How Long Are People on Weight Loss Drugs? Understanding Duration, Persistence, and Discontinuation Rates

Most patients stop GLP-1 weight loss medications much sooner than advised, raising concerns about long-term results.

The explosive popularity of GLP-1 receptor agonist medications for weight loss has revolutionized obesity treatment, but a critical question remains largely unanswered: how long do people actually stay on these medications? Recent research reveals a sobering reality—most people discontinue weight loss drugs far sooner than recommended, with significant implications for long-term weight management and health outcomes.

The Reality of Treatment Duration

Despite being designed for long-term use, the majority of patients discontinue GLP-1 medications within the first year of treatment. Recent data from 2024-2025 shows improving but still concerning^[1] persistence rates.^[1]​

According to a comprehensive analysis by Prime Therapeutics^[2] examining more than 23,000 patients, approximately 63% of those who started Wegovy or Zepbound in early 2024 remained on treatment after one year. While this represents a significant improvement from the 40% persistence rate observed in 2023 and 34% three years ago, it still means more than one-third of patients discontinue within the first year.^[1]​

The persistence rates decline dramatically over longer periods. At two years, only about 24% of Wegovy users and 22% of Ozempic users continue their medication. For patients who initiated treatment in 2021, merely 15% remained on any GLP-1 medication after two years^[3]. Even more striking, only 14% of patients continued using Wegovy after three years.^[4]​

Discontinuation Timeline: When Do Patients Stop?

The pattern of discontinuation follows a predictable trajectory, with the highest dropout rates occurring early in treatment.^[5]​

Early Discontinuation (First 3 Months)

Nearly one-third of patients discontinue GLP-1 medications^[6] within the first month of treatment. By three months, discontinuation rates range from 18% to over 30%, depending on the medication and patient population.^[7]​

A comprehensive study published in JAMA Network Open found that among 125,474 patients initiating GLP-1 receptor agonists, 53.6% discontinued by one year and 72.2% discontinued by two years. Patients without type 2 diabetes^[7] showed significantly higher discontinuation rates (64.8% at one year and 84.4% at two years) compared to those with diabetes (46.5% at one year and 64.1% at two years).^[8]​

Six-Month Mark

At six months, approximately 47% of patients remain on treatment. This represents a critical period when many patients face challenges with side effects, cost, or insurance coverage changes.^[3]​

One-Year Persistence

One-year persistence rates vary significantly by medication and patient population. Recent studies show^[9]:^[9]​

• Dulaglutide: 51% persistence at 12 months
• Liraglutide (Saxenda): 17-36% persistence
• Semaglutide (Wegovy/Ozempic): 22-40% persistence
• Exenatide twice daily: 21% persistence
• Exenatide weekly: 35% persistence

For patients using GLP-1s specifically for obesity without diabetes, persistence rates are substantially lower than for diabetes treatment^[10], with only 32.3% remaining on therapy at one year in some cohorts.^[10]​

Long-Term Use (Beyond Two Years)

Long-term adherence remains particularly challenging. Analysis shows that persistence continues to decline beyond the first year, with only 14-15%^[11] of patients maintaining treatment at two years. For three-year persistence, the rate drops to just 14% for Wegovy.^[11]​

Medication-Specific Persistence Patterns

Different GLP-1 medications demonstrate varying persistence rates^[12], influenced by dosing frequency, efficacy, and tolerability profiles.^[12]​

Weekly Injections vs. Daily Medications

Once-weekly formulations consistently show better persistence than daily injections^[13]. Semaglutide products (Wegovy and Ozempic) administered weekly demonstrated approximately 24% and 22% two-year persistence, respectively. In contrast, daily liraglutide products (Victoza and Saxenda) showed only 7% persistence at two years.^[14]​

Tirzepatide (Mounjaro/Zepbound)

Tirzepatide has demonstrated higher persistence rates^[15] compared to earlier GLP-1 medications. Studies show 55-73% persistence at six months when using various gap definitions. The medication’s superior weight loss efficacy—with patients achieving 15.3% weight loss at 12 months compared to 8.3% with semaglutide—may contribute to better adherence.^[15]​

Real-world evidence indicates that tirzepatide users show 60.6% persistence^[16] with a 45-day gap allowance, though this varies by indication and patient characteristics.^[16]​

Semaglutide (Wegovy/Ozempic)

Semaglutide persistence at 12 months ranges from 29% to approximately 40% in various real-world studies. A Danish population-based study found that 52% of patients discontinued semaglutide by one year, with discontinuation rates rising from 18% at three months.^[17]​

When comparing on-label Wegovy to off-label Ozempic use for weight loss, both show similar persistence patterns, with Wegovy demonstrating slightly better two-year retention (24.1%) compared to Ozempic (22.2%).^[4]​

Why Do Patients Discontinue Weight Loss Medications?

Understanding the reasons behind discontinuation is crucial for improving long-term treatment success. Research identifies multiple contributing factors^[18], with cost emerging as the predominant barrier.^[19]​

Cost and Insurance Coverage

The high cost of GLP-1 medications represents the single largest barrier to continued use. Without insurance coverage^[20], these medications cost between $900 and $1,350+ per month.^[21]​

Nearly 13% of patients cite affordability as a primary reason for stopping treatment^[22]. A consumer survey found that 35% of patients discontinued GLP-1s specifically due to out-of-pocket costs, while only 18% stopped because they achieved their weight loss goals.^[18]​

Insurance coverage^[23] remains highly variable. Only 18% of large employer health plans covered GLP-1 agonists for weight loss as of 2024, though this percentage rises to 28% for firms with 5,000 or more employees. Medicare historically has not covered weight loss medications, though recent policy developments in November 2025 announced expanded coverage for qualifying beneficiaries starting in mid-2026.^[23]​

Side Effects and Tolerability

Gastrointestinal side effects consistently rank among the top reasons^[19] for discontinuation across all studies. Common adverse effects include nausea, vomiting, diarrhea, constipation, and abdominal discomfort.^[24]​

However, the actual discontinuation rate due to side effects may be lower than commonly perceived^[24]. Clinical trials show approximately 5% discontinuation due to adverse events over 30 weeks. Real-world data suggests that while side effects contribute to discontinuation, they represent only one of multiple factors, with cost and access issues playing larger roles.^[24]​

Interestingly, physicians often underestimate the impact of side effects on patients. One study found that 56% of patients reported preferring oral medications over injections as a concern, while only 33% of physicians recognized this as an issue^[25].^[25]​

Medication Shortages and Supply Issues

Supply chain disruptions significantly impacted GLP-1 persistence between 2022 and 2024^[26]. During peak shortage periods in November 2023, medication availability accounted for 14.6% of discontinuations for patients using GLP-1s for obesity.^[26]​

The FDA drug shortage list included semaglutide from 2022 through February 2025 and tirzepatide through December 2024. These shortages forced many patients to switch medications, use compounded alternatives, or discontinue treatment entirely.^[27]​

As of early 2025, the FDA has resolved shortages for most GLP-1 products^[28], though monitoring continues. The resolution of these shortages represents a significant development that may improve future persistence rates.^[28]​

Achievement of Weight Loss Goals

Some patients intentionally discontinue medications after reaching their target weight, viewing GLP-1s as a temporary tool rather than a chronic disease therapy. However, data suggests this represents a minority of discontinuations. Only 18% of patients who stopped GLP-1s reported doing so because they achieved their weight loss goals.^[22]​

This perception of GLP-1s as short-term treatments conflicts with clinical evidence showing that sustained treatment is typically necessary^[29] to maintain weight loss. Studies consistently demonstrate that most patients who discontinue medications experience significant weight regain.^[30]​

Healthcare Access and Provider Factors

Patients who see healthcare providers with specialized expertise in weight management and obesity demonstrate significantly better persistence. Regular follow-up visits after prescription also correlate with improved adherence.^[19]​

Younger patients (ages 18-34) show higher discontinuation rates^[31] compared to older adults. People living in underserved health regions or those with limited access to healthcare services are more likely to stop treatment early.

^[32]​

Demographic Patterns in Medication Persistence

Research reveals important demographic differences^[33] in how long patients remain on GLP-1 medications.^[33]​

Age-Related Differences

Younger adults demonstrate higher discontinuation rates across multiple studies. Adults aged 18-34 are significantly more likely to stop treatment compared to those aged 35 and older.^[34]​

Conversely, middle-aged adults (ages 50-64) show the highest usage rates and better persistence. Among adults with diagnosed diabetes^[35], 33.3% of those aged 50-64 used GLP-1 injectables, compared to 20.8% of those 65 and older.^[35]​

Gender Patterns

Women represent the majority of GLP-1 users for weight loss, comprising 70-81% of patients in most studies. However, gender shows minimal impact^[36] on overall discontinuation rates in most analyses.^[36]​

One study^[37] found that women had a slightly higher risk of discontinuation (16% increased relative risk) compared to men over the study period, potentially related to higher rates of gastrointestinal side effects in women.^[37]​

Socioeconomic Factors

Higher income levels correlate with lower discontinuation rates^[7], particularly among patients with type 2 diabetes. Education level also matters—lower educational attainment associates with reduced adherence and persistence.^[38]​

Access to regular healthcare significantly improves medication adherence, with patients having consistent healthcare access showing 2.8 times higher odds of adherence.^[31]​

The Recent Improvement Trend

Despite concerning overall statistics, recent data reveals encouraging improvements in persistence rates from 2023 to 2024^[2].^[2]​

The Prime Therapeutics analysis documented a dramatic increase in one-year persistence from 40% for patients starting in 2023 to 63% for those initiating treatment in the first quarter of 2024. This nearly doubling of the persistence rate represents “a notable transformation,” according to researchers.^[2]​

Several factors contribute to this improvement:^[1]​

• Resolution of supply shortages: Better medication availability reduces forced discontinuations
• Expanded insurance coverage: More comprehensive coverage reduces cost barriers
• Improved side effect management: Healthcare providers have developed better protocols for managing gastrointestinal symptoms
• Enhanced patient education: Better understanding of GLP-1s as long-term treatments
• Newer, more effective medications: Introduction of tirzepatide and other next-generation therapies with improved efficacy and tolerability

Reinitiation After Discontinuation

Many patients who stop GLP-1 medications eventually restart treatment, though reinitiation rates vary^[7] significantly by patient population.^[39]​

Among 41,792 patients who discontinued GLP-1 receptor agonists and had weight data available, accounting for censoring showed that 47.3% of patients with type 2 diabetes and 36.3% of patients without diabetes reinitiated treatment within one year of discontinuation. At two years, these rates increased to 57.3% and 46.4%, respectively.^[7]​

Weight regain after discontinuation strongly predicts reinitiation. For every 1% of weight regained from discontinuation, patients showed a 2.3% increased likelihood of restarting medications. This finding highlights that weight rebound serves as a powerful motivator for returning to treatment.^[39]​

Patients with greater initial weight loss during treatment were less likely to discontinue in the first place, suggesting that treatment efficacy plays a crucial role in persistence.^[38]​

Weight Regain After Stopping Medications

One of the most concerning aspects of discontinuing GLP-1 medications is the nearly universal pattern of weight regain.^[29]​

Research consistently shows that patients who stop taking GLP-1s begin regaining weight within approximately two months. In the landmark STEP 1 follow-up study, participants who discontinued semaglutide after losing more than 15% of their body weight over 16 months regained approximately two-thirds of their lost weight within one year.^[40]​

A comprehensive review of 11 studies^[29] examining weight outcomes after GLP-1 discontinuation found that weight regain continued for several months before leveling off. Importantly, this weight regain occurred even among participants who continued healthy eating and exercise habits.^[30]​

According to obesity expert Dr. Louis J. Aronne, “What happens after stopping an obesity medication is exactly what happens after stopping a diabetes, cholesterol-lowering, or a blood pressure medication. The effect of the medicine goes away, and people tend to go back to where they started”.^[30]​

Biological Mechanisms of Weight Regain

The body defends a metabolic “set point” through multiple compensatory mechanisms:^[41]​

• Increased appetite hormones (particularly ghrelin)
• Metabolic slowdown to conserve energy
• Enhanced sensitivity to hunger cues
• Reduction in brown fat activity
• Central nervous system adaptations that promote weight regain

These biological responses explain why maintaining weight loss typically requires continued treatment rather than representing a failure of willpower or lifestyle habits.^[29]​

Long-Term Weight Trajectories

Two years after stopping GLP-1 treatment, Epic Research data^[42] shows that while most patients regain some weight, many sustain at least partial benefits. For semaglutide users, 25.9% doubled their weight loss after discontinuation in some cohorts, though this represents a minority of patients.^[43]​

The pattern of weight regained typically consists primarily of fat rather than muscle, making subsequent weight loss attempts more challenging.^[44]​

Clinical Guidelines on Treatment Duration

Professional medical organizations recommend GLP-1 medications as long-term treatments for obesity management, not short-term interventions.^[45]​

FDA-Approved Duration

Six anti-obesity medications are FDA-approved for long-term use, including liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound). Unlike older weight loss medications approved for only 12 weeks, these GLP-1 agonists carry no maximum duration^[46] of therapy restrictions.^[46]​

Evaluation Timeframes

The American Diabetes Association (ADA) and other professional societies recommend evaluating patient response to therapy after 3 months of use^[47] at the maintenance dose. If patients achieve greater than 5% weight loss by 3 months, continued therapy is likely beneficial.^[47]​

For medications with longer titration schedules, such as Wegovy (which takes 16 weeks to reach maintenance dose), the 3-month evaluation period begins after achieving the target dose.^[47]​

Long-Term Treatment Philosophy

Clinical guidelines emphasize that obesity represents a chronic disease requiring ongoing management. The Endocrine Society, American Association of Clinical Endocrinologists, and American College of Endocrinology all recommend selecting weight loss medications based on individual patient characteristics and continuing treatment indefinitely if effective and well-tolerated.^[48]​

There is no specified maximum duration for GLP-1 therapy. Clinical trials have demonstrated safety and efficacy for up to 104 weeks (approximately 2 years), with emerging data supporting treatment duration beyond 3 years for tirzepatide^[49].^[49]​

Strategies to Improve Persistence

Given the critical importance of long-term adherence for sustained weight loss, healthcare systems and providers are developing strategies to improve persistence.^[50]​

Provider-Level Interventions

• Prescribing by specialists in endocrinology or obesity medicine significantly improves persistence^[19]​
• Frequent follow-up visits after initiating GLP-1 therapy enhance adherence^[19]​
• Comprehensive side effect management protocols help patients tolerate treatment^[24]​
• Patient education about GLP-1s as chronic disease therapies rather than quick fixes^[48]​

Health System Strategies

• Case management and disease management programs focused on behavioral changes^[3]​
• Integration of lifestyle counseling, nutritional guidance, and exercise support alongside medication^[51]​
• Addressing insurance coverage barriers and prior authorization requirements^[23]​

Patient-Centered Approaches

• Dietary self-monitoring^[52] improves outcomes and predicts better long-term persistence^[52]​
• Regular weight tracking and biomarker monitoring^[47]​
• Support groups and behavioral health integration^[44]​
• Tapering strategies rather than abrupt discontinuation when stopping is necessary^[44]​

The Future of GLP-1 Treatment Duration

Several developments^[53] may influence how long patients remain on weight loss medications in coming years.^[53]​

Policy Changes

Recent announcements from the Trump administration in November 2025 detail agreements with pharmaceutical manufacturers Eli Lilly and Novo Nordisk to reduce GLP-1 prices to $245 per monthly dose for Medicare. This expanded Medicare coverage through a pilot program begins mid-2026 and may significantly improve persistence for the approximately 10% of Medicare enrollees newly eligible for coverage.^[54]​

However, earlier in 2025, the administration declined to finalize broader Medicare and Medicaid coverage^[55] for anti-obesity medications, stating the proposal was “not appropriate at this time”. This inconsistent policy environment creates uncertainty about future access.^[55]​

Next-Generation Medications

The pharmaceutical pipeline^[56] includes multiple new agents with potentially improved persistence profiles:^[56]​

• Oral GLP-1 formulations may improve adherence by eliminating injection requirements^[57]​
• Combination therapies targeting multiple pathways (GLP-1/GIP, GLP-1/amylin) may enhance tolerability^[24]​
• Extended-duration formulations requiring less frequent dosing
• Lower-cost biosimilars as patents expire

Compounded Alternatives

The resolution of GLP-1 shortages in 2024-2025 has restricted access to compounded semaglutide and tirzepatide. FDA regulations now prohibit regular compounding of products no longer in shortage, except in specific cases of medical necessity.^[58]​

While compounded products provided temporary access during shortages^[59], their unregulated nature raised safety concerns. The transition back to FDA-approved formulations may improve quality control but could create access challenges for patients who relied on lower-cost compounded alternatives.^[59]​

Practical Implications for Patients

For individuals considering or currently using GLP-1 medications, understanding treatment duration expectations is essential for setting realistic goals and planning for long-term success.

Key Takeaways

Most patients will need to remain on GLP-1 medications indefinitely to maintain weight loss. Planning for long-term treatment from the outset helps set appropriate expectations and reduces the likelihood of premature discontinuation.^[46]​

Cost represents a major barrier that requires proactive planning. Patients should thoroughly investigate insurance coverage, manufacturer assistance programs, and alternative options before starting treatment. Direct-to-consumer programs from manufacturers offer reduced pricing ($349-499/month) compared to standard retail prices.^[60]​

Side effects are common but often manageable with proper strategies. Working closely with healthcare providers experienced in GLP-1 management significantly improves tolerability and persistence.^[44]​

Questions to Discuss With Your Healthcare Provider

• What is the expected treatment timeline for my specific situation?
• How will we evaluate whether the medication is working effectively?
• What strategies can help manage common side effects?
• What insurance coverage or financial assistance options are available?
• What happens if I need to stop the medication temporarily or permanently?
• What lifestyle changes can support medication effectiveness and prepare for potential discontinuation?

Conclusion

The current evidence reveals a significant gap between the recommended long-term use of GLP-1 medications and real-world persistence patterns. While these medications demonstrate remarkable efficacy for weight loss and metabolic improvement, most patients discontinue treatment within the first year, with fewer than 15-25% remaining on therapy at two years.^[11]​

Recent improvements in persistence rates from 2023 to 2024 offer encouragement that better medication availability, insurance coverage, and clinical management strategies can meaningfully improve adherence. However, substantial barriers remain—particularly cost, which drives approximately one-third of discontinuations.^[22]​

The consistent pattern of weight regain after discontinuation underscores that obesity represents a chronic condition requiring ongoing management rather than a temporary problem with a permanent solution. Just as patients with hypertension or diabetes require continued medication to maintain health benefits, individuals with obesity typically need sustained pharmacotherapy to maintain weight loss and associated metabolic improvements.^[48]​

For patients, healthcare providers, and health systems, improving long-term persistence with GLP-1 medications represents a critical priority for realizing the full potential of these transformative therapies in addressing the obesity epidemic.

Frequently Asked Questions

How long do most people stay on GLP-1 weight loss medications?
Most people discontinue within the first year, with only 40-63% remaining on treatment at 12 months depending on the medication and when they started. At two years, persistence drops to approximately 15-25%.^[1]​

Do you have to take weight loss drugs like Wegovy or Ozempic forever?
While not strictly required, most people need to continue GLP-1 medications indefinitely to maintain their weight loss, as stopping typically leads to regaining two-thirds of lost weight within a year. These medications treat obesity as a chronic condition requiring ongoing management.^[61]​

What happens if you miss a dose of your weekly GLP-1 injection?
If you remember within 2-3 days (48-72 hours), take the missed dose immediately and resume your regular schedule. If more than 3 days have passed, skip the missed dose entirely and wait for your next scheduled injection—never double up.^[62]​

Can you stop taking GLP-1 medications without side effects?
Stopping GLP-1s doesn’t cause dangerous withdrawal symptoms, but you’ll likely experience increased appetite and hunger within 5-7 days as the medication leaves your system. Most people regain significant weight after discontinuation unless they maintain strict lifestyle changes.^[63]​

Why do so many people stop taking weight loss medications early?
Cost is the primary reason, with 35% citing affordability concerns. Other common reasons include side effects (particularly nausea and gastrointestinal issues), medication shortages, lack of insurance coverage, and some patients believing they’ve achieved their goals.^[22]​

Are GLP-1 medications safe for long-term use?
Clinical trials demonstrate safety for up to 3-4 years, with most side effects being mild to moderate gastrointestinal symptoms that often improve over time. However, as relatively new medications, very long-term data (beyond 5 years) is still emerging.^[64]​

How quickly do you regain weight after stopping Ozempic or Wegovy?
Weight regain typically begins within 2 months of stopping, with most people regaining approximately two-thirds of their lost weight within one year. Some metabolic benefits like improved blood pressure and cholesterol also decline toward baseline.^[65]​

Do you still need to diet and exercise while on GLP-1 medications?
Yes—these medications work best when combined with healthy eating and regular physical activity. You should prioritize protein (60-80+ grams daily), fiber, strength training, and consistent exercise to maintain muscle mass and maximize results.^[66]​

What’s the difference between taking Ozempic and Wegovy for weight loss?
Both contain the same active ingredient (semaglutide) but in different doses—Wegovy is FDA-approved specifically for weight loss at higher doses (up to 2.4 mg weekly), while Ozempic is approved for diabetes at lower doses (up to 2 mg weekly). Persistence rates are similar between the two.^[67]​

Will insurance cover GLP-1 medications for weight loss?
Coverage varies widely—only about 18-28% of employer health plans cover these medications for weight loss as of 2024. Medicare historically hasn’t covered them, though new policies announced in November 2025 will expand limited coverage starting mid-2026. Individual insurance policies should be checked carefully.^[21]​

How much weight can you expect to lose on GLP-1 medications?
In clinical trials, semaglutide (Wegovy) produced average weight loss of 15% over 68 weeks, while tirzepatide (Zepbound) showed 15-21% weight loss at one year. Real-world results are typically lower than clinical trial outcomes, averaging 8-12% depending on the medication and patient adherence.^[68]​

What should you do if you can’t afford your GLP-1 medication long-term?
Explore manufacturer savings programs (which can reduce costs to $245-$550/month), patient assistance programs, or discuss alternative medications with your provider. Some patients work with their doctors on strategic “drug holidays” or transition to lower-cost alternatives, though this requires careful medical supervision.

Jose Rossello, MD, PhD, MHCM

Dr. Rossello is a medical doctor specializing in Preventive Medicine and Public Health. He founded PreventiveMedicineDaily.com to provide evidence-based health information supported by authoritative medical research.

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