Why We Need to Shift the Conversation from ‘Offboarding’ to Ongoing Care

As GLP-1 medications like semaglutide and tirzepatide continue to transform obesity care, there’s a growing push to figure out how to “wean off” these treatments.

Patients want to stop them.

Systems want to reduce costs.

And entire business models are springing up around “offboarding” support.

But let’s be honest: the data just doesn’t support this idea.

A new real-world study published in Obesity tracked nearly 8,000 people treated with semaglutide or tirzepatide for obesity (without diabetes). It found that people who stopped their medication—early or late—lost significantly less weight than those who stayed on it:

• Average 1-year weight reduction was 8.7%

• 11.9% weight loss at one year for those who continued treatment

• Only 3.6% if they stopped early

• And 6.8% with late discontinuation

• Higher maintenance dosages and continued therapy correlated with higher odds of achieving ≥10% weight loss.

And it wasn’t just the scale that suffered. In people with prediabetes, A1c improved by 0.4% when they stayed on treatment—but barely moved (or even worsened) when they stopped. That means higher risk for diabetes, fatty liver, heart disease, and more.

So Why Are People Stopping?

Depending on the region, cost and access remain the biggest barriers. But surprisingly, the second most common reason is that people felt the medication “wasn’t working.” That’s despite an average real-world weight loss of 5-10%—a clinically meaningful number, but possibly not “life changing”.

This likely has less to do with the medication and more to do with expectations. Many people assume that as long as they’re on the drug, weight loss should continue indefinitely. So when the inevitable plateau happens (which is normal, biological, and expected), it feels like the medication has “stopped working.”

We’ve done a poor job of educating patients and providers about what success actually looks like. A plateau isn’t failure—it’s maintenance. And long-term maintenance is a massive win in a disease that’s historically been defined by regain.

There’s also a deeper cultural issue: this enduring belief that “I should be able to do this on my own.”

Where does that come from? Likely decades of diet culture whispering that we just need the right app, the right cleanse, or the right willpower. The false promises of the weight loss industry have always outpaced what science could offer—and now, they’re seeping into how we talk about medications.

We sold people false hope with diets.

And now we’re at risk of doing it again with medications.

Obesity is a chronic disease. And like other chronic diseases, it often requires ongoing treatment. The exact form of that treatment may change—dose, drug, modality—but the need for treatment doesn’t go away just because someone feels better or hits a number on the scale.

This study is a reminder that real-world care is messy. Discontinuation is common. Expectations are misaligned. And yet, even under those imperfect conditions, the results—when people stay on treatment—are powerful.

It’s time we stop selling the fantasy of “getting off” treatment.

Instead, let’s start building a system that supports staying on it—physically, emotionally, AND financially. It’s not cheating, it’s simply treatment.

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