Weight regain after stopping GLP-1 medicines isn’t a treatment failure — it shows that obesity is a chronic, relapsing condition. Like other long-term therapies, benefits last only while treatment continues. Reframing obesity this way can improve outcomes and reduce stigma.
A recent newspaper article described the results of a large meta-analysis of glucagon-like peptide 1 hormone (GLP-1s) for weight loss, noting (in the fifth paragraph) that people lost an average of 8.3kg while on treatment. This would seem to be a positive development for people living with obesity.
However, the focus of the article was on the fact that people who stopped treatment quickly regained their weight. This is, of course, a valid research question – how long do the benefits of treatment persist? – but to us, leading with this finding highlights differences in how obesity and its treatments are sometimes perceived relative to other chronic conditions. Indeed, the article quotes Dr Sam West, the lead investigator of the study, who emphasises, “This [weight gain] isn’t a failing of the medicines – it reflects the nature of obesity as a chronic, relapsing condition.”
The World Health Organization describes obesity as “a chronic, relapsing disease arising from complex interactions between genetics, neurobiology, eating behaviours, access to healthy diet, market forces, and the broader environment”. A symptom of obesity is excess weight but, as with any chronic condition, the underlying disease remains even when the symptoms are successfully managed. Weight-loss treatments – perhaps better described as weight-management treatments – help persons living with obesity maintain a healthier weight, but they do not cure obesity.
For most chronic conditions, we don’t expect the benefits of treatment to persist once medication is stopped, nor would we see this as a failure of the medicine. Of course we would hope for a ‘silver bullet’ treatment that can cure an otherwise chronic condition, but just as we would not be surprised if a person’s high blood pressure returned when they stop treatment, we should not be surprised if a person’s weight returns when they stop treatment.
The difference in expectation comes from a difference in perception
We think this framing is indicative of differences in how the public perceives obesity compared to other chronic conditions, even conditions like high blood pressure or high cholesterol that have similar genetic, environmental and lifestyle risk factors.
Arguably, at the heart of this difference is the widespread stigma around obesity. Obesity is still widely viewed as a personal failing, rooted in poor willpower and bad choices, rather than as a complex, chronic condition shaped by biology, environment, behaviour and circumstance. Against that backdrop, weight-loss medicines are often framed as a shortcut, or even ‘cheating’, rather than effective medical care. Addressing this stigma will be central to improving outcomes for people living with obesity, as well as reducing wider healthcare and economic costs.
Part of how this stigma plays out is through the visibility of obesity. Body weight is visible to others in a way that high LDL-C cholesterol or high blood pressure are not. This makes it easier for society to judge those living with obesity. Likewise, fluctuations in weight are more visible than fluctuations in blood pressure or cholesterol. Such fluctuations are a routine part of managing any chronic disease, but in the context of obesity, they can be perceived as visible ‘failures’ in a way fluctuations in other measures are not. Early controversies around access, supply constraints and cosmetic use of GLP-1s have also muddied perceptions of weight loss medicines for obesity.
Obesity management is long term, not acute
Perhaps the most striking manifestation of this stigma is how ongoing treatment is framed. Staying on obesity medication is often described as “dependency”, whereas in other areas of medicine we would simply call it persistence or adherence. Statins provide a useful comparison: many people take them for life, even when cholesterol is well controlled, because their benefits only persist while an individual is on treatment. When statins are stopped, cholesterol and cardiovascular risks usually rise again. In that context, staying on treatment is seen as effective adherence to prescribed care, not a failure.
This is not to suggest that weight-management medicines are a silver bullet as we described above, or that long-term use will be appropriate in every case. There are still open questions about the effects of long-term use, adverse effects, and how we should combine medical treatment with effective behavioural and social supports.
However, we must also ask whether we have different expectations for obesity treatments than we do for treatments for other chronic conditions, and if so, how much of this is driven by our perceptions of obesity.
When weight returns after treatment ends, it’s easy to interpret that as a limitation of the medicine. To us, however, it is simply confirmation of Dr West’s observation of obesity as a chronic, relapsing condition. Understanding obesity and its treatment as we do any other chronic condition, rather than as a personal failing or dependency, would improve the lives of people living with obesity, and reduce their risk of costly and potentially fatal consequences.
Disclaimer: This blog was not commissioned or paid for by any organisation. The views expressed are those of the authors and reflect a personal, evidence-informed interpretation of current research and public discourse. The content is intended for general discussion and does not constitute clinical advice.