Preparing To Move on from GLP-1 Drugs

Despite GLP–1 drugs being around for over 30 years, they’ve only been available with an indication for diabetes treatment. Now, the world has embraced higher-dose GLP-1 meds with an indication for weight loss.

There’s a good reason for this. Semaglutide, also known by its brand name Wegovy, and Tirzepatide, known as Zepbound, offer incredible potential for those needing to lose a moderate amount of weight. In studies, approximately one-third of patients treated with semaglutide lost more than 20% of their body weight. In comparison, a similar proportion of patients treated with tirzepatide lost up to 26% of their body weight.

This is stunning by any measure, but the current crop of GLP-1 drugs has some distinct downsides.

First, effective GLP-1 medications for weight loss require a weekly injection into the belly, and, let’s be honest, many patients do not keep up with their injection schedule. This is not a phenomenon seen only with these weight loss drugs. Injectables have always been difficult to stick to.

The side effects of the GLP-1 class of drugs range from very mild to potentially severe. Most patients will experience some gastrointestinal upset, which typically worsens as they increase their dose. These incremental increases occur about once a month.

At higher doses, the side effects may be somewhat more severe. Nausea and vomiting are typically manageable, especially once patients see that they’re losing a significant amount of weight – the trade-off sort of becomes worth it. However, gallbladder issues, pancreatitis, and gastroparesis or stomach paralysis can also occur and typically require stopping the medication – those risks are not worth the benefit.

The cost of medication is also a concern. In the early days, the medication was sold at over $1,000 per month. This was not sustainable for most patients. During a nationwide shortage, compounding pharmacies were permitted to create their own formulations to meet the demand, which drove prices down to as low as $250 per month. When the shortage ended, and the brand-name was back as the sole option available, the price returned to its original level. The makers of Wegovy, Nova Nordisk, have recently struck a deal with GoodRx to keep the price relatively lower; however, it may ultimately be too high for many patients.

Insurance coverage nationwide has been spotty at best, and it is particularly poor in Alabama. Without insurance coverage, patients lack a program that mitigates some of the cost of the medication.

Why do you need to prepare for stopping GLP-1 medications?

Any of the above are good reasons to stop taking GLP-1 medication. We know from preliminary data that most patients will regain all the weight they lost from GLP-1 drug usage within two years following their last injection, unless they have managed to change their diet and exercise to the degree that they can maintain the weight loss they achieved.

More often than not, the struggle lies with getting to a personal weight goal rather than maintaining it. To that end, we don’t want patients who have worked so hard to lose the weight in the first place to then regain it after a short period of backing off on medication. This often causes a level of frustration and may lead to thinking that future weight loss efforts are futile.

What to do

Have a plan for weaning off the medication. Speak to your doctor or a GLP-1 program administrator to understand how long you should expect to be on the drug and how, when you reach that point, you will begin transitioning off of it.

We typically don’t suggest quitting cold turkey, as this may trigger a surge in hunger that you can’t control. Instead, we prefer to see patients gradually reduce their dose until they are off it. With their renewed energy and improved physical ability, patients can draw on both willpower and motivation from their progress, channeling that momentum into healthier habits that support lasting results and help them sustain weight management over the long term.

For patients who began their GLP-1 journey with a BMI of 40 or higher, bariatric surgery should remain part of the discussion once the medication phase is complete. In many cases, GLP-1 therapy alone does not provide sufficient weight reduction to achieve long-term goals.

However, using these medications beforehand can meaningfully lower surgical risk while also jumpstarting weight loss, which allows patients to approach surgery with fewer potential complications once they plateau on the drug. Beginning the procedure at a lower weight can also make it easier to reach, and sometimes even surpass, post-surgical expectations.

Start right, choose a practice, and follow up.

One of the most concerning aspects of the rise of GLP-1 meds is that many practices and prescribers lack a structured follow-up protocol. This is especially critical for patients losing a significant amount of weight through calorie restriction and appetite suppression. That’s why our program, led by nurse practitioner Claudia, is designed to provide the consistent guidance and support patients need.

The dangers of rapid or substantial weight loss, especially on one’s own, are not unique to medications. Patients who undergo bariatric surgery and skip their follow-up appointments can also face serious physical and emotional consequences. The same holds true for patients who attempt extreme or binge diets, where they are consuming far fewer calories than what we would expect to be healthy.

We do not prescribe the medication and send our patients home to fend for themselves. Instead, we provide ongoing guidance, monitoring, and support to ensure safe and sustainable weight loss.

The unfortunate reality is that patients who are not guided with proper diet and exercise programs may lose up to 60% of their weight from muscle mass and bone density loss – that isn’t good. As a result, patients may increase their risk for several metabolic and physical challenges. Bone loss can make middle-aged and older patients, especially our female and post-menopausal patients, susceptible to osteopenia and osteoporosis.

Having a healthcare team that monitors your progress, helps optimize diet and exercise specifically for your body and goals, and performs regular blood tests to ensure your safety is critically important.

The bottom line

Any patient who is taking these medications should have a backup plan in case they experience side effects, lose their coverage, or hit a plateau they can’t get beyond.

Once patients decide to discontinue their GLP-1 meds (for reasons other than serious side effects), they can often do so gradually by weaning off the drug; cutting it out cold turkey can cause significant cravings and a return to the former weight very quickly. Stopping the drug should be discussed with a qualified physician or nurse practitioner.

But it all starts with choosing the right program to administer GLP-1 medications in the first place. It can be very easy to get a prescription these days. The real challenge is finding a prescriber who will stay by your side as you lose weight — one who will monitor your progress, guide your diet, and help create an exercise plan that’s conducive to your long-term health and weight maintenance.

To that end, we invite you to join SAMPA’s medical weight loss program, which remains at the forefront of patient care by being an integral part of the weight loss journey from beginning to end. Each of our patients has a one-on-one, in-person meeting throughout the program to make sure the treatment is being maintained and to decide if or when a new plan needs to be developed – as a team.