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As the graphic implies, many people do, indeed, stop taking GLP-1 receptor agonist (GLP-1 RA) medications. What researchers were tasked with puzzling out was why.
For many people, these medications offer something they’ve never experienced before: meaningful fat loss, fewer food cravings, and a sense of control over eating. But they also bring up real-world questions – about cost, side effects, long-term use, and how they compare to more established treatments like bariatric surgery.
A recent large study involving more than 125,000 adults took a close look at how people actually use GLP-1 medications in the real world – how long they stay on them, who tends to stop, who later restarts, and what factors make a difference.1 The results give us valuable insight not only into medication adherence, but also into how these drugs actually fit into the bigger socioeconomic picture of people’s lives, especially within the context of our healthcare system.
The Study’s Framework
The study analyzed an enormous amount of health data from a lot of people – 125,474 to be exact. That number included adults who were over 18 years of age with overweight or obesity who started a GLP-1 medication between 2015 and 2023. The group included people with and without type 2 diabetes (T2D), which turned out to be an interesting variable in how long people stayed on GLP-1 RA treatment.
Researchers used real-world, privacy-protected healthcare data to examine the following:
- If and when people stopped taking their GLP-1 RA
- If and when people later restarted the medication
- The stretches of time between starting, stopping, and reinitiating
- What factors were associated with stopping or restarting
- How body weight changed over the course of treatment and after discontinuation
The study also captured demographic information (age, income, sex), medical conditions, and adverse events associated with GLP-1 RA use. Researchers were not just looking at BMI and weight loss. They evaluated health data to investigate human behavior in the context of a chronic disease, which makes the findings more reflective of what actually happens outside of a clinical trial.
The Variables
The researchers assessed multiple sets of variables that influenced whether a person stayed on the medication or not.
Age
Researchers noticed a pattern among older adults (65+) of stopping the medication, and they were less likely to restart it during the two-year research follow-up period. The assumption was that age may affect tolerability, but the individual’s insurance situation (e.g., Medicare exclusions) could also be a factor.
Older age independently increased the likelihood of stopping the medication in both groups, but the effect was stronger among people without T2D. Why does this matter? Older adults were more likely to report moderate or severe gastrointestinal side effects, but the same older adult who might stop due to tolerability issues may also be facing substantial out-of-pocket costs if they do not have diabetes – the combination likely contributes to the age-related drop-off.
Weight Loss During Treatment
This was one of the most important predictors of whether a person stayed on the medication. For every 1% of body weight lost, the risk of discontinuation dropped by about 3%. For example, if someone weighed 250 pounds, they were 3% more likely to continue therapy for every 2.5 pounds they lost.
People who lost more weight were simply more motivated to continue, and the trend was seen in both T2D and non-T2D groups. But the effect was more substantial in people without diabetes, who tended to discontinue more overall. In other words, weight loss was a motivational buffer, no matter what, and it mattered most to people taking GLP-1 drugs for weight loss alone.
Weight Regain After Stopping
As you can imagine, this was a strong predictor of medication reinitiation. On the flip side of the previous statistic, for every 1% of weight regained, the chance of restarting increased by 2 to 3% – a 250-pound individual, for instance, would be increasingly likely to restart GLP-1 therapy for every 2.5 pounds of regain.
People tended to come back when the weight came back. But some didn’t. Some aspects of this study have pointed to older age, tolerability, affordability, and insurance coverage as reasons why; you have to think, if they could, they would, so why are they not?
Income and Cost
Although the study did not measure cost or cost-benefit relationships, it indirectly touched on affordability via income quartiles, associating health data that was collected with income brackets. Affordability likely influences discontinuation due to high out-of-pocket costs; the study reflects lower discontinuation among high-income patients and lower retention rates among older adults, a population likely to have Medicare coverage gaps. Other clues include:
- People without diabetes stopped far more often than those with diabetes.
- Lower-income individuals were more likely to quit, even after adjusting for other factors.
The correlation is clear. When people have to pay hundreds or thousands per month, they discontinue far more quickly. When insurance covers it, they stay on longer.
Side Effects
Side effects, unsurprisingly, are one of the most consistent real-world barriers to long-term medication use. Moderate to severe gastrointestinal issues (nausea, vomiting, gastroparesis symptoms, gallbladder complications) are common side effects of GLP-1 RA medications, and each individual tolerates them differently.
You’ve probably guessed it already: people who experienced these issues were more likely to stop. And, on that note, they are less likely to restart the medication later. But researchers noticed that the side effects influenced T2D and non-T2D users differently. It seemed that people without diabetes were disproportionately affected: they were more likely to stop because they lacked a strong medical reason to push through discomfort. The calculation was different for those with T2D: GLP-1 medications help control blood sugar, reduce A1c, and provide cardiovascular benefits, so the medication’s dual purpose (weight reduction plus health benefits) helped offset the deterrent effect of adverse symptoms.
Presence of T2D
We mentioned earlier that noting the presence or absence of T2D made patient decision-making more interesting to investigate. Obviously, motivating factors change, at least slightly, when a diagnosed comorbidity is present; and it was a major dividing line in this research. People with diabetes were more likely to stay on the medication, more likely to restart it if they stopped, and, drum roll, more likely to have clearer medical justification for insurance coverage to obtain the medication, easing the financial burden.
The Solid Takeaways of the Study
Here’s the heart of the study’s findings.1
- Within one year of beginning GLP-1 RA therapy, 64.8% of people without diabetes stopped, while 46.5% of people with diabetes stopped.
- Within two years of starting GLP-1 RA therapy, 85% without diabetes stopped, and 65% with diabetes stopped. Most people using GLP-1s for weight loss alone stopped within a year – and nearly all have stopped by year two.
- Within one year of stopping GLP-1 medication, 47.3% with diabetes started taking it again, while only 36.3% without diabetes restarted it.
- Within two years of discontinuing GLP-1 medication, 57.3% with diabetes restarted, and 46.4% without diabetes restarted.
What does this mean? People regain weight after stopping the drug, many seem to want to restart it, and there are barriers of some sort preventing continuation.
Back to the Big Picture
Zooming out from the study, we can’t help but ask: If GLP-1 medications are this hard to stay on, do they offer the best long-term value? If not, then what does?
Bariatric surgery isn’t an either-or decision, but it is a treatment option with fundamentally different economics, durability, and outcomes.
GLP-1 medications work extremely well – while you’re taking them (and racking up a bill). But once you stop, appetite returns, weight regain is common, and metabolic improvements fade. Bariatric surgery, on the other hand, works biologically, hormonally, and mechanically. It alters hunger signals, improves insulin sensitivity, and resets metabolic pathways in ways medications cannot fully replicate.
Unlike GLP-1 medications, which often cost hundreds of dollars each month (with or without insurance), bariatric surgery is covered by most major insurance plans, and out-of-pocket costs often end up being far lower over time. From a cost-over-time vantage point, surgery is uniquely accessible, especially compared with long-term medications.
Let’s assume a GLP-1 RA costs $350 each month (and that prices remain stable, with or without insurance). Over the course of five years, that adds up to $21,000. Studies have shown that the results gained from GLP-1 RA use are lost when the medication is discontinued. With bariatric surgery, your results are in your control, whether it’s a year out or 10 years out.
Surgery is usually a one-time cost, and after insurance, many patients pay only deductibles or copays. Even self-pay packages can be lower than a few years of GLP-1 drugs. From both a financial and weight loss sustainability perspective, surgery provides more lasting health benefits at a lower lifetime cost.
Let’s hark back to the comment about surgery not being an either-or solution in relation to GLP-1 RA medications. Some patients can benefit from actually layering treatments – surgery plus medication can improve long-term success. Front-loading surgery with GLP-1 therapy can help patients lose weight prior to surgery, making the procedure safer. It can also help get pre-existing health conditions in check, again, making procedures safer. After surgery, it’s not unusual to hit a weight loss plateau after a few years, so GLP-1 RAs are great at getting people over that hump. It’s not an all-or-nothing with either option, but it does take some crafting with a trusted bariatric team to figure out what’s right for you, your health, and your pocketbook.
At Gastric Sleeve Center, we help you understand every option on the table so you can choose the path that gives you the greatest return on your investment: health-wise, financially, and in terms of your time and energy.
If you want to discuss which approach is right for you (or how to combine multiple strategies), reach out. We’re here to help you choose the method that gives you the most effective, most sustainable, and most cost-efficient results.
1Rodriguez, P. J., Zhang, V., Gratzl, S., Do, D., Goodwin Cartwright, B., Baker, C., Gluckman, T. J., Stucky, N., & Emanuel, E. J. (2025). Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among US Adults With Overweight or Obesity. JAMA network open, 8(1), e2457349. https://doi.org/10.1001/.
