Yet, as prescribing rates have surged, the conversation around long-term strategy has been skewed by unrealistic expectations.
Many healthcare leaders and employers view GLP-1s as a temporary fix, assuming that if a patient loses significant weight, they will inevitably off-ramp and maintain their weight loss on willpower and lifestyle alone.
In most cases, this isn’t a realistic assumption.
A major randomized trial found that about 83% of patients failed to maintain their weight loss a year after stopping tirzepatide, even with continued diet and activity counseling. The reality is that most patients who stop their GLP-1 will likely regain weight. So the question isn’t how do we get more patients off of GLP-1s:
GLP-1s are chronic disease medications, not temporary fixes
Obesity and metabolic conditions are chronic, progressive diseases. Just as we do not expect all patients with high blood pressure to permanently stop their medication once their numbers normalize, we must acknowledge the biological reality of anti-obesity medications (AOMs): many patients who start one will need to remain on anti-obesity therapy for years if not for life.
When we look at the spectrum of GLP-1 care across varying indications, most patients will require continuous, long-term medication therapy to sustain their weight loss and health improvements. Among those who achieve their weight loss goal, some can successfully titrate down or wean to a lower maintenance-level dose while sustaining their health outcomes, and a smaller group can discontinue the medication entirely and maintain their weight loss and health gains over the long term.
We must stop framing “getting everyone off GLP-1s” as the default expectation. The goal should not be deprescribing to a quota; instead, the goal should be to find the right long-term dosage and care plan for each individual patient and to leverage data to determine who can safely titrate off.
Finding those who can wean requires high-touch clinical oversight
If only a portion of patients can titrate down to a lower maintenance dose, and only a small minority can discontinue entirely, how do we safely identify those who can?
You cannot find them through unmanaged discontinuation. A patient stepping off a medication simply because their prior authorization expired, or because they stopped filling their prescription, is not a clinical strategy; it’s abandonment.
The first step is to initiate care for the right patients with the right medications at the right time. At Vida, about 10% of members who aren’t already on a GLP-1 are prescribed one at their first visit, while others start with lifestyle intervention, Medical Nutrition Therapy (MNT), or a lower-cost AOM, not only ensuring employers are not overspending on GLP-1s but also making sure their employees are receiving appropriate treatment from the start.
Then, to safely test whether a patient can move to a lower maintenance dose, or to identify those patients who can successfully maintain their health after weaning off GLP-1 support, you need a structured, protocol-driven program with physician or nurse practitioner oversight.
When clinical protocol is ignored during dose reductions or discontinuation, several distinct risks pile up. Stopping without guidance can trigger rapid metabolic risk rebound, weight regain, food noise, rising A1c and blood pressure. It also causes lean mass loss that weakens body composition. Additionally, experiencing weight regain without ongoing multidisciplinary support can create psychological distress, while the loss of metabolic progress creates significant financial and clinical waste for health plans and employers.
What sound protocol and care actually require
When dose reduction or deprescribing is clinically appropriate, it cannot be treated as a quick exit. It requires an intentional, step-by-step plan led by clinicians, including:
Active biomarker and composition tracking: Regularly monitoring body composition, glycemic control, and metabolic markers to catch early signals of regain or metabolic regression before full relapse occurs.
A structured tapering schedule: Gradually titrating dosages down under close medical supervision rather than stopping cold turkey, allowing the neurohormonal system time to adapt while actively evaluating whether the patient can maintain their health improvements at a lower dose.
Personalized Medical Nutrition Therapy: Working directly with registered dietitians to establish high-protein, nutrient-dense eating strategies specifically engineered to manage returning appetite and protect lean muscle mass.
Targeted behavioral coaching: Providing continuous behavioral support to help patients reinforce the long-term lifestyle habits built during active therapy.
The goal isn’t treatment discontinuation. The goal is health.
In healthcare today, “getting patients off GLP-1s” is far too often celebrated as the primary success metric. But stopping a medication was never designed to be the ultimate goal of pharmacotherapy. The goal of medication therapy is, and has always been, to achieve and maintain long-term health for the patient, whether that requires continuous therapy, a lower maintenance dose, or a guided off-ramp.
If we fail to plan for long-term pharmacotherapy and dose adjustments, we turn what should be a durable, life-changing health outcome into a temporary illusion.
Medication is a powerful tool that works best within a clinical framework that plans for the whole journey, from initiation to long-term maintenance, dose adjustment, and cessation. If our care strategies focus solely on starting the prescription without providing the individualized support needed to navigate the long haul, we aren’t delivering the best possible metabolic care.
