There’s no denying the transformative potential of GLP-1 drugs like semaglutide and tirzepatide. For many obese patients, these medications have offered something that diet and exercise alone rarely deliver—substantial and sustained weight loss. They’ve also shown promise in improving metabolic health and reducing cardiovascular risk. But as enthusiasm for GLP-1s continues to surge, we seem to be overlooking two uncomfortable truths: the high discontinuation rates and the unknowns surrounding long-term use.
The Reality Behind the Numbers
While GLP-1 drugs have become a cornerstone of modern obesity management, the reality is that many patients can’t stay on them. Studies show that roughly half of patients discontinue treatment within the first year, most often due to gastrointestinal side effects like nausea, vomiting, diarrhea, and constipation. These aren’t minor inconveniences—they’re daily disruptions that make adherence challenging, especially for people already juggling complex health conditions.
Despite the media and industry hype, discontinuation isn’t just a patient preference issue—it’s a clinical one. When treatment stops, most patients regain the weight they lost, often quickly. That’s not just demoralizing; it may also set them up for long-term metabolic instability.
The Unknowns of Long-Term Use
GLP-1s were not designed as lifelong drugs, yet that’s how they’re now being positioned. We still don’t know the long-term effects of extended use—on the pancreas, gastrointestinal system, or mental health. Early data hint at potential risks such as muscle loss, gallbladder disease, and changes in appetite regulation that could persist long after discontinuation.
And while drug manufacturers are rushing to develop next-generation formulations and oral versions, the clinical community hasn’t caught up in understanding what chronic GLP-1 exposure truly means for the body over 5, 10, or 20 years.
Beyond the Hype
It’s easy to see why these drugs are being hailed as a medical breakthrough—and in some ways, they are. But the conversation has become too one-sided. Physicians, payers, and policymakers need to start discussing the real-world tradeoffs: side effects, affordability, long-term adherence, and the ethics of promoting a drug with such limited longitudinal data.
GLP-1 drugs can play a valuable role in obesity treatment—but only if we balance optimism with caution. Until we have more evidence, we should stop pretending these drugs are a cure-all and start treating them for what they are: a powerful, but imperfect, medical tool whose long-term story is still being written.
