MW Half of GLP-1 users ditch their injections - and some are turning to other weight-loss methods instead
By Jaimy Lee
New research has found that 50% of patients regain the weight they lost if they stop taking Wegovy and Zepbound
There are two new weight-loss treatments in the U.S., and some patients are now considering procedures and pills if the GLP-1 medications are not a good fit.
Millions of Americans have tried GLP-1s, but some people find that the weight-loss drugs have too many side effects, are expensive or just don't work for them.
Patients also have to deal with changes to their health insurance at the start of a new year, and more employers have withdrawn coverage of the pricey medications. About half of the people who stop taking GLP-1s, like Eli Lilly's $(LLY)$ Zepbound or Novo Nordisk's (NVO) Wegovy, discover that they gain back all the weight they lost within two years.
"The only way that they work is if you keep taking them," said Scott Isaacs, an endocrinologist at the Grady Health System in Atlanta. "And when people stop taking them, they have a lot of weight regain, and the medical problems that went away tend to come back."
There's a group of patients who are now considering more lasting forms of treatment to achieve their weight-loss goals. This includes bariatric surgery, which has been around since the 1950s, or newer minimally invasive procedures like the endoscopic sleeve gastroplasty.
There's no one reason that people choose surgery over medicine, but surgeons say most, if not all, of their patients first tried an injectable GLP-1. Some stop treatment because of nausea or because they can't afford to spend hundreds of dollars every month on a drug they may need to take for the rest of their lives. (Oprah Winfrey recently told the magazine People that taking a GLP-1 "is going to be a lifetime thing" for her after she regained weight while off treatment.)
And now a growing body of medical research shows that the benefits of these medications go away once treatment ends, putting patients in the tough position of deciding what kind of medical intervention will help them maintain a healthy weight now and in the decades to come.
"You're 35 years old. You started a GLP-1. You lose 35 pounds and do really well with it. When do you come off of it? Or ever?" asked Joe Northup, director of metabolic and bariatric surgery at the Vanderbilt Health hospital system in Nashville, Tenn. "Is this a lifelong treatment?"
GLP-1s aren't a 'panacea'
The popularity of these drugs is undisputed. Zepbound and Wegovy, which are expected to have generated a total of $25 billion in sales in 2025, have revolutionized weight loss, upending classic businesses like Weight Watchers $(WW)$ and serving as a basis for new companies. But an armamentarium of more personalized treatment options is emerging, and it includes pills, injections and procedures.
"This is a chronic disease and a deadly disease," Northup added. "We need multiple forms of treatment and the right treatment for the right patient, and, depending on your body-mass index, that will determine where you're going to see the most success."
GLP-1s work best for people with a BMI between 28 and 34, according to Northrup. But if someone has a BMI that's higher than 35, which is considered severe obesity, surgery may be a better option. BMI, he added, should be treated as a vital sign, much like blood pressure.
There are several types of bariatric surgery, including the gastric sleeve and gastric bypass, and it produces the most significant amount of weight loss of any medical intervention.
But it's not a popular choice, and it's often viewed as a last resort. Less than 1% of people who qualify for bariatric surgery get it, with the number of Americans having weight-loss surgery falling sharply in recent years, first driven by the slowdown in elective procedures during the pandemic and then by the arrival of Wegovy in 2021. Some hospitals even shut down their bariatric centers.
Despite the wild success of GLP-1s, they don't work for everyone, and discontinuation rates are high. In a study published last year, researchers assessed the health records of 77,310 adults in Denmark who tried Wegovy for the first time. They found that 52% stopped taking it within a year, citing cost and unpleasant gastrointestinal side effects. (Even though Denmark has a national health system, it doesn't widely reimburse for Wegovy.)
Another recent study found that people who stop taking weight-loss medications, including GLP-1s, gain back the weight they lost more quickly than people who lost weight by making lifestyle changes or made no changes. The research, which was published this month in the professional journal the BMJ, also discovered that the cardiovascular benefits associated with reducing weight were lost within 1.4 years of discontinuing treatment.
There are also people who don't lose weight or the weight they lost while taking GLP-1s is not as notable as they expected.
The GLP-1s have "caused a lot of patients to re-engage with the healthcare system in order to get medical guidance on managing their obesity," said Brian Dunkin, chief medical officer at Boston Scientific. "But the medicines aren't a panacea either - in their current iteration."
Boston Scientific $(BSX)$ markets a suturing device that's used in endoscopic sleeve gastroplasty $(ESG)$, a minimally invasive procedure that stitches the stomach into a smaller size. The medical-device company believes the procedure can bridge the gap between bariatric surgery and medication. It takes a few hours and is performed in an outpatient setting, with patients going home the same day. It's not as widely used as bariatric surgeries.
Northrup and Isaacs both say cost is one of the top reasons patients consider surgery. ESG can cost about $12,000, while bariatric surgery can cost about $17,000, depending on the region, facility and health-insurance coverage, according to Bariendo, a network of weight-loss surgery clinics. On the other hand, patients pay at least $4,200 out of pocket every year for Zepbound and Wegovy.
A maintenance option
For other patients, surgery is a hard "no" or is viewed as unnecessary to meet health goals. This is where the new GLP-1 pills come into play. Earlier this month, Novo launched its Wegovy pill in the U.S., and Lilly told investors this week that it expects the FDA to decide whether to approve its novel weight-loss pill - orforglipron - by this summer.
Patients have to follow strict rules for the Wegovy pill, taking it first in the morning with up to half a cup of water, and then holding off on any food, beverages or medications for at least 30 minutes. Lilly's experimental pill doesn't have any of those restrictions.
Lilly has pitched its pill as a way to maintain weight loss. "Cold turkey is not a great idea for most people," Lilly CEO David Ricks said earlier this week at an investor conference in San Francisco. "Having a maintenance option is key."
A pill is easier than an injection, and it doesn't need to be refrigerated, but there are also questions about the step-heavy administration process and its effectiveness in the real world. In a Phase 3 clinical trial, patients taking the Wegovy pill lost an average of 17% of their body weight after 64 weeks. In Lilly's late-stage trial for orforglipron, patients lost about 11% of their body weight.
But medicines are often more effective in clinical trials than in everyday life, in which costs, health-insurance issues and fewer check-ins with providers can impact how well someone adheres to their medication.
"My gut is it won't be as effective as the injectables," Northrup said.
-Jaimy Lee
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(END) Dow Jones Newswires
January 15, 2026 11:51 ET (16:51 GMT)
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