Embarking on a weight-loss journey involves evaluating a range of potential strategies and formulating a comprehensive plan to achieve your health objectives. For people with obesity, this plan might include the use of prescription medications. Ozempic is technically approved to treat Type 2 diabetes, but Wegovy contains the same active ingredient, semaglutide, and is approved for weight loss. Semaglutide has shown to effectively promote weight loss and reduce the risk of adverse cardiovascular events in people who have obesity or are overweight. A few other drugs in or adjacent to the GLP-1 family are either approved for weight loss now (liraglutide) or expected to be by the end of 2023 (tirzepatide).
These drugs are fairly new and have recently surged in popularity. Unsurprisingly, patients have a lot of questions. One of the most common inquiries is how long to take them. A substantial portion of patients who are prescribed GLP-1s, research suggests, stop taking their medication at some point. In a 2021 study on GLP-1 use in Type 2 diabetes patients, 45% of participants discontinued therapy within one year and 64% stopped within two years. And in a recent analysis of US pharmacy claims, 68% of patients taking GLP-1s for weight loss discontinued therapy by the one-year mark.
How should patients who are taking or considering GLP-1s interpret this information? Are these drugs only effective or tolerable on a short-term basis? Nope. According to experts, they’re intended as long-term medications, and should be used that way in most cases. Here’s what to know about proper duration of usage for GLP-1s.
How long are GLP-1s typically used for?
Obesity is classified as a medical condition, and weight management is often considered a long-term healthcare challenge. Healthcare professionals approach treatment as they would for most other chronic conditions, with the intent to continue therapy even if a patient achieves their health goal (weight loss, in this case). Long-term use is advised for most weight-loss medications, including GLP-1s.
“These medications are initiated with the intent they will be used long-term unless you become pregnant or develop a contraindication,” says Dr. Holly Lofton, Clinical Associate Professor of Surgery and Medicine at the NYU Grossman School of Medicine. (Contraindications for GLP-1 drugs include a personal or family history of medullary thyroid carcinoma and severe renal impairment, but the full list of contraindications is longer than that. Some medical issues become contraindications if they’re severe enough.)
Unless a medical problem arises, Dr. Lofton says, “Plan to stay on [a GLP-1] for at least six to eight months, because that’s when we see the most weight loss. After that you can still lose weight for up to a year, but it tends to get slower.”
If you encounter a non-medical barrier to continuing therapy — such as a change in insurance coverage or a drug shortage, your healthcare provider may be able to help you navigate the situation.
Are there any risks of long-term use?
The U.S. Food and Drug Administration (FDA) granted approval for the first GLP-1 receptor agonist, exenatide, in 2005. Based on the current available data, there’s no evidence to suggest that these medications pose safety concerns. “Studies from older GLP-1s help us predict what may happen with newer ones and they have been safe so far,” Dr. Lofton says. “The FDA is constantly reevaluating safety of medications that are already on the market to ensure they are safe for continued use.”
When starting a GLP-1, your healthcare provider should inform you about all of the risks, benefits and side effects associated with the medication. Common side effects include GI complaints, and less common but more serious ones include pancreatitis. Other less common side effects may include low blood sugar or fatigue. If you develop side effects, you should not stop the medication on your own. Discuss your concerns with your healthcare provider, who will determine if a dose adjustment is appropriate.
Are there problems with stopping GLP-1s?
Regaining weight and an appetite are the most common complications, according to Dr. Lofton. “People don’t realize how much the medication is suppressing appetite, so if you go from 2.4 milligrams to 0 milligrams, 80% of your hunger comes back. You naturally produce more hunger hormone when you lose weight, so you have more hunger than before you started the medication and you feel that.”
Sometimes, people make significant lifestyle changes while taking a GLP-1 and then decide to try going off their medication, says Dr. Tina Wu, Sunrise’s Medical Lead. If they’re unable to maintain a healthy weight without medication, they’ll resume using it.
Are certain weight-loss drugs better for long vs. short-term use?
GLP-1 receptor agonists, and most other FDA-approved weight-loss medications, are generally intended for long-term treatment. The exception is Phentermine, an anorectic drug that’s different from GLP-1 receptor agonists. It’s approved for short-term use up to 12 weeks.
GLP-1s also work best when combined with lifestyle changes, as optimal results come from a multifaceted treatment plan that includes exercise and diet. The primary objective of using weight-loss medication should be to improve your quality of life. If you take a GLP-1 and find the side effects difficult to tolerate, your doctor can help you decide if continued use is advisable. “These are not medications that you just want to try your best on your own,” says Dr. Lofton. “There are risks and if the risk is greater than benefit, the medication may not be for you.”