What Divides Patients and Providers on GLP-1 Adherence
By Justin Wu, MD and Liz Connolley
This edition covers:
- The phenomenon of GLP-1 discontinuation
- Clinical guidelines versus patient behavior
- How Omada members view the role of GLP-1s
In my tenure as a physician, I have never seen another drug come close to the all-encompassing fervor surrounding GLP-1 medications—from their impressive outcomes to a myriad of financial, social, and clinical challenges. One such challenge is that GLP-1s are designed to be taken for the long-term, however, up to 68% of people have discontinued their treatment as soon as one year later. While there are a variety of reasons why an individual might discontinue their medication—and we’ll get into some of the data below—how can these “miracle weight loss drugs” work their “magic” in the long-term if more than half of patients stop taking them?
In this edition of Proof Points, we’ll share learnings from a recent survey of Omada Health members to better understand this phenomenon—but before we explore those insights, let’s take a look at the published evidence.
What Does the Medical Literature Say?
Unfortunately, not much at the moment. With GLP-1s still relatively new on the scene for their weight loss indication, we’re only just beginning to see published data on medication persistence rates, and very little in the peer-reviewed literature. That said, a real-world analysis by Prime Therapeutics and Magellan Rx looked at integrated pharmacy and medical claims data from 16 million commercially insured members and found that a whopping 68% had stopped taking their GLP-1s after just one year. Other studies have had similar findings, including an Obesity journal article examining the electronic health records of 1,911 patients, which found that 60% of patients had stopped taking Wegovy within one year.
A treatment is only useful if people have access to it and actually take it. With a price tag of about $10,000 a year per person, and so many individuals stopping the medication, potentially falling short of realizing successful long-term weight loss, it’s paramount to figure out two things: why people are discontinuing their medication and what can be done to sustain their outcomes.
What We’re Learning From Omada Members
At Omada Health, we support hundreds of thousands of people each year in managing their weight health, affording us first-hand experience in what’s happening in the real world. A recent survey of 461 Omada members, conducted in September 2023, offers a few hints at what might be behind the discrepancy between recommended clinical guidelines and patient behavior.
Members View GLP-1s as a Short-Term Solution
One such finding is that patients may view the role that GLP-1s play in their weight loss journey differently than their clinicians. Among members who were taking a GLP-1 at the time they were surveyed, less than a third indicated that they expected to be on the medication “for the foreseeable future." Compare that to almost half of members who selected “until I reach a target weight or other outcome.” Similarly, when we asked our members what they found appealing about the idea of trying a GLP-1, they used terms like “kickstart”, “jumpstart”, and “boost”, all of which we believe suggests our members may view medication as short-term support on a long-term journey.
The perspective that GLP-1s are a quick fix to obesity is in sharp contrast to the medical community’s recognition of obesity as a chronic disease, designated as such by the American Medical Association in 2013. It also bumps up against the mechanism of action of GLP-1s, which are approved by the FDA for long-term weight management because their discontinuation can lead to weight regain.
People Have Mixed Feelings About Weight Regain
For the most part, Omada members on GLP-1s are aware of the risk of weight regain after discontinuation.
Forty-two percent report worrying about weight maintenance after stopping their medication, and this fear is grounded in experience as well as data.
It’s common for members who are interested in or currently taking GLP-1s to describe multiple unsuccessful attempts at weight loss and maintenance in the past. What about the other 58%? They either “haven’t thought about it” (29%) or, are among those responding “neutral”, “excited” and “relieved.” We believe their responses indicate that they are confident that the lifestyle changes they’ve made through the Omada program will help them keep the weight off.
The Downsides of GLP-1 Use are Discouraging
In the long run, the downsides of being on these medications may also discourage patients from staying on them indefinitely, especially when considering the high copays and some not experiencing the expected results.
Side effects were most frequently cited by our surveyed members as the “worst part” of taking their medication, followed by the discomfort of injections.
In addition, the data we have from members who have already discontinued a GLP-1 strongly suggests that when the cost (literal and figurative) outweighs the perceived benefit, patients opt out.
We believe that cost and access will continue to be barriers to GLP-1s for the foreseeable future, particularly for low-income or marginalized populations, widening the equity gap in obesity care. For those who do have access to GLP-1s, utilizing a lifestyle change program staffed with clinicians with expertise in the medications could help address some of the issues raised by those who choose to discontinue their treatment.
As a busy primary care provider with the best intentions of being available to my patients when starting them on a new medication, I typically wouldn’t find out about side effects or what prompted them to stop taking the drug until our next visit, months later—and by then, they had already made up their mind that they wanted to try something else! Timely access to a care team that can address these issues in the moment may help improve GLP-1 outcomes.
What’s next?
We’ve uncovered a divide between the way patients perceive GLP-1s as a short-term fix and the clinical science behind how GLP-1s work. In addition, side effects, repeated injections, as well as cost and access are all contributing barriers at the moment.
There is still a great deal to learn about the GLP-1 landscape and its barriers, which requires further analysis and examination. Stay tuned for more learnings coming out of the Omada Insights Lab, through our new ANSWERS Initiative, whose next planned project will examine real-world evidence on the effectiveness of the Omada program on weight maintenance following GLP-1 discontinuation.
