
Finally, the financial toll of millions cycling on and off these medications is staggering. Individuals make significant sacrifices to spend thousands of dollars annually on these medications — only to regain the weight. On a macro level, the economy cannot sustain the ballooning costs. States across the country are already suspending insurance coverage due to unsustainable expenses.
I fear we will look back on this era — after patients have spent tens of thousands of dollars, endured uncomfortable and sometimes serious side effects, and experienced recurring weight gain and resurgent food noise — and ask: Even if these drugs “work,” did they really work? Or did they ultimately harm our patients, our society, and our economy? It’s a sobering thought, but one I fear is all too real.
Christopher McGowan, MD, is an obesity medicine specialist, gastroenterologist, and founder of True You Weight Loss, which offers various non-surgical procedures for weight loss.
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