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Cosmos Study

Patients with Higher Initial BMIs and Greater Weight Loss While on GLP-1s Most Likely to Maintain or Continue Weight Loss After Stopping GLP-1s 

June 13, 2024
Dual-Team Study
Team A:Kersten Bartelt, RNJoe Deckert, PhD
Team B:Matthew Gracianette, MDBrendan Joyce

Key Findings

  • One in four patients who started a glucagon-like peptide-receptor agonist (GLP-1) medication at a BMI of 40 or higher doubled their weight loss one year after discontinuing semaglutide or liraglutide. 
  • Two in three patients who lost at least 40 pounds on semaglutide or liraglutide maintained or continued their weight loss one year after discontinuing the medication. 
  • More than half of patients who were prescribed semaglutide or liraglutide for at least 90 days were able to maintain or continue their weight loss one year after treatment.  

In a previous study, we found that a majority of patients maintain their weight loss a year after stopping GLP-1 use.1 To further understand what factors might influence whether patients were likely to maintain, regain, or lose more weight, we studied 25,552 patients prescribed semaglutide and 33,456 patients prescribed liraglutide for at least 90 days continuously between January 1, 2017, and February 1, 2023.  

In the year following discontinuation of semaglutide or liraglutide, patients with class 3 obesity–a BMI of 40 or greater–when starting a GLP-1 medication were much more likely to maintain or lose additional weight compared to those who started treatment with a healthy weight–a BMI between 18.5 and 25. Among patients prescribed semaglutide, 62% of patients with class 3 obesity maintained or continued to lose weight after one year, compared to 37% of patients with a healthy BMI. Patients prescribed liraglutide saw similar rates with 62% of patients with class 3 obesity and 45% of patients with a healthy BMI maintaining or losing additional weight after one year. 

Figure 1
Post-GLP-1 Weight Change by Starting BMI Classification
Post-GLP-1 Weight Change by Starting BMI Classification
Figure 1. Weight change one year after stopping GLP-1 by starting BMI classification.

We also found that patients who lost at least 40 pounds while on semaglutide or liraglutide were more likely to maintain or continue their weight loss one year after the end of their treatment compared to those who lost less weight during treatment. Of patients who lost at least 40 pounds, 67% prescribed semaglutide and 68% prescribed liraglutide either maintained their weight or continued to lose additional weight one year after ending treatment.  

Figure 2
Post-GLP-1 Weight Change by Weight Lost on Treatment
Post-GLP-1 Weight Change by Weight Lost on Treatment
Figure 2. Weight change one year after stopping GLP-1 by weight lost on treatment.

Patients who were prescribed semaglutide or liraglutide for at least one year were slightly more likely to maintain or continue to lose weight in the year following treatment. More than half of patients prescribed semaglutide or liraglutide for all treatment durations studied were able to maintain or continue their weight loss one year after treatment.  

Figure 3
Post-GLP-1 Weight Change by Duration of Treatment
Post-GLP-1 Weight Change by Duration of Treatment
Figure 3. Weight change one year after stopping GLP-1 by duration of treatment.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 246 million patient records from 1,400 hospitals and more than 32,500 clinics from all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.   

References

  1. Bartelt K, Mast C, Deckert J, Gracianette M, Joyce B. Many Patients Maintain Weight Loss a Year After Stopping Semaglutide and Liraglutide. Epic Research. https://epicresearch.org/articles/many-patients-maintain-weight-loss-a-year-after-stopping-semaglutide-and-liraglutide. Accessed on April 11, 2024.