A new study of nearly 8,000 patients shows that in the real world, a large number of weight loss drugs such as Ozempic and Wegovy have significantly less weight loss than it has made it possible to reduce weight in its famous clinical trials.
A year later, the average patient lost only 8.7% of his body weight, much lower than the 15-21% weight loss reported in clinical trials. The difference boils down to two main factors: Patients often stop taking medications, and doctors dosages are lower than those used in the study.
The findings, published in the journal Obesity, challenge high expectations surrounding GLP-1 drugs that have changed obesity treatments and attracted public attention. Although these drugs are still powerful tools for weight management, research shows that their real-life impact may be more important than many patients and doctors expect.
Reality gap
Researchers at the Cleveland Clinic analyzed prescription records and health data from 7,881 cases starting to take Semaglutide (Ozempic, Wegovy) or Tirzepatide (Mounjaro, Zepbound) to perform weight loss between 2021 and 2023. Results A prominent picture of these drugs was drawn in a carefully controlled study environment.
More than half of patients either stopped taking medication within one year or never reached a higher dose, which is most effective in clinical trials. Specifically, 20% withdrawal within three months, and another 32% ceased between three and twelve months, with maintenance doses lower throughout the treatment, exceeding 80% maintenance doses.
“Our study shows that obesity treated with half-lubin or trizepatide in a conventional clinical setting compared to what was observed in randomized clinical trials,” said Hamlet Gasoyan, Ph.D., of the Cleveland Value-Based Nursing Research Center. “Based on our data, the rate of discontinuation used in clinical practice and the lower maintenance doses can be explained by the use of randomized clinical trial environments.”
Key Real-World Results:
- Average weight loss: 8.7% (15-21% in clinical trials)
- Early smoking cessation (within 3 months): Only 3.6% of your weight reduction
- Late smoking cessation (3-12 months): 6.8% weight reduction
- Continuous Users: 11.9% reduction in weight
- High-dose serial users: tirzepatide lost up to 18%
Why patients stop taking these medications
The study identified several obstacles that could prevent patients from achieving huge weight loss in clinical trials. The most expensive, with many patients facing insurance coverage issues or potentially reaching $1,000 or more per month.
Side effects also drove the shutdown, although the study did not quantify its specific impact. Common complaints include nausea, vomiting, and gastrointestinal problems, which can make daily life uncomfortable. In addition, during the study period, drug shortages forced some patients to interrupt their treatment.
What is particularly striking is that in this real world, the cessation rate far exceeds the termination in clinical trials. Although the study reported a 14-17% withdrawal rate, the analysis found that more than 52% of patients stopped treatment within the first year.
Dosages vary
In clinical practice, widespread use of lower drug doses may be more surprising than the rate of discontinuation. The study showed that 79% of patients taking hemimerudamine and tirzepatide were still at low maintenance doses, which was lower than the level of huge results produced in clinical trials.
This finding is not emphasized within the initial coverage, but is a key insight into why real-world results are behind the experimental results. Patients who do reach higher doses and remain treated can achieve weight loss close to clinical trial results: 13.7% of high doses of half rupee, 18% of high doses of tirzepatide.
The reasons for lowering the dosing pattern are not entirely clear from the study, but may reflect physicians’ caution about side effects, higher dose insurance restrictions, or patient tolerance issues.
Beyond Weight: Blood Sugar Benefits
The study also traced blood sugar control in 1,320 patients with prediabetes at the beginning of treatment. Here, the effectiveness of the drug is obviously related to the durability of the treatment.
Among patients with prediabetes, 68% of patients who continued treatment reached normal blood sugar levels within one year, compared with only 33% of patients who stopped early. This difference has important implications because people with obesity can increase their risk of developing type 2 diabetes.
“Type 2 diabetes is one of the most common complications of obesity, so it is important to prevent diabetes,” Gasoyan noted. “This study highlights that discontinuing treatment, especially early treatment, has a negative impact on weight and glycemic control outcomes.”
Who benefits the most?
The study identified several factors that increased the clinically significant weight loss of patients by 10% or more. Women are almost twice as likely to reach this threshold as men. Patients taking Tirzepatide achieved better results than those taking Semaglutide, and those who achieved higher maintenance doses had better results.
Surprisingly, the study found that based on clinical trial data, patients who stopped taking the medication did not recover as quickly as expected. After the discontinuation of delivery, the weight trajectory remains relatively stable, indicating that patients can adopt other weight management strategies once the medication is stopped.
What does this mean for patients
For millions of Americans, who are considering or currently taking these medications, these findings should be both cautious and hopeful. Although real-world results may not match the sharp weight loss shown in clinical trials, these drugs still provide meaningful benefits to many patients, especially those with the ability to maintain treatment for a long time.
“Our findings on the realistic usage patterns of these drugs and related clinical outcomes can provide decisions on the role of discontinuation and maintenance doses in treatment in achieving clinically meaningful weight loss,” Gasoyan explained.
The study highlights the importance of addressing cost and access barriers to prevent patients from achieving optimal results. As these drugs become more extensive and potentially more affordable, their realistic effectiveness may be greatly improved.
Currently, patients and physicians should treat with realistic expectations while working to maximize their chances of success with adequate medication, ongoing treatment and comprehensive support for lifestyle changes. These drugs obviously work – just as huge as the headlines suggest.
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