GLP-1 Discontinuation: What It Means for Weight Loss Brands

Author

Jared Dashevsky, MD
February 16, 2025 • Estimated Reading Time: 10 minutes

GRAND ROUNDS

GLP-1 Discontinuation: What It Means for Weight Loss Brands

The Hims & Hers Super Bowl ad made one thing clear—they’re here to help patients struggling with weight in a system that feels rigged against them. And they’re far from alone. Ro, Found, Noom—pretty much every DTC health company—are offering these meds as the future of weight management.

But are patients actually staying on these medications long-term?

A new JAMA study analyzed GLP-1 discontinuation and reinitiation trends among adults with and without type 2 diabetes. And given how much money is flowing into this space, now feels like the perfect time to dig into the numbers.

In this article, I break down the study, highlight key trends, and explore what this means for the long-term value of weight management companies.

Study Overview: Discontinuation & Reinitiation of GLP-1 Therapy

Purpose: Evaluate the rates and factors associated with discontinuation and reinitiation of GLP-1 receptor agonists (GLP-1 RAs) in adults using them for type 2 diabetes (T2DM) or obesity treatment.

Type of Study: Retrospective observational cohort study

Population: New users of GLP-1 RAs (semaglutide, tirzepatide, liraglutide) with overweight or obesity (BMI ≥27), regardless of type 2 diabetes status.

Outcome Measures:

All of the below are time-to-event outcomes.

  • Primary discontinuation: First instance of being ≥60 days without any GLP-1 RA on hand.

  • Reinitiation: First new prescription fill of a GLP-1 RA after discontinuation.

  • Factors associated with discontinuation and reinitiation: Including demographics, weight change, GI adverse events, and income.

Sample Size: 125,474 adults

  • T2DM (61.0% of total sample, n = 76,524)

    • 98.6% (n = 75,434) using GLP-1s as antidiabetic medications

    • 1.4% (n = 1,090) using GLP-1s as antiobesity medications

  • Without T2DM (39.0% of total sample, n = 48,950)

    • 61.8% (n = 30,236) using GLP-1s off-label as antidiabetic medications

    • 38.2% (n = 18,714) using GLP-1s specifically for weight management

Data Source: Truveta Data – Aggregated electronic health record (EHR) data from 30 U.S. healthcare systems

Results

Discontinuation of GLP-1:

Source: Rodriguez PJ, Zhang V, Gratzl S, et al. (2025)

  • T2DM:

    • 46.5% discontinued by 1 year

    • 64.1% discontinued by 2 years

  • Without T2DM:

    • 64.8% discontinued by 1 year

    • 84.4% discontinued by 2 years

  • Key Factors Linked to Discontinuation:

    • Higher rates among patients without T2DM

    • Age ≥65 years → More likely to discontinue

    • Higher weight loss during treatment → Associated with lower discontinuation rates

    • Moderate to severe GI side effects → Higher likelihood of stopping treatment

    • Higher income (T2DM only) → Lower discontinuation rates

Reinitiation of GLP-1:

Source: Rodriguez PJ, Zhang V, Gratzl S, et al. (2025)

  • T2DM:

    • 47.3% reinitiated GLP-1 therapy within 1 year of discontinuation

    • 57.3% reinitiated within 2 years

  • Without T2DM:

    • 36.3% reinitiated within 1 year

    • 46.4% reinitiated within 2 years

  • Key Factors Linked to Reinitiation:

    • Patients age ≥65 years → Less likely to reinitiate

    • Weight regain after discontinuation → Higher likelihood of restarting therapy

    • Moderate to severe GI side effects during initial treatment → Lower likelihood of reinitiation

Main Takeaway: Most patients who initiated GLP-1 therapy stopped within one year, with higher discontinuation rates among those without T2DM. Reinitiation rates were also lower among non-T2DM patients, reinforcing challenges in long-term adherence and access to GLP-1 therapies.

Limitations: Since this study pulled EHR data from health systems—not digital health companies—it might not reflect adherence trends in the popular DTC obesity space (e.g., Hims & Hers, Ro, Noom). Plus, it didn’t account for insurance coverage, out-of-pocket costs, or GLP-1 shortages, all of which play a huge role in whether patients stay on these meds. Defining discontinuation as 60+ days without a refill doesn’t tell us if patients actually wanted to stop or just couldn’t get their hands on it. Lastly, how does this compare to discontinuation rates with other medications?

#Trending

The weight management space is moving fast, and several key trends are worth watching.

Epidemiological Data

Around 75% of adults in the U.S. have either overweight or obesity. 43% have obesity. The medical costs add up to $173 billion annually.

GLP-1 in Clinical Trials

It feels like every other month, we’re seeing new RCTs demonstrating additional benefits of GLP-1s. Some of the latest:

  • SUMMIT Trial: Tirzepatide reduced the risk of cardiovascular death and worsening heart failure in patients with HFpEF and obesity, compared to placebo.

  • Semaglutide for Alcohol Use Disorder: A phase 2 trial showed that low-dose semaglutide reduced alcohol cravings and improved drinking outcomes in patients with AUD not actively seeking treatment.

In regulatory news, Ozempic just secured FDA approval for CKD in patients with T2DM, thanks to results from the FLOW Trial.

Access Barriers

Despite their proven benefits, GLP-1s remain out of reach for many patients.

  • Insurance restrictions: Most private insurers will cover GLP-1s for diabetes but not obesity.

  • Out-of-pocket costs: If patients want to pay cash, they’re looking at $1,000+ per month.

  • Drug shortages: Ongoing supply issues have fueled the rise of compounded GLP-1s.

Compounded GLP-1s

Nearly every digital health company is tapping into compounding pharmacies to make “semaglutide” more affordable and accessible. Companies like Ro, Hims & Hers, Noom, Found, Lemonaid Health, and Sesame offer compounded versions, often for under $200 per month—a fraction of the out-of-pocket cost for the brand name. Note: these products can’t be marketed as “semaglutide” but as containing the same active ingredients.

Funding Trends: Rock Health

The weight management, obesity, and diabetes spaces were some of the highest-funded clinical categories in 2024, according to Rock Health’s annual digital health funding report.

  • Weight management funding: $700M in 2024

  • Diabetes funding: $600M in 2024

  • Combined total: $1.3 billion pouring into the sector

This level of investment signals strong confidence in the long-term potential of GLP-1s and weight management solutions.

Dashevsky’s Dissection

Reading through all of this, a few alarms should be going off in your head.

Alarm #1: The Problem Is Bigger Than GLP-1s

Overweight and obesity—or metabolic syndrome in general—are among the biggest public health challenges we face. And while GLP-1s are an effective tool, they’re not a standalone solution (unless the price drops dramatically). Long-term success requires structural changes—not just individual prescriptions. Public health interventions, policy shifts, and deeper lifestyle integrations will be just as important as the medications themselves.

Alarm #2: The Overcrowded Digital Health Race

The weight management space is beyond saturated—it’s turned into an arms race. Digital health companies have flocked to GLP-1s, not necessarily because they specialize in obesity care, but because they don’t want to miss out on the cash flow.

Even companies that had no business in weight management (Lemonaid Health) suddenly pivoted to prescribing GLP-1s. Why? Follow the money.

I summed this up in a prior newsletter:

Differentiating as a weight-management digital health company will get harder. We’re already seeing companies following each other closely: first, classic weight-management companies focused on nutrition and counseling. Then, as one added GLP-1s, everyone else did, too. Soon after, they all jumped on the compounded GLP-1 bandwagon to address affordability.

Alarm #3: The Compounded GLP-1 Dilemma

Right now, many of these companies’ business models depend on compounded GLP-1s—which aren’t federally regulated. The FDA is still debating what to do about this even though semaglutide was removed from the drug shortage list.

And here’s the risk: if the FDA decides to crack down on compounded GLP-1s, the entire foundation of these companies crumbles.

The Biggest Question: Where’s the Long-Term Value?

Let’s loop back to the JAMA study. Nearly 85% of patients without T2DM stopped taking GLP-1s within two years. That’s a massive churn cycle—patients onboard, take the medication for a while, and then leave.

So what happens when your entire business model is built around prescribing a medication that most patients won’t stick with long-term? Where’s the long term value?

As I’ve said over and over, the companies that win will be the ones that move beyond short-term prescriptions. They’ll build comprehensive, sustainable models that help patients achieve long-term metabolic health—whether or not they stay on GLP-1s (see Virta Health for a great example).

In summary, the GLP-1 boom has fueled a crowded, fast-moving weight management industry, but the latest JAMA study highlights a major challenge—most patients discontinue treatment within two years, especially those without T2DM. While GLP-1s offer undeniable benefits, long-term adherence remains a problem, access barriers persist, and the regulatory landscape around compounded versions is uncertain. For digital health companies, the real test will be moving beyond short-term prescriptions and creating sustainable, long-term metabolic health solutions that deliver value beyond just selling GLP-1s.

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