Diet or Drugs 3? First Wegovy, Then What?

Some large proportion of GLP-1 drug users will discontinue use eventually. What do they eat then to maintain their weight loss?

Medical professionals and insurance benefits administrators have started avidly searching for effective off-ramps for people on GLP-1s. That is partly because once patients reach their target weight with the drug’s help, they might be able to dispense with the weekly self-injections and any uncomfortable side effects. It’s also because the popularity of the expensive drugs threatens to bankrupt some insurance providers if too many people never go off the medications.

Bradley Olson, “A Year After I Stopped Taking a Weight-Loss Drug, I’ve Lost 20 More Pounds,” The Wall Street Journal, March 21, 2025.

Conspicuously absent from that Wall Street Journal short-list of organizations “avidly searching for effective off-ramps for people on GLP-1s” are the pharmaceutical companies themselves. The industry has plenty of financial incentive to get consumers on their drugs, and precious little—if any—to get them off.

Even if these drugs turn out to be Pharma’s gift to humanity, making some large proportion of users indefinitely leaner, healthier and happier—as Pennsylvania Senator John Fetterman says in a recent NY Times op-ed has happened to him over his 10 months of use—there will always be those for whom the risk-benefit analysis, whether financial or physiological, doesn’t work out so well.

The more people who go on these drugs, the more people will eventually want to get off. If nothing else, they’ll want to see if they can maintain the drug-induced benefits without the seemingly inherent risks and complications of lifelong drug therapy.

Many will justify the use of these drugs, and whatever discomfort they might produce, until they’ve achieved a healthy weight. As the years go by, they’ll wonder if they can maintain that weight loss without the drugs and any associated discomfort and expense. Others will want to get pregnant (or find themselves pregnant) and will worry about what the drugs might do to their unborn child. As for insurance companies, how cheap will these drugs need to be such that insurers can afford to pay not just for a year or two of weight loss, but a lifetime of weight maintenance?

The GLP-1 drugs will solve the weight loss problem for a huge portion of humanity, but that problem has never been that difficult to solve. We’ve always known that most people can lose a significant amount of weight by semi-starving themselves, if nothing else. The problem has always been maintenance: maintaining the necessary dietary fix for life. The GLP-1 drugs don’t remove this challenge. They just reassign the lifetime adherence/maintenance obligation from diet to drugs.

Obvious question: for those who either can’t afford lifetime GLP-1 therapy, or prefer not to live with the risk and expense, what’s the post-drug alternative? That question, of course, shifts the weight maintenance problem right back to diet: What’s the dietary alternative to lifelong GLP-1 therapy? Is there one?

Can we look to an anecdote for guidance?

With no roadmap to follow for post-GLP-1 weight maintenance, maybe an anecdote will help. As with virtually all weight loss stories, we do have a good one.

This is the story told by the WSJ editor, Bradley Olson, whose WSJ article I quoted up top. That article is Olson’s third, so far, describing his experience, first losing 40 pounds in five months on Mounjaro (a GLP-1 drug similar to Wegovy and Ozempic), then struggling to maintain that weight loss, and finally, in this latest, winning that battle (so far) and losing another 20 pounds.