GLP1s – The Health Care Blog

The ‘After Phase’ Is Missing: Why Every GLP-1 Prescription Needs an Exit

Nov 4, 2025

By HOLLI BRADISH-LANE

I’ve seen clients start GLP-1 medications full of hope—and stop them feeling betrayed by their own biology.

Some reached their limit with side effects: relentless nausea, fatigue, or the quiet loss of joy in eating. Others simply couldn’t afford to stay on. A few never saw the promised results at all. But for nearly all of them, the story ended the same way—one step forward, five steps back.

We celebrate the success stories of GLP-1s, but we rarely talk about the crash that follows when treatment stops. And it’s not just psychological. The body rebounds fast—hunger, weight, and metabolic chaos rush back in.

The problem isn’t the medication itself. It’s that we’ve built an elegant on-ramp for GLP-1s—and almost no off-ramp at all.

The Evidence Is Already Warning Us

The data couldn’t be clearer. In the STEP-1 extension trial, participants who stopped semaglutide regained roughly two-thirds of the weight they had lost within one year. Their blood pressure, cholesterol, and blood-sugar levels slid back toward baseline.

A nearly identical pattern appeared in the SURMOUNT-4 trial for tirzepatide: those who continued therapy maintained—or even deepened—their weight loss; those who stopped rapidly regained.

Meanwhile, the SELECT cardiovascular outcomes trial showed semaglutide reduced major cardiac events in people with overweight and obesity. That’s a major win—but also a reminder that stopping abruptly can erase much of the benefit.

Both the American Diabetes Association 2025 Standards of Care and the American Gastroenterological Association guidelines now emphasize continuing anti-obesity pharmacotherapy beyond initial weight loss goals.

The implication is simple: for most patients, GLP-1s are not a 12-week intervention—they’re chronic therapy.

Yet in real life, chronic use isn’t always realistic.

Why So Many Will Stop Anyway

Insurance coverage ends. Supplies run short. A job changes, or a deductible resets. Some patients plan a pregnancy, experience intolerable side effects, or simply want to know who they are without the injection. Others plateau despite perfect adherence and feel the drug has stopped working.

In each case, the result is the same… withdrawal without a plan.

Sami Inkinen, Virta Health

Oct 21, 2025

Virta Health is in the diabetes reversal business. It’s a medical group that for a decade has been aggressively coaching people with diabetes and cardiometabolic disease to radically change their eating habits–basically to eat the right things for them, to saity. Some how in a nation obsessed with processed food and carbs they have succeeded for a lot of people. And the business is growing fast, with over $160m in annual run rate. Ten years in since it started I spoke with CEO Sami Inkinen about how and why it works, and what the future for this approach is in a world of GLP1s (and no there’s no GLP sales in that revenue number!)–Matthew Holt

Seriously, Aon, you think weight loss drugs save money?

May 14, 2025

By AL LEWIS

Last month Aon, the major benefits consulting firm, released a “study” claiming:

A significant opportunity to reduce healthcare costs for employers and enhance overall workforce health through a comprehensive obesity management program that includes GLP-1 medications.

This, of course, is the opposite of what most researchers have shown. And in the immortal words of the great philosophers Dire Straits: “Two men say they’re Jesus, one of them must be wrong.” We’ll shortly see who’s wrong (um, meaning about weight loss drugs) when we dive into the study in a minute. But first, let’s review Aon’s previous analyses.

A brief history of Aon

Aon claimed that Accolade saved 8%, but it looks like they must coincidentally have been absent both on the day that the biostatistics professor explained how control groups work, and also on the day the fifth-grade math teacher explained how averages work.

Then, they claimed that Lyra – which is a mental health company – achieved the following non-mental improvements in the set of patients who had at least one mental health encounter with one of their “220,000 high-quality providers”:

§ A 30% reduction in non-mental health-related ER visits

§ A 30% reduction in generic drug spending

§ A 20% reduction in specialty drug spending

Thanks in part to starting the y-axis at $4000 to improve the optics, Aon also revealed that Lyra achieved a very high “efficiency ratio”:

A graph of a number of people

AI-generated content may be incorrect.

I can’t object to that finding because – despite three decades in this field, about 100 articles/interviews/quotes/citations including the Wall Street Journal, two trade-bestselling books and one Harvard Business School case study – I still don’t know what an “efficiency ratio” is, other than that has nothing to do with comparing participants to non-participants in a mental health study. Apparently an “efficiency ratio” in healthcare measures how quickly a hospital turns over its inventory. So Aon’s use of the term recalls the immortal words of the great philosopher Bob Uecker: “Juuussst a bit outside.”

When publicly and privately asked to explain any of these things, Aon clammed up. That was likely wise on their part.