A recent NY Times article suggests that we will probably need to use them forever. You can read the article below and see how they make their case. While there are definitely benfits healthwise to lowering your weight, and even benefits derived as the GLP-1 medications such as Zepbound by Lilly lower our desire for certain cravings and may help people overcome things such as alcoholism, the truth is that we do not fully appreciate what problems will be caused years later from malnutrition caused by a reduced desire to eat. In the USA, often the problems begin with what we eat and how much of it we consume. Other problems with the gut which also controls our desire to eat,. our inflammation levels and how we keep weight off were years in the making. Often this started with a poor food pyramid, high calorie and low nutrition processed foods and juice boxes full of sugar which alters our gut from early in our lives. Reversing this takes time and requires thoughtful management other than just buying the drug. The Hard Truth of Weight-Loss Drugs: You Probably Need Them Forever Why I see these drugs and their benefit as a bridge to lower weight. Many of my patients have heard me suggest that GLP-1 drugs should be a bridge to better eating habits. There is some evidence that due to cost or just practicality, some patients are weaning themselves off of the drugs and successfully keeping the weight off. This one size fits all approach in a small study group can offer some hope that what I have said may be correct and people are naturally weaning down but not off the drugs and maintaining their weight while exploring this for themselves. Most Patients Keep Weight Off With Fewer GLP-1 Shots, Study Finds This recent article suggests that we can wean ourselves off but I believe that we can totally get off of the drugs by modifying our diets and food desires while on them. What the exact protocols would be for a year long GLP wean off program may require further study and it may require us to think outside of one size fits all solutions as different people have different issues that make it difficult to break the food habituation and turn it into better diets and habits. An effective evidence based use GLP-1 medications in a successful weight loss program. It is important to consider using these meds as a tool to use to help you reprogram the gut, change bad dietary habits and improve health with weight loss over the short term. We may even be able to use them to help diabetics reverse insulin resistance developed over years of poor dietary habits and too much sugar. The focus and ultimate failure of many weight loss regimens and surgeries such as the sleeve with its mandatory counseling has to do with why we cannot change our eating habits. Our understanding of why we maintain weight, the hormones that drive us to overeat and the types of food we eat ultimately affect our health. Treating them on the medical side with drugs and management making these chronic conditions is expensive and non curative. The idea that food is medicine has caught on because better food equals less illness. Perhaps, part of the reason other countries are healthier and have lower healthcare costs and require fewer drugs has to do with how they get their food, their dietary habits and how they use their medical systems. Here’s is how I would design a Glp-1 based weight reduction program. GLP-1 treatment for a period of 5-6 months to reach the desired weight. Concurrent evaluation of diet and transition to healthier foods while avoiding sweets and most sugars. Eventual weaning off of GLP-1 meds while maintaining desired weight. Final transition to a healthier diet and a weaning away from most sugars to resolve carbohydrate compulsions. Maintenance phase until GLP-1 meds are no longer needed. These programs should be co managed by dietitians and physicians who prescribe the medications. As many people who are overweight have metabolic syndrome, are of different genetic and sex backgrounds, we should customize the approach according to the needs of the individual, something our healthcare system does not do well. Better incentives result in better care, data and ultimately a method to improve the health of people who need not just weight but metabolic change to keep the weight off. This combined with more active lifestyles will help this approach succeed better than most diets ever could. Will we ever get there?