Study finds cost, not side effects, is the main reason people stop

Cost and insurance problems — not nausea, not disappointing results — were the most common documented reason people stopped taking injectable semaglutide or tirzepatide for obesity, according to a Cleveland Clinic study published October 2, 2025 in the journal Obesity ^[2].

Researchers pulled electronic health record data from a single integrated health system in Ohio and Florida covering January 2022 through December 2024 ^[1]. They randomly selected 288 adults with overweight or obesity and without type 2 diabetes who started injectable semaglutide or tirzepatide and then stopped within the first year. Of those, 145 had been on semaglutide and 143 on tirzepatide ^[1].

What the chart notes said

Cost or insurance-related issues were the primary documented reason for 137 patients, or 47.6% of the sample ^[1]. Inability to tolerate side effects accounted for 42 patients (14.6%). Another 34 (11.8%) could not fill their prescription because of drug shortages. Seven patients (2.4%) switched to a compounded version of the medication, and just 5 (1.7%) stopped because their weight loss was unsatisfactory ^[1].

The remainder fell outside those buckets: 31 patients (10.8%) stopped for other reasons, and for 32 (11.1%) the record did not specify a reason at all ^[1].

Timing mattered too. The authors reported that cost or insurance barriers were the most common reason at every time point studied, but patients who quit over cost tended to do so later in treatment, while those who quit over side effects tended to do so earlier ^[2].

The study is cross-sectional, meaning it captured reasons documented in the chart at one point rather than following patients forward. It draws on one health system in two states, so the mix of reasons could look different under other insurance markets or in other regions. The 11.1% of records with no stated reason is a real gap — those patients could have stopped for any of the listed causes. The paper does not report what happened to these patients afterward, including whether they restarted or regained weight; that is not covered in the available material.

For context, the authors note that randomized trials of semaglutide and tirzepatide have shown body weight reductions of roughly 15% to 21% in people with overweight or obesity who do not have type 2 diabetes ^[2].

Why it matters for patients

The practical takeaway is that in this US sample, stopping these drugs looked less like a medical decision and more like an access problem. Nearly half of the discontinuations traced back to what a plan would or would not cover, or what the out-of-pocket price turned out to be. Side effects — the reason that gets the most attention in public conversation — accounted for less than a third as many stops ^[1].

That has a few implications. Coverage for obesity medications can change at plan renewal, when an employer drops a benefit, or when a prior authorization expires, and the finding that cost-driven stops cluster later in treatment is consistent with people hitting those walls after they have already started ^[2]. Shortages were also a meaningful factor in this 2022–2024 window, driving 11.8% of stops ^[1].

Only 2.4% of patients in the sample were documented as switching to a compounded product ^[1]. That is a small share, though the study period overlaps with the years when brand-name supply was constrained.

The authors conclude that the findings "highlight the need for policies to address cost" and could shape conversations between clinicians and patients about both cost and side effects before treatment starts ^[1].

The work was funded by the Cleveland Clinic Research Program Committees ^[2]. Two authors disclosed industry ties: Dr. W. Scott Butsch reported advisory board fees from Novo Nordisk, Eli Lilly, Boehringer Ingelheim and Abbott, plus research funding from Eli Lilly, all outside the submitted work; Dr. Michael Rothberg reported consulting fees from the Blue Cross Blue Shield Association. The other authors declared no conflicts ^[1].