It's quite common for people to start on GLP-1 drugs like Ozempic and Zepbound, especially as the diabetes and obesity treatments become more ubiquitous. They're designed to treat chronic conditions, so the medicines are intended for lifelong use; yet a high percentage of people who start them also quit.
"We found that fewer than 1 in 4 patients remained on a GLP-1 medication after a year," says Dr. Jaime Almandoz, an obesity medicine specialist at the University of Texas Southwestern Medical Center. He looked at insurance claims data in a research letter published in JAMA and found that few patients actually adhere to the drugs for the long term.
"Many times obesity treatment is framed as a limited duration intervention that once people get to a weight goal or percentage of weight reduction, that then treatment can be discontinued," Almandoz says. That's outdated thinking, he argues. Patients also stop because of cost, loss of insurance, or side effects.
Interestingly, a separate survey found that most people who quit the drugs said they plan to restart, says Leigh O'Donnell, who analyzes shopper behavior for the market-research firm Kantar. "Seventy-four percent of lapsers say that they are likely or very likely to come back onto a GLP-1," she says. And consumer behavior is shifting very rapidly, as more drugs become available in pill form, at a lower price, and from various online sellers without doctor or insurance approvals. "The barriers to use and reuse are getting so low that it's a little hard to project."
As with many things relating to GLP-1s, consumer behavior is far outpacing research about the effects of their use in different situations. There isn't a lot of research on the health effects of periodic use, though other studies show weight regain after stopping GLP-1s is faster compared to other diets that focus on behavior changes.
Yet, as O'Donnell notes, on-again-off-again use is already in the cultural zeitgeist. Celebrity use of the drug as a kind of diet aid is "normalizing" cycling behavior, she says.
Social media ads capitalize on that message, too. One online seller, Willow, features younger, fit-looking women in its ads, saying GLP-1s are available even to people who wear a size 4. In one such video, a svelte young woman on a couch asks a doctor, "I'm only looking to lose a couple of pounds, maybe use it temporarily." The doctor assures her it's fine for brief use.
Willow did not respond to requests seeking comment about its marketing. Late last year, Willow declined to modify or discontinue its health-related claims at the Better Business Bureau's request.
The pharmaceutical industry, represented by the trade organization PhRMA, would like to see Medicare rules changed to allow more patients to take the drugs and is pushing for more oversight and reining in of some of the compounding pharmacies that sell GLP-1 drugs directly to consumers.
Experts say one problem is that temporary use could undermine health by diminishing lean muscle mass, every time a person resumes GLP-1s.
As much as 40% of all weight lost on GLP-1s is lean muscle, says Mahmoud Salama Ahmed, a medical chemist at Texas Tech University. While muscle loss is standard with any diet or weight-loss regimen, loss of muscle on GLP-1s can be more dramatic, Ahmed says, causing what's been dubbed "Ozempic face," a bonier, looser-skinned look, where the muscle loss is particularly noticeable.
The problem, he says, is that when people stop the drugs, they tend to gain back fat rapidly. Meanwhile, it is not clear how — or how much — the muscle they lost is also eventually regained. If the patient doesn't work to rebuild that lean mass, Ahmed says, that could lead to sarcopenia — muscle loss — which adversely affects balance, movement, metabolism and can lead to broken or weakened bones.
"We might find some real problems if we are not monitoring the body composition, especially for the older patients," Ahmed says.
However, some say the impacts on muscle might not be so dire; that GLP-1s also improve muscle quality, even if they reduce overall quantity.
When looked at closely, the muscles of those on GLP-1s appear to be healthier — with less fat infiltration and better, stronger fibers, says cardiologist Ian Neeland at Case Western Reserve University.
"The key point is not just how much muscle, but how healthy and functional the muscle is," Neeland says, because the goal is always to gain strength, even while losing weight.
Both Neeland and Ahmed say more research is needed on the health effects from short-term use of GLP-1s.
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