Optimizing weight health: Reasons to de-escalate or discontinue anti-obesity medications

As demand for GLP-1 medications continues to rise, WeightWatchers for Business (WW4B) offers employers, pharmacy benefit managers (PBMs), and health plan buyers access to a product that provides individualized experiences at every stage of the weight health spectrum and strategies to effectively manage medication costs.

GLP-1s may need to be discontinued or de-escalated for various reasons. For example, when members reach the maintenance phase of their weight-loss journey, they may not want and/or have access to chronic GLP1 care. Or some patients may achieve their weight health goals even before the medication has been maximally titrated, allowing them to maintain a lower dose or transition to a less expensive class of medication for maintenance. In other words, if a member and their clinical provider determine that they’ve reached a healthy weight or BMI for them, it may be appropriate to de-escalate the member from a GLP-1 medication.

Additional factors may lead to an individual
de-escalating from GLP-1 medications

1. Intolerance

The most common signs of intolerance to a GLP-1 medication are chronic nausea, vomiting, and diarrhea that is not improved even after the clinician tries a variety of options. If the symptoms are mild enough, a member may not choose to discontinue, but severe symptoms that affect a person’s day-to-day life may warrant stopping the medication, though this is rare.

2. New contraindication
If a patient begins a new medication that shouldn’t be used with a GLP-1, it may require that the medication be discontinued.

3. BMI under 22
GLP-1s are FDA-approved for people with a BMI over 30 or a BMI of 27 or higher (with at least one weight-related health issue, like type 2 diabetes or high blood pressure, for example). If a member has achieved a BMI of 22 or lower, a lower dose of a GLP-1 or de-escalation from a GLP-1 to a less expensive medication for maintenance may be offered. However, if a patient is living with type 2 diabetes and weight loss has plateaued, the drug may be continued based on the provider’s and patient’s clinical assessment.

4. Sustaining weight loss after de-escalation
Regardless of the treatment modality, behavior change serves as the foundation, and encourages lifelong healthy lifestyle habits. This, combined with supportive communities and individualized coaching, empowers members to continue working toward reaching and maintaining their weight health goals, with or without the aid of GLP-1 medications.

Based on decades of WW research in members without medications, and a WW observational study with more than 6,000 participants, clinically significant weight loss is achievable for members with or without medication. (1)

In one study, participants who used the WeightWatchers behavior change program and clinical interventions with medication management saw an increase of 11% in relative weight loss performance compared with those using clinical interventions alone — regardless of whether they were on a second-generation GLP-1 medication or a different AOM. (2) 

These studies suggest long-term, clinically significant weight loss is possible on and off medications using the WW behavior change program elements.

Join the movement to do weight health management better. Request a demo from WeightWatchers for Business. 

Read more:

Check out part one in this two-part blog: Utilizing step therapy and de-escalation to manage costs while optimizing weight health 

1 Ard JD et al. Twelve-month analysis of real-world evidence from a commercial telehealth obesity treatment provider. 2024. Under review.

2 Based on an analysis of virtual clinic member data at 4 weeks of membership comparing those who initiate WW’s behavior change program and those who don’t completed in Jan 2024.