Improve Antiobesity Medication Adherence to Improve Results: Hamlet Gasoyan, PhD

Hamlet Gasoyan, PhD, researcher at the Center for Value-Based Care Research at Cleveland Clinic, says improving adherence to antiobesity medications requires honest, early conversations about both the adverse effects of long-term treatment and the risks associated with discontinuing.

A Cleveland Clinic study from 2023 showed less than 20% of study participants were still taking their antiobesity medication at 1 year.1 When asked if doctors need to take a new approach to boost adherence, Gasoyan said absolutely.

Patients are unlikely to achieve the widely publicized results seen in clinical trials and on social media unless they continue treatment long enough to reach high maintenance dosages, Gasoyan explained. While acknowledging the reality of cost- and side effect–related discontinuation, he added that future work must focus on building evidence-based recommendations for patients who stop glucagon-like peptide-1 (GLP-1) therapy and offering clear guidance on next steps.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What are the next steps to improve patient adherence to antiobesity medications in real-world settings?

The difference, as you mentioned, in the prior study compared to this study was that prior study also included older generation obesity medication, so the overall rate was low. But when you look, even in that study when we were looking at the subset of patients who started on semaglutide, their persistence rate was higher, it was around 40%.

Now here, obviously it's a little bit different time period, shortages have improved, and our outcome measurement was a little bit different.2 In that study we looked at persistence; here we looked at discontinuation. It was a little bit lower than 50%, so the results are comparable. But going back to your question about whether we should do something about it, absolutely.

First, I believe that all this data prompt us to emphasize [that] the discussion between the health care provider and patient at the time of decision-making on whether GLP-1 medication or dual agonist medication is the choice for the treatment of obesity should be focused on the stakes of treatment and continuation. You don't see the results that everyone pretty much expects from the ads and social media if you only take it for a short time. So, stakes are high in terms of treatment continuation and also being able to reach these higher maintenance dosages to achieve the topline results that people hear from the randomized controlled trials.

But also, I think we need to meet the patients where they are. We do understand that there are certain realities that dictate the need to discontinue. If someone cannot afford it or they cannot tolerate the side effects, well, that's their reality. That's where we need to meet them at where they are.

In our future body of work, we're trying to build evidence-based recommendations on what other options are out there for them. Because the conversations about obesity pharmacotherapy really became popular after GLP-1s, and we should be thankful for that, but there are other tools for the treatment of obesity also. Unfortunately, currently, there aren't really evidence-based recommendations for patients who start, achieve some weight loss, and then they discontinue, and that's what we are working next, to produce those recommendations for what's next for them.

References

1. Gasoyan H, Pfoh ER, Schulte R, Le P, Rothberg MB. Early- and later-stage persistence with antiobesity medications: A retrospective cohort study. Obesity (Silver Spring). 2024;32(3):486-493. doi:10.1002/oby.23952
2. Klein HE. Real-world use of GLP-1s yields less weight loss than clinical trials. AJMC®. June 10, 2025. Accessed June 18, 2025. https://www.ajmc.com/view/real-world-use-of-glp-1s-yields-less-weight-loss-than-clinical-trials