Cost, side effects are the best reasons to skip GLP-1s

In late 2025, the nonprofit KFF Health Policy Organization released the results of a survey that found that about one in eight Americans were taking GLP-1 drugs for weight loss or another health condition. Eighty percent of respondents reported having taken drugs in the past, and expected to continue using drugs.

As the popularity of GLP-1s grows, so does the population of people who skip them, regardless of whether they meet their health goals. Good common reasons for quitting include financial constraints and financial constraints. However, until recently, the evidence for why people quit was anecdotal.

The results of a recent study by Cleveland Clinic researchers strengthen the evidence for the hypothesis and provide further evidence. Research shows that among people who stopped injectable semaglutide or terzapatide for obesity:

• 47.6% stopped for financial reasons, including denial of insurance, expiration of discount coupons, or unaffordable out-of-pocket costs.
• 14.6% discontinued due to drug side effects.
• 11.8% were discontinued due to drug shortages.
• 2.4% dropped out because they switched to a combination drug.
• 1.7% dropped out due to unsatisfactory weight loss.
• 10.8% discontinued use for other reasons.
• The reason for discontinuation was unknown for 11.1%.

The study, Reasons for Discontinuation of Obesity Pharmacotherapy with Semaglutide or Terzapatide in Clinical Practice, is published in the journal. obesity.

In addition to quantifying the data, the researchers had other reasons for their research, says first author Hamlet Gusoyan, PhD, a researcher at the Cleveland Clinic’s Center for Value-Based Care.

First, understanding why people quit is because people usually regain weight after stopping GLP1s; Identifying solutions that allow patients to achieve and maintain their goals depends on understanding the barriers.

Second, the researchers wanted to see if the reasons for leaving corresponded to when people left. The study looked at those who quit less than three months, and those who quit between three months and a year. As hypothesized, while financial barriers were the most common reason for discontinuation at any time, patients who discontinued due to cost were more likely to discontinue treatment after treatment, whereas those who discontinued due to side effects did so earlier.

Description of the study

Participants were adults who filled their first prescription for injectable semaglutide or terzapatide for obesity between January 1, 2022, and December 31, 2023, and who discontinued injections within the first year. They had a body mass index (BMI) of at least 30 on the date of initiation of treatment or at the last available primary care visit, or a BMI of at least 27 with one or more weight-related diseases such as hypertension, dyslipidemia, sleep disturbances or heart disease.

Participants were not eligible if they had a diagnosis of type 2 diabetes or if they had undergone bariatric surgery within two years of the start of the study.

Researchers analyzed electronic health record data from a pool of 288 randomly selected eligible participants. One hundred and seventy participants were female and 109 were male. The average age was 52 years; The average weight was 256 pounds; The average BMI was 39.7. Most (about 77%) are privately insured.

Research background

Dr. Gaswan’s research on anti-obesity drugs yielded initial insights in a study published in 2023. obesity It showed that only 19% of participants were still using obesity medication one year after their initial prescription.

“After we published the first study on discontinuation rates and the impact on real-world outcomes, other groups across the country replicated our findings,” says Dr. Gasoyan. “It was gratifying to see that what we reported was true and applied in other settings, but it still didn’t sit well with me that we still only had guesses about why people stop.”

Objective information can be useful, but policymakers and insurers need objective information.

“We wanted to look at this systematically to address the Catch-22 of third-party payers refusing to cover anti-obesity drugs because people drop them at high prices, when in fact some people are stopping the drug because coverage was canceled by the insurance company or the patient failed to give prior authorization or they couldn’t afford the cost.”

The information is also important for clinicians and patients, he adds.

“It is important for a physician to explain these factors to the patient early in the decision about GLP-1 medication for obesity,” says Dr. Gaswan. “Patients need to understand the challenges surrounding medication adherence, and that it is common for patients to stop. And, as we explained in our previous research, once you stop, the results will be similar to those reported in randomized clinical trials where, on average, patients lose 15% to 20% of their weight.”

Pathways cut by bariatric surgery

Years ago, Dr. Gasoyan’s PhD thesis concerned the underutilization of bariatric surgery to treat obesity. He sees parallels with GLP-1s.

“To date, bariatric surgery is the most effective treatment for severe obesity, but when it was new, like new anti-obesity drugs, it was labeled weight loss surgery or cosmetic surgery, and was not covered by Medicare or most third-party payers.” “Then the evidence accumulated over a decade. It showed not only the effectiveness of surgery in weight loss, but also in saving money by preventing many chronic diseases and reducing obesity-related deficiencies.”

He expects that new anti-obesity drugs may follow a similar path. And improving care and options for obese patients drives his research.

“Anything we can do to help patients get the care they need is good, even if they can’t stay on the GLP-1 medication,” he says. “We want to know what the best alternative would be, if they need to stop their GLP-1 medication. We’re trying to help provide evidence-based recommendations for patients who want to manage their obesity and then help them access care and stay with it.”