Why Half of GLP-1 Users Quit, and What Changes That

Nearly half of people taking a GLP-1 for weight management stop within a year. Among people without diabetes specifically, it's closer to two-thirds; by two years, over 80%.¹ A separate study of 77,310 first-time semaglutide users in Denmark found more than half discontinued within a year, with the steepest drop-off between three and nine months.²

The catch in reading this as savings

It's tempting to read a high discontinuation rate as money saved: fewer months on therapy, lower spend. The problem isn't the arithmetic. It's what the employer got for the months they did pay for.

In the largest study on this to date, 36 to 47% of people who stopped a GLP-1 had restarted within a year, typically after regaining the weight they'd lost.¹ For that group, the employer pays for the same course of treatment twice, with nothing durable to show for either round. For the group that doesn't restart, the outcome isn't obviously better: stopping early, before a lasting change takes hold, usually means the spend already made didn't produce the health outcome it was meant to buy in the first place.

Either way, the employer can't tell in advance which group a given employee will land in. That uncertainty, not the raw spend total, is the real problem: a benefit meant to produce a measurable health outcome, where whether it actually does is largely out of the employer's hands. It starts with a basic question: why do people quit in the first place.

Why people actually quit

The most direct answer comes from a 2026 national survey that asked people who'd stopped a GLP-1 why. The top reasons: cost (36.1%), side effects (33.3%), losing insurance coverage (28.2%), and having reached their weight-loss goal (26.1%).³ A separate analysis of real-world pharmacy claims found a similar pattern: adverse reactions and cost concerns were the two leading documented reasons for discontinuation.⁴

Two of those four reasons have nothing to do with support around the medication. Cost and coverage are benefit-design and formulary questions. But the other two, side effects and “I reached my goal,” are exactly where a behavior and data layer has something concrete to offer.

The problem hiding inside “reached my goal”

Reaching a goal weight and stopping sounds like success. It usually isn't one. GLP-1s are indicated as long-term therapy, and stopping reliably leads to weight regain. Dr. Robert Kushner, a lead investigator on the STEP trials, makes the point directly on our podcast: obesity medicine has historically treated weight loss and weight maintenance as the same challenge, when they're driven by different biology entirely, and what happens after someone stops a GLP-1 is often where the real work of keeping results was supposed to start.⁵ A quarter of people who quit are quitting for a reason that will very likely bring them right back to where they started, plus a restart six months later.

A second, quieter problem: results erode even for people who stay on

Independent of who quits, there's a separate issue with what people who stay on a GLP-1 are actually losing. A 2024 systematic review and network meta-analysis of 22 randomized trials found that lean mass accounted for roughly 25% of total weight lost on GLP-1 therapy, a figure that climbs to 40% or higher with some higher-dose compounds.⁶ That matters for older employees and anyone already at risk of sarcopenia. It's also preventable: the Danish S-LITE trial found that patients combining a GLP-1 with supervised resistance and aerobic training preserved and even gained lean mass, an outcome medication alone didn't produce.⁷ Separately, a 2026 review drawing on data from more than 480,000 GLP-1 users found meaningful rates of nutrient deficiency emerging within a year of starting therapy, with most users falling short of recommended calcium and iron intake.⁸ The same appetite suppression that drives weight loss makes it harder to hit the protein and nutrient targets that protect muscle and health through the process.

What actually changes this

Two different fixes for two different problems.

For the side-effect and “reached my goal” drivers of quitting: structured guidance through the early months (when GI side effects are most common) and an explicit maintenance plan once a goal is hit, rather than a silent taper nobody's tracking, addresses two of the three most-cited reasons people stop before the therapy has done its job.

For the erosion problem among people who stay on: protein and nutrient guidance paired with structured movement, the same combination the S-LITE trial tested, protects the muscle and nutritional status that GLP-1 therapy alone puts at risk.

This isn't only Levels making this argument. Mercer, whose guidance most large self-insured employers already follow, tells clients directly that GLP-1 medications are meant to be prescribed alongside coaching or guidance for lifestyle changes, and that members supported this way get help managing side effects and nutrient risk while being set up for success whether or not they stay on the medication.⁹ In separate guidance on 2026 planning, Mercer notes that most PBMs have now partnered with lifestyle-management vendors specifically because pairing medication with behavioral support improves outcomes.¹⁰ The direction of the market, among PBMs, consultants, and employers rethinking coverage design, points at the same pairing described above.

Neither of these changes the sticker price. Both change whether the spend converts into an outcome that holds, on the medication or after it.