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VIENNA — Just over half the adults without diabetes who started taking the GLP-1 semaglutide (Wegovy) for weight loss discontinued treatment within a year, with a marked drop-off in younger adults, according to a large nationwide study in Denmark.

Adults aged 18-30 years were nearly 50% more likely to discontinue treatment than those aged 45-60 years. Men and individuals with socioeconomic deprivation, higher levels of comorbidity, and prior use of gastrointestinal or psychiatric medications had a greater likelihood of stopping within the first year.

“We know that how these medications perform in real life can be very different from the controlled settings of clinical trials, in which patients are carefully selected and their treatment plans closely followed,” remarked Reimar W. Thomsen, MD, PhD, physician and clinical epidemiologist, Aarhus University Hospital, Aarhus, Denmark, while speaking to Medscape Medical News. “Financial constraints and a predisposition to experiencing adverse effects seem to play a role in discontinuation [of semaglutide for weight loss].”

Thomsen presented the findings at the European Association for the Study of Diabetes (EASD) 2025 Annual Meeting.

Real-World Data Are Different From Trials

Semaglutide for weight loss shows significant weight reduction, noted Thomsen. But, he emphasized, “these trials included selected patients with obesity who had very high adherence (> 80%), nearly all reaching maximum dose, and who received free treatment, close follow-up, and extensive support.”

He added that US data already suggest high discontinuation rates within the first year of semaglutide use for weight loss. “We wanted to know if Denmark would do any better and to understand if specific patient characteristics or subgroups would drive early discontinuation and to what extent this might be caused by lack of tolerability or simply financial constraints.”

The researchers drew on Denmark’s nationwide health registries to estimate the likelihood of stopping semaglutide for weight loss in the first year and to explore baseline predictors of discontinuation in adults without diabetes, adjusted for age and sex.

The study included 77,310 adults who initiated semaglutide between December 2022 and October 2023. Median age was 50 years, and 71% were women.

Thomsen noted that the population was largely Caucasian and that, despite Denmark’s tax-financed healthcare system, semaglutide for weight loss is paid for out of pocket (approximately €2000 per year for the lowest dose, mid-2025), similar to most other countries. “Our study includes all social levels, education, and backgrounds as it is a truly population-based nationwide study,” he said, underscoring the generalizability of the findings.

Young People Most Likely to Stop

Within 1 year, 52% of adults (n = 40,262) discontinued semaglutide for weight loss; discontinuation occurred in 18% at 3 months, 31% at 6 months, and 42% at 9 months.

Age showed the strongest association with discontinuation after adjusting for sex — participants aged 18-30 years were significantly more likely to stop than those aged 45-60 years (risk ratio [RR], 1.48; 95% CI, 1.45-1.51).

The next strongest association was found among those living in low-income areas, who were 14% more likely to discontinue than those living in high-income areas (RR, 1.14; 95% CI, 1.10-1.17).

Thomsen highlighted the disconnect between discontinuation and obesity prevalence. In Denmark, lower-education and lower-income groups have about twice the prevalence of obesity compared with those with higher education. “This is especially among younger people, where severe overweight is socially very skewed,” he said.

Young people also have less disposable income for out-of-pocket drug costs, which was reflected in the findings — younger adults and those in low-income municipalities were more likely to discontinue. “This is of special concern since these factors are also associated with a more severe obesity burden,” he noted.

He referenced a recent study showing a strong socioeconomic gradient in semaglutide prescription rates, where only 1.3% of individuals in the lowest income quartile received the drug compared with 3.6% in the highest income quartile. “This is directly opposed to obesity prevalence and really concerns me,” Thomsen said. “It increases social inequality, rather than improving it.”

History of Gastrointestinal or Psychiatric Medications

People with prior gastrointestinal medication use (RR, 1.09; 95% CI, 1.08-1.11) or psychiatric medication use (RR, 1.12; 95% CI, 1.10-1.14) were more likely to stop.

Thomsen noted that discontinuers were more likely to initiate psychiatric medications after starting semaglutide, suggesting psychiatric side effects may play a role. Gastrointestinal side effects, commonly reported with GLP-1 receptor agonists (RAs), likely contributed as well.

Individuals with cardiovascular disease or other chronic conditions were about 10% more likely to discontinue (RR, 1.11; 95% CI, 1.08-1.14 vs RR, 1.09; 95% CI, 1.04-1.14). Men were also more likely than women to stop treatment (RR, 1.12; 95% CI, 1.11-1.14).

Some discontinuers may have been satisfied with modest weight loss, Thomsen added, “maybe just a modest loss of some kilos, without major side effects and without believing in the need for long-term use.” However, he cautioned that many may be surprised by the difficulty of maintaining weight loss after stopping.

Commenting for Medscape Medical News, David D’Alessio, MD, chief of the Division of Endocrinology and Metabolism, Duke University School of Medicine, Durham, North Carolina, said the study confirms several previous reports of poor adherence to GLP-1 RAs in large cohorts.

“Given the intense demand by patients to start these drugs, the relatively rapid cessation of what should be chronic treatment is surprising,” D’Alessio said. “It seems likely that multiple factors contribute to discontinuation, including cost, side effects, and failure to meet expectations.”

He added, “Greater communication about patient experience on semaglutide and similar drugs, including appropriateness of dose, is important to understand why people do and do not stay on treatment.”

Thomsen declared that Thomsen’s employer, the Department of Clinical Epidemiology, is involved in other studies with funding from various companies as research grants to (and administered by) Aarhus University. None of these studies relate to the present study. Thomsen reported giving presentations on epidemiologic research (with or without financial compensation) for companies, including AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and Sanofi. D’Alessio reported serving on the executive committee for two tirzepatide trials (Eli Lilly).