Getty; Marianne Ayala/Insider
New GLP-1 drugs such as Ozempic and Mounjaro can help people lose a massive amount of weight.
But once people stop taking the injections, they tend to regain weight.
Some employers and startups see the drugs as short-term fixes, setting people up for failure.
Tara Rothenhoefer lost 176 pounds on Mounjaro, and she wants to keep the weight off. But she knows — from experience — that probably won’t be possible if she has to stop taking the drug once her manufacturer-issued coupons expire.
Rothenhoefer already tried going off Eli Lilly’s blockbuster weekly shot once before. Nearly immediately, her weight started to creep back up, she told Insider’s Gabby Landsverk.
Bill, a 63-year-old in San Francisco, faced the same issue. He lost 80 pounds on Wegovy through the startup Calibrate’s yearlong weight-management program. At the company’s suggestion, he tapered off the drug, expecting to maintain his weight loss. But his hunger rushed back, and he quickly regained 15 pounds.
Rothenhoefer’s and Bill’s experiences aren’t just anecdotes. They’re symptomatic of a bigger issue that large, rigorous clinical trials have also found: The new, injectable anti-obesity and diabetes drugs — Mounjaro, Ozempic, and Wegovy — deliver stunning weight loss and improvements to patients’ health.
But the injections don’t work once people stop taking them.
Tara Rothenhoefer dropped 176 pounds on Mounjaro. Now she worries about losing access to the drug.
Courtesy of Tara Rothenhoefer
Novo Nordisk, the manufacturer of Ozempic and Wegovy, says that much like cholesterol-controlling statin drugs, this new class of medications is likely a lifelong commitment. A study of hundreds of Ozempic takers released in 2022 found that after one year without the drug, patients regained two-thirds of the weight they had lost.
“If we want to be looking at sustainable weight loss, we’re probably also talking about chronic treatment,” Dr. Martin Lange, Novo Nordisk’s executive vice president for development, told Insider. “To be honest, that doesn’t surprise me.”
But it appears that this paradigm of “chronic” prescriptions for drugs such as Ozempic, Wegovy, and Mounjaro is a surprise to many of those who are footing the bill.
Some employers say they’ll pay for the drugs for only one year. Online startups such as Calibrate and Omada Health suggest that you can stop taking these drugs and maintain weight loss.
And the manufacturers themselves don’t address what happens after their savings cards for these drugs expire. With the coupons, patients can save hundreds to thousands of dollars a month on their prescriptions. But the coupons last for only a set number of months or a certain number of refills.
Rothenhoefer, for example, has been paying $25 a month for Mounjaro using a savings card she got from Eli Lilly. But that deal is scheduled to eventually end — and the drug retails for over $1,000 for a four-week supply.
Both Eli Lilly and Novo Nordisk told Insider their savings programs were meant to operate as stopgap measures, to help patients afford the new drugs until more insurers agreed to cover them.
The gap between what companies are willing to pay for and what patients require for better health is setting up a battle that will likely result in wasted money, wasted time, and disappointing healthcare outcomes.
Can we afford to have patients on weight-loss drugs for life?
A Novo Nordisk manufacturing plant.
Li Ran/Xinhua via Getty Images
Many health insurers and employers have long declined to pay for weight-loss drugs. Rising demand is forcing them to reconsider, and they’re searching for ways to blunt the cost of the drugs, which can exceed $1,000 a month.
Paying for the drugs as if they’re a temporary springboard to weight loss, rather than a way to maintain it, has emerged as one strategy. Omada CEO Sean Duffy told Insider that some employers wanted his startup to help their workers get off the drugs after a year, for example.
Omada doesn’t prescribe weight-loss drugs, but it’s betting it can help people who choose to stop taking them to limit the weight they regain through lifestyle changes. The startup plans to study and eventually publish its findings.
“We fully agree that there will inevitably be a segment of the population where it’s the right clinical decision to stay on a GLP-1s for life,” Duffy said in an email. “But it’s our belief that by coupling GLP-1s with behavior change, we can help minimize that number of individuals that remain on the medication for the long-term.”
Experts contend that such a strategy represents a fundamental misunderstanding of obesity and our biology — and sets most patients up for failure. The reason that GLP-1 drugs work is that they mimic glucagon-like peptide 1, the full name for GLP-1, which is a hormone our body produces naturally that helps control hunger and regulates blood sugar.
The drugs, though, are more powerful and longer-lasting than our natural gut hormones. They override out-of-whack hunger cues, slow digestion, and change how our bodies convert food into energy. GLP-1-mimicking drugs have been found to help people lose 15% to 20% of their body weight by essentially suppressing people’s appetites and improving blood-sugar control.
Take the drug away, and that person will start to feel hungrier again, no matter what other changes they’ve made to their diet or exercise habits, Dr. Nisha Patel, an obesity-medicine doctor in San Francisco, said.
A minority of users may be able to keep weight off or slow down how fast they regain it with vigorous exercise, but it’s difficult to predict who those lucky few will be, she said.
Is it possible to reset your body weight for good?
For a long time, scientists who study metabolism have struggled to understand how different bodies react to diet and exercise. While some people may have no trouble shedding a few extra pounds, many bodies seem hardwired to fight to maintain a higher weight. Most people who lose weight through caloric restriction eventually regain what they lose, a study in the National Library of Medicine found.
Experts often talk about this idea as a metabolic “set point” that can be hard to adjust. Our genes, environment, and hormones all play a role in body size, and complex physiological factors that are still poorly understood can make it tough for many people to sustain weight loss.
Startups such as Calibrate say they can help lower a person’s “set point,” even after they stop taking weight-loss drugs, though it’s not scientifically clear that this is possible.
A spokesperson for Calibrate said in an emailed statement that the company’s program, which combines medication and lifestyle intervention, is designed by clinical advisors that include pioneers in research on set points. She said Calibrate doctors work with members to determine if and when they should taper off of medication based on the member’s medical history and progress. The program helps members sustain their health outcomes after stopping medication, she said.
Calibrate has early data showing its members can successfully keep weight off after stopping drugs, and plans to publish those results, the spokesperson added.
Meanwhile, drug companies including Novo Nordisk are clamoring to figure out ways to maintain GLP-1-induced weight loss, perhaps with new kinds of maintenance drugs people would take once they reached a lower body weight.
“I can’t go into details, but obviously that would be a focus from a research perspective, both I think of ours but also of others,” Lange, the Novo Nordisk executive, said.
Bill, the Calibrate member, said that when he started on Wegovy, no one told him he was embarking on what could be a lifetime commitment. After his failed experiment with tapering off the drug, he said it had become obvious that he’d need it long term. He has resumed taking weight-loss medication but said he hoped to go down to a lower dose.
Had he known he’d need to take the drug for life, he may have opted to seek a prescription from a primary-care doctor rather than Calibrate, he said. But he doesn’t regret taking Wegovy.
“This is a really great solution for most people,” he said. “I see this as a game changer — even if it’s a lifelong drug.”
Gabby Landsverk contributed reporting.