Semaglutide is a weekly injection that mimics a hunger-regulating hormone in the body. Insiders
New GLP-1 drugs like Ozempic and Mounjaro can help people lose a tremendous amount of weight.
But once people stop getting the injections, they tend to put the weight back on.
Some employers and startups see drugs as short-term solutions, setting people up for failure.
Tara Rothenhoefer has lost 176 pounds on Mounjaro and wants to keep the weight off. But she knows from experience that it probably won’t be possible if she has to stop taking the drug after the manufacturer’s coupons have expired.
Rothenhoefer has already tried his way out of Eli Lilly’s weekly blockbuster once before. Almost immediately, her weight started to climb again, she told Insider’s Gabby Landsverk.
Bill, a 63-year-old from San Francisco, faced the same problem. He lost 80 pounds on Wegovy through startup Calibrate’s annual weight management program. At the company’s suggestion, he tapered off the drug, expecting to maintain his weight loss. But his hunger came racing back and he quickly regained 15 pounds.
Rothenhoefer and Bill’s experiences are not just anecdotes. They’re symptomatic of a bigger problem that large and rigorous clinical trials have also encountered: The new injectable obesity and diabetes drugs Mounjaro, Ozempic, and Wegovy offer dramatic weight loss and improvements to patient health.
But the injections don’t work once people stop taking them.
Tara Rothenhoefer lost 176lbs on Mounjaro. She now worries about losing access to the drug. Courtesy of Tara Rothenhoefer
Novo Nordisk, the maker of Ozempic and Wegovy, says that just like cholesterol-controlling statins, this new class of drug is likely a lifelong commitment. A study of hundreds of Ozempic users released in 2022 found that after a year without the drug, patients regained two-thirds of the weight they had lost.
“If we’re looking at sustainable weight loss, we’re probably also talking about chronic treatment,” Dr. Martin Lange, executive vice president of development at Novo Nordisk. “To be honest, that doesn’t surprise me.”
But it seems that this paradigm of “chronic” prescriptions for drugs like Ozempic, Wegovy and Mounjaro AND a surprise to many who foot the bill.
Some employers say they will only pay for the drugs for one year. Online startups like Calibrate and Omada Health suggest you can stop taking these medications and still maintain your weight loss.
And the manufacturers themselves don’t address what happens after their savings cards for these drugs expire. With coupons, patients can save hundreds to thousands of dollars a month on their prescriptions. But coupons only last for a certain number of months or a certain number of top-ups.
Rothenhoefer, for example, paid $25 a month for Mounjaro using a savings card he received from Eli Lilly. But eventually the deal should close, and the drug retails for over $1,000 for a four-week supply.
Both Eli Lilly and Novo Nordisk told Insider that their savings programs were meant to work as a fallback, to help patients afford the new drugs until more insurers agree to cover them.
The gap between what companies are willing to pay for and what patients need for better health is sparking a battle that is likely to 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 facility. Li Ran/Xinhua via Getty Images
Many health insurers and employers have long refused to pay for diet drugs. Increased demand is forcing them to reconsider, and they’re looking for ways to smooth out the cost of drugs, which can exceed $1,000 a month.
Paying for drugs as if they were a temporary stepping stone to weight loss, rather than a way to maintain it, has emerged as a strategy. Omada CEO Sean Duffy told Insider that some employers wanted his startup to help their workers quit drugs after a year, for example.
Omada doesn’t prescribe diet drugs, but she bets it can help people who choose to stop taking them to limit the weight they gain back through lifestyle changes. The startup plans to study and possibly publish its results.
“We are in full agreement that there will inevitably be a segment of the population where it is the right clinical decision to stay on a GLP-1 for life,” Duffy said in an email. “But it’s our belief that by coupling GLP-1 with behavior change, we can help minimize the number of individuals who stay on the drug long-term.”
Experts argue that such a strategy represents a fundamental misunderstanding of obesity and our biology and sets most patients up for failure. The reason GLP-1 drugs work is that they mimic glucagon-like peptide 1, the full name of GLP-1, which is a hormone our bodies naturally produce that helps control hunger and regulate blood sugar.
The drugs, however, are more potent and longer lasting than our natural gut hormones. They ignore out-of-control hunger cues, slow digestion, and change the way our bodies convert food into energy. Drugs that mimic GLP-1 have been found to help people lose 15% to 20% of their body weight by essentially suppressing people’s appetite and improving blood sugar control.
Take the drug off and that person will start feeling hungrier again, no matter what other changes they make to their diet or exercise habits, said Dr. Nisha Patel, an obesity medicine physician in San Francisco.
A minority of users may be able to maintain the weight or slow the rate at which they regain it with vigorous exercise, but it’s hard to predict who those lucky few will be, he said.
Is it possible to restore body weight forever?
Insiders
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 problem shedding a few extra pounds, many bodies seem hard-wired to struggle to maintain a higher weight. Most people who lose weight through calorie restriction eventually regain what they lost.
Experts often talk about this idea as a metabolic “benchmark” that can be difficult to regulate. Our genes, environment and hormones all play a role in body size, and complex physiological factors that are still poorly understood can make it difficult for many people to sustain weight loss.
Startups like Calibrate claim they can help lower a person’s “set point,” even after they stop taking weight-loss drugs, although it’s not scientifically clear that this is possible.
A Calibrate spokesperson said in an emailed statement that the company’s program, which combines medication and lifestyle intervention, is designed by clinical consultants that include pioneers in set point research. He said Calibrate doctors work with members to determine if and when they should taper off medications based on the member’s medical history and progress. The program helps members sustain their health outcomes after they stop their medications, she said.
Calibrate has early data showing its members can successfully maintain weight after stopping their medications and plans to release those results, the spokesperson added.
Meanwhile, pharmaceutical companies, including Novo Nordisk, are clamoring to find ways to maintain GLP-1-induced weight loss, perhaps with new types of maintenance drugs that people would take once they reached a lower body weight. .
“I can’t go into details, but obviously it would be a focal point from a research point of view, I think both for ours but also for others,” said Lange, director of Novo Nordisk.
Calibrate insider Bill said when he started with Wegovy, no one told him he was embarking on what could be a lifetime commitment. After his failed experiment with tapering the drug, he said it had become obvious that he would need it long-term. He resumed taking diet drugs, but said he hoped to go down to a lower dose.
Had she known she would have to take the drug for life, she might have chosen to ask a primary care physician for a prescription rather than Calibrate, she said. But she doesn’t regret taking Wegovy.
“This is a really great solution for most people,” he said. “I see it as a game changer even though it’s a lifelong drug.”
Gabby Landsverk contributed to the report.
Would you like to tell us about your experience with health insurance and slimming drugs? You can contact Shelby Livingston at slivingston@insider.com and Hilary Brueck at hbrueck@insider.com.