Can You Stop Taking a GLP-1? What the Research Says w/ Henrik Gudbergsen, MD, PhD

If you’ve reached your goal weight on a GLP-1, you may be wondering what comes next. Do you stay on the same dose indefinitely, move to a lower dose, or gradually taper off?

Ana speaks with Henrik Gudbergsen, MD, PhD, about the emerging evidence around personalized GLP-1 dosing and structured tapering. They examine what early observational research suggests, why lifestyle and behavioral support may matter during maintenance, and why stopping medication will not be appropriate, or possible, for everyone.

**IN THIS EPISODE**

- Why the least effective dose may be more appropriate than automatically increasing to the maximum
- How Embla’s gradual GLP-1 tapering approach works
- What early observational data suggests about maintaining weight after tapering
- Why nutrition, exercise, coaching, CBT, and acceptance and commitment therapy are part of the program
- Whether most people should expect to remain on GLP-1 medication long term
- How insurance coverage and cost can limit personalized dosing
- Why GLP-1 prescribing differs between Denmark and the United States
- How future medications, genetics, health conditions, and the gut microbiome may shape more individualized treatment

**ABOUT THE GUEST**

Henrik Rindel Gudbergsen, MD, PhD, is the medical lead and advisor at Embla, a digital weight-care company combining low-dose GLP-1 treatment, behavioral coaching, and digital tools. He is a practicing physician, associate professor, and principal investigator on anti-obesity medication trials, with a PhD in medical imaging and obesity research.

Henrik has spent more than 15 years at the intersection of clinical medicine, pharmaceuticals, and digital health. His previous experience includes roles at Novo Nordisk, Radiometer, Philips Healthcare, and IBM Watson Health, along with board-level experience in software as a medical device.

**CONNECT WITH HENRIK**

Embla:
https://www.joinembla.com/

Henrik’s YouTube channel:
https://www.youtube.com/channel/UCMdA5N4TeytPYmbfXjEPJDA

Read the GLP-1 study discussed in this episode:
https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.70096

**SPONSORS**

This episode includes messages from:

gutzy Organic—organic fruit and vegetable pouches with 8 grams of fiber:
https://gutzyorganic.com/

Johnson Fitness & Wellness—fitness equipment, expert guidance, delivery, and professional installation for your home workout space:
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Use code GLP1Hub5 for an exclusive GLP-1 Hub listener offer.

**CHAPTERS**

00:00 Can you taper off a GLP-1?
00:28 Episode introduction
01:47 Meet Henrik Rindel Gudbergsen
04:26 Why Embla uses the least effective dose
07:18 What the early tapering data showed
10:07 Behavioral support beyond diet and exercise
11:14 Sponsor: gutzy Organic
11:52 Why human coaching matters
13:16 Can most people stop GLP-1 medications?
18:02 Insurance barriers and personalized dosing
20:31 New real-world research from Denmark
23:28 Sponsor: Johnson Fitness & Wellness
24:43 How dosing practices differ between Denmark and the U.S.
26:07 The future of personalized obesity treatment
28:03 How Embla combines medication and coaching
29:41 GLP-1 Hub membership and closing

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Transcript

SPEAKER_00 0:00

And then over time, people started asking, so what do we do now? I've lost the weight that I I aimed for. How do I fare from here? Do I just continue or can I doze a bit down? Can I potentially taper off? And then we started a a more rigid approach that that ran over weeks to months before taking the decision to either doze down a bit or aiming for full tapering out of medication.

SPEAKER_02 0:27

You've reached your goal weight on the GLP1, and you might be wondering, do I need to stay on this medication forever? And if I want to lower my dose or stop, is there a structured way to go about that? Welcome to the GLP1 Hub Podcast. I'm Anna Reisdorf, registered dietitian and GLP1 user. And today I'm joined by Henrik Guberson, a family physician, associate professor at the University of Copenhagen, and chief medical officer at EMBLA. His research explores personalized dosing, intensive behavioral support, and what happens when people gradually taper off the medication. We discuss why Henrik's clinic focuses on the least effective dose instead of automatically moving everyone to the max, what his early observational data suggests about maintaining weight after a gradual taper, and why coaching, nutrition, exercise, and behavioral therapy may be so important. We also talk honestly about the limitations, how tapering won't be right for everybody. Many people may need the medication long term, and stronger long-term research is still needed. And if you've ever wondered whether a lower dose or eventually stopping could ever be part of your future, this conversation offers a thoughtful, evidence-aware place to get started. Let's get into the episode. Welcome to the GLP1 Hub Podcast. I am so excited today to speak to a researcher out of Denmark. Henrik, he did an incredible study that I first came across maybe a year ago about tapering off GLP1 medications. And I am so excited that I finally got him to come on. So can you introduce yourself and tell us a little bit about what you do?

SPEAKER_00 2:10

So my name is Henrik Gulbersen. I work as the chief medical officer for EMBLA. And besides that, I'm also a family physician practicing in my own practice in Copenhagen, and I'm an associate professor at the University of Copenhagen as well. Yeah, I think that's me in short, with a background from the pharmaceutical industry in the Nordisk and the tech industry in IBM, and then from the med tech industry in in Danaher, which is a large organization that owns med tech companies around the world, including one in Denmark.

SPEAKER_02 2:42

Wow. So what do you teach at the university?

SPEAKER_00 2:44

I teach in the general practice of family medicine. I have students on their last semester before they graduate. And then I have a couple of PhD students that I guide. Yeah, that's it. So a bit of teaching, a bit of research, and some supervision of PhD students.

SPEAKER_02 3:00

Okay. Awesome. Awesome.

SPEAKER_00 3:02

Yeah.

SPEAKER_02 3:02

So your family practice, is it just focused on kind of general medicine? Is there a specific focus of that practice?

SPEAKER_00 3:09

Or no, it it is focused mostly on general medicine. So everyday issues and challenges that people have and their family physician. So in demic that means that you have around 2,000 patients coupled to my practice. And then I'm exploring, I've been that been doing that for the last two years, how to bring clinical research into primary care, basically meaning that in the future we hope to conduct and be part of a phase two, phase three trials in clinical practice in the primary care sector in Denmark, which is new for us. So that's a big big challenge and and very exciting.

SPEAKER_02 3:47

Awesome. Awesome. Well that would probably give you a lot of subjects if you could like bring it into the primary care office.

SPEAKER_00 3:53

Yeah, and it's a good transition from doing most of the research in in the hospital setting, getting these trials into primary care will mean that we can hopefully shape protocols to fit what you could say a large group of patients, everyday patients with all that brings of comorbidities, the context of being in primary care, from my point of view at least, can really bring some value into the results we generate from clinical trials.

SPEAKER_02 4:20

Yeah. Well, I wish you wish you luck on that endeavor. Sounds like a valuable thing to do.

SPEAKER_01 4:25

Yeah.

SPEAKER_02 4:26

So let's talk a little bit about the research that you did with, I believe with Embla. Can you just start and tell us a little bit about what the study was about, how it was structured, and what you found?

SPEAKER_00 4:39

Yeah. So basically what we maybe if if I can take it just step a bit back and give a brief intro on what we do in Emblem because it it ties to what we then did in this investigation. So when we started creating Embla, we wanted to create a weight loss clinic that was, you could say, built within the framework of having a digital component and a coaching component, as well as a, you could say, medication protocol that put a strong emphasis on lifestyle change on top or as part of using a weight loss medication. And that really meant that we we developed the app and the framework, the digital framework we have at Empler, in in a context where we also had a strict focus on what that means and what we have to do digitally in order to support lifestyle changes over time. Not only being a weight loss clinic for three and six months out of people's life, but being that partner that you hang on to for years as you lose weight and hopefully maintain that weight loss over time. So that was really why we started. And then as we launched the clinic, we set a target based on previous research of wanting to aim for half we could say half percent, one percent weight loss per week. We know that you can lose weight faster or slower, but if we summarize, you could say, the evidence that we had at that point of time, it seemed beneficial to lose around half to one percent of your body weight per week. And with that, we we also wanted to use the least effective dose of weight loss medication. Not that we wanted to low dose on purpose, we just wanted to match up whatever is needed, or you could say medication-wise in the context of aiming for half a percent, one percent weight loss per week. And over time that developed into us using far less medication than the standard titration scale that you see in when you read the labeling weight loss medication. And then over time, people started asking, so what do we do now? I've lost the weight that I aimed for. How do I fare from here? Do I just continue or can I doze a bit down? Can I potentially taper off? And then we started a a more rigid, you could say, approach that that ran over weeks to months before taking the decision to either doze down a a bit or aiming for full tapering out of medication. And that clinical practice then became this publication that we represented back in at Eco in 25.

SPEAKER_02 7:19

And so you slowly tapered them off the medication, and then the study said that they were able to maintain their weight loss within a certain window for a period of time. So can you explain how long that was that they were able to maintain it with that protocol?

SPEAKER_00 7:36

Yeah, well, it it it took us a median, the median duration of of tapering down or off was around 20 weeks. So half a year about Yeah and then following this tapering off, we follow people. So what happens when when people come off medication? And when we looked in our data set at that time, a point in time, we could see that tapering off the megalotine did not result in a body weight regain within the first 12, 20 weeks. So basically people came off within 10 weeks' time after dose tapering was planned and initiated, and then the weight was maintained over 20 weeks. The thing is then that that we would like to redo that trial, and we're planning that because the the cohort is far bigger now, so a lot more participants in the cohort, and we have a longer time frame from when they started the uh the tapering. So this was just the data that we had at that time point.

SPEAKER_02 8:30

So would you say that their success on keeping the weight off was about the lifestyle changes that you were also helping them implement through the app and through the program? Or do you think that there's something about this tapering that is what's supporting the weight loss?

SPEAKER_00 8:46

We don't know that for sure. But to the best of my lot, it's because we don't have RCT data exploring that question. If we look at our main publication from around that time, we showed that people lost more or less the exact same amount of weight over 64 weeks, regardless of whether or not they were on 0.25, 0.5, or 1 milligram of sematlotide. Which in our interpretation of that science, and there can be multiple interpretations of that, was that that weight loss medication is important. But since we're able to gain the exact same weight loss over 64 weeks, regardless of your your level of medication, the lifestyle changes that you also engage in seems to be very important. Because we can basically reach the same weight loss target or amount of weight loss over 64 weeks, independent of your weight loss medication dose. And that also talks into what we've seen in the era before these very effective weight loss compounds coming out, that weight maintenance and weight loss can be achieved if you have support for altering your lifestyle. Not saying that it's easy, but it can be done. And lifestyle has always, you could say, been important when we look at weight loss data back in time, 10, 15 years back.

SPEAKER_02 10:07

Sure. So what what are the pieces of that lifestyle program? Like what does it entail?

SPEAKER_00 10:14

So in in our context, I think the a key part of it is that the app is not just built for weight loss. It's built for supporting a lifestyle journey. That that's one uh one one part of it. The second is that we learn we we work with psycho psychological psychosocial learning principles. So we work with cognitive behavioral therapy and acceptance and commitment therapy, CBT and ACT, on top of diet, exercise as as key elements. And that can for some entail a focus on emotional eating patterns, discussions and engagement in why we approach life in in specific ways. Could be you could say previous traumas or experiences from the past that influence behavior right now when it comes to eating, drinking, exercise, etc.

SPEAKER_01 11:06

Mm-hmm.

unknown 11:07

Right.

SPEAKER_00 11:07

So I think that's that's that's a key component of why we reach these uh these results.

SPEAKER_02 11:13

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SPEAKER_00 12:03

So you have recipes, you have small, yeah, you could call it lessons or you could say educational pieces that you can go through, you have a digital assistant that could that you can engage with, and you have, and that was mainly what we had at the beginning, because we as we set off, you have humans that you can discuss and engage with, either over text or video or phone calls. And they played a huge role initially, and then the digital universe has developed over time for the last uh few years.

SPEAKER_01 12:34

Mm-hmm. Right, right.

SPEAKER_00 12:36

And with that, you could say that live engagement entails the use of coaches, psychologists, nurses, physicians.

SPEAKER_02 12:43

Mm-hmm. So I think the personal personal support is a big piece of it. Like it is. There's a lot of apps out there that you can get information from. And you know, YouTube is full of maybe information, maybe not all good quality information, but there's plenty of information in the available in the world. But I think the human part is is really important.

SPEAKER_00 13:01

Yeah, I agree. In in in most cases within medicine, we we do not lack information. We have a lot of it. It it's getting it into action and you could say converting it into something that that seems feasible and attractive is is the tricky part.

SPEAKER_02 13:16

Right. Right. So in terms of people being able to get off the medication, you know, I don't have I don't I'm not a aware of like all the research about it, but from what I've seen, it seems like 80% or people gain 80% of the weight back within a year. That's kind of like the bigger trials. And we were talking before we came on. It's hard for me to tease out how much of that is kind of propaganda from pharmaceutical companies wanting you to stay on it forever, how much of that is happening in real life. Or like your research was interesting to me because it seemed like that was the first time I came across some type of protocol, you know, some type of plan, right? Everybody asked me, what do I do now? And I haven't seen anybody else really answering that question. Um, and maybe there is more research that you're probably familiar with. So, where are you at with people being able to stop this medication? Do you think that that's gonna be a common thing that's possible for most people? Do you think that most people are gonna have to stay on a little bit? Or like where, in your opinion, where where are we at with that?

SPEAKER_00 14:19

I think most people will have to continue medication when we look at data right now. Some people will be able to taper a bit down and some will be able to taper completely off. And even with those tapering off, there might be a need for reinitiating the uh the medication again. I think the majority will have to stay on for a very long period. I won't say forever because we we don't have data showing that, and there's a lot of investigations done on animal in animal studies that if we extrapolate from there may be shown over time, if it also entails humans, may show over time that you can actually taper off or taper down at least when when you could say a longer period has has gone. So when we look at what we know right now, and you're correct in saying that it it it looks as if most will regain weight and have to stay on medication. We just had a publication roughly two months ago based on taceptide, and it did in fact show that if you use a lower amount of you could say medication, you lose a bit less weight compared to when you taper to the uh the maximum dose. And if you stop using the medication, you will regain weight. And we've seen that in many trials. This was just a recent one. I think the important aspect here is that if you have an ambition to taper down or off, you need to, at least based on the data we've shown and published, you need to engage in in a program where you significantly alter your habits or your lifestyle. If you are to have a chance at some point to taper down or completely off. If if we move back, that must be around 15 years. There's a study I did with some of my fellow PhD students, uh published back in must be around 2013-14. We showed that you could actually maintain weight loss over three years after initially losing around 10% of your body weight. And that was done completely on dietary uh and and and a dietary intervention and a lifestyle intervention, including exercise. The important aspect back then was that the uh coaches, dietitians that participants engaged with initially during their initial weight loss were also engaged in being part of people's or participants' weight maintenance phase over time. So basically we split the group after the initial weight loss, we split them into two groups, one with everyday adaptations where they replaced one of their main meals with a bar or soup or porridge, and the other group coming in once every quarter for a boost of you could say engagement and focus on lifestyle changes. And both groups over 36 months actually maintained the initial 10% weight loss, more or less. So the importance of lifestyle is not to be underestimated. I think weight loss medication is fantastic. Looking at data in the broad sense, also if you go into each publication and read about how much emphasis that trial had on lifestyle, changes in engagement shows that lifestyle is really key for achieving uh a great initial weight loss, but also for creating an opportunity to weight, maintain your body weight or weight loss over time, and potentially, but we don't know that for sure right now. Also creating an opportunity for for those tapering either down or completely off. But we don't know for sure. So I think the short answer will be most will will will have to be keep taking the the weight loss medication at least for a very long period.

SPEAKER_02 18:02

Right, right. The challenge, at least here in the United States, is that the insurance company wants to control your dose. So I wanted to be on a ha on a half 2.5 milligrams, and they wouldn't pay for that. No, they only pay for 5, 10, or 15. So this kind of thing, while I find it really interesting, makes it challenging like with navigating the restrictions and like getting them to pay for medication, which is very expensive. So it's just I hope that that will resolve so people can personalize their plan a little bit more. Um, because I do I am seeing a change with providers realizing that maybe you don't need the highest dose, maybe you don't need the highest dose forever, maybe you can come down a little bit. Like the the issue, the limitation, at least in the United States, is is the insurance company.

SPEAKER_00 18:49

They just Yeah, yeah. Yeah, and I think if if we view how we behave a physician and patients in other, you could say, areas of of of health and and medicine, we always or most likely will take the approach of using the least effective dose available. I I can't I I can't we could say there's no area from from what I can see where we just you could say titrate to the maximum dose without reviewing or assessing whether or not we're achieving what we set out to achieve. So using the least effective dose in in weight loss makes sense. Yeah. Why go for a higher? Because we we know that we have side effects, it is more expensive. But but let's see over time. And I think another area that's important in relation to your question is that over time, just within the next three to five years, we will have several other compounds coming out. And some will be, you could say, ru well, the pattern will run off on some of the older compounds. So in the future you would have 10, 15, 20 different weight loss medications to choose from. I foresee a future where you will be choosing a compound based on who you are, the weight loss you're trying to achieve, your baseline weight when you engage in the weight loss uh journey, and you may even change between different medications over time. So I think it will be far more flexible when it comes to dosing, but also the choice of weight loss medication depending on who you are, your comorbidities, your your your your aims as a patient. We don't know nearly enough about that yet, but it hopefully hopefully we will in the future.

SPEAKER_02 20:32

Sure. So you mentioned that you're involved in some new research. What can you share about that? Like what are the things that you're working on right now?

SPEAKER_00 20:39

Yeah, so right now we will submit an abstract to Obesity Week, a US conference. We'll do that next week, I think. That's the deadline. And in in that abstract, we'll show data that are based on Danish data from EMBLA in uh in Denmark around the uh the management that that we have of patients in Denmark losing weight. And we, in that abstract, have combined our own data with nationwide register-based data. So basically in Denmark, we can access all publicly available data through a research license, and we can even take this the social security code, which is unique for each individual in Denmark, we can take that from our EMBLA population of patients and combine that with the nationwide register-based data. And that gave us the opportunity could to compare how do patients in EMBLA fare over time when and compare that up against patients who uh using weight loss medication in general practice, so basically all GPs in Denmark. And we could compare EMBLA up against all other online clinics in Denmark. So basically we could create three three different groups and look at how people fare over time. And what we can show there is that we do, in fact, use less medication and people. Tend to stay on treatment in EMBLA far longer when compared up against the GPs and other online clinics.

SPEAKER_02 22:08

And do they lose weight with the support?

SPEAKER_00 22:11

That's the only thing that we can't look at because weight los weight, body weight is not registered anywhere in the registries in Denmark. So we only have our own data, which is not something that we can just change. So basically we have a lot of data around use of medication and how often people pick up their prescriptions, AIDS, uh educational level, etc. etc. But we don't have body weight.

SPEAKER_02 22:34

Too bad.

SPEAKER_00 22:35

Which is annoying. But that's how it is. So so we compared what we can compare. That's probably not going to change anytime soon. It it's it's not systematically captured in in any HR systems in Denmark, unfortunately.

SPEAKER_02 22:48

Right. That's that's that's unfortunate because it would be cool to see if the lifestyle piece that you are implementing compares to somebody just like going to their doctor, getting a prescription, and you know, see you later.

SPEAKER_00 23:01

Yeah. Well, I we we probably won't ever be able to show that. But we we we could at least show that they they stay uh roughly a hundred days longer when they join MBLA. And we do use uh less medication when we look at pickup at the pharmacist. So it's not just something that we can see in our own data. We can actually validate that up against register-based data on actual use of medication in real life from the pharmacist.

SPEAKER_02 23:28

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SPEAKER_00 25:06

Sure, sure. I think it's a bit it it is a bit different here in Denmark. So we use a bit less medication than than GPs. And I think that is because of the lifestyle and the behavioral therapy program that we have. But we also know looking at register-based data from the Danish healthcare system broadly, that GPs tend to use far less medication than than than physicians in in the US as an example. So physicians in Denmark would typically titrate people up to one milligram and rarely above that. And that's generally speaking, there's a publication on that that has looked into what is the real-world use of her magnetotide in Denmark. And it doesn't follow the the usual, you could say, approach of going all the way up to 2.4. So it is it is very different from the US. But it's also because it's out of pocket. So people pay for this themselves, and it is expensive.

SPEAKER_02 26:01

Mm-hmm. Yeah, that would make sense. And they're like, let's stay on the lowest dose. So the price doesn't have to go up for me.

SPEAKER_01 26:07

Yeah.

SPEAKER_02 26:07

Yeah, that totally makes sense. So I like to ask at the end of the podcast, what are you excited about for the future? Maybe in your own research or in other studies that you've heard about or something that's that's coming down the pipeline.

SPEAKER_00 26:19

I think practically everyday perspective on that is that I'm really looking forward to, and I that's just a hope that we will get reimbursement, at least for some groups, for the use of weight loss medication. It is a tough thing to get through as a GP or physician in general. I have one patient as a general practitioner who gets to Sebathaide paid for by uh the healthcare system in Denmark, but it's a it's a long process of getting that reimbursement and it takes three to six months of back and forth discussions. And and creating a framework where this can be become more available for patients in need could be specific groups with a high BMI or comorbidities that we need to manage would be great for patients. I think that's that's the number one for me. Number two is for sure seeing a growth in the amount of weight loss medication that we will have available in the future. It will be interesting to to move to a place where a phenotype, maybe even a genotype, over time can be used to select what medication for for which patient. And then I think some some of the uh the uh the science that we are looking into now, focusing on the gut microbiome and various other domains in relation to to weight loss and weight loss medication is gonna be super interesting. We don't know nearly enough about how the gut microbiome, as an example, influences uh weight loss. What's the impact of the gut microbiome in relation to weight loss medication, etc.? So that's that's that's one domain. There are many others, but that I think that that would be my top three areas of interest.

SPEAKER_02 28:05

Yeah, I think there's still so much to unpack with this weight thing and the lifestyle, the microbiome, and the genes and all of these things. It's just like so much, so much that we still don't understand, which is surprising. So um can you tell the people a little bit more about Embler or where they they can connect with with you or the program or anything like that?

SPEAKER_00 28:25

Sure. Yeah, so shortly now Embler is operational in Denmark and in the US. I think the the key takeaway and thing to know about EMBLA is that we pair low-dose medication with this intensive behavioral coaching approach. And when we look at the published data, we have access to data on more patients. We have published data on close to 3,000 patients showing that we deliver around 16, 17% weight loss, the same as you see in clinical trials. On about a third of the drug compared to to these uh pivotal trials. And based on what we know right now from science at large, but also our own, we believe that medication opens the door, but the engagement in lifestyle and the habits that we work with are what keeps uh the weight off over time.

SPEAKER_02 29:15

Yeah, definitely. I agree. I agree. And thank you so much for for doing that and and putting emphasis on that. And I I really appreciated that that paper that you wrote. It was, like I said, the first one that that I came across that had some kind of plan for the people to get to maybe have hope of of how we could get either get off the medication or lower the dose, because that's a question that I get often. So I really, really appreciate you being here and sharing all your insight.

SPEAKER_00 29:38

Thank you. Thanks for the invite.

SPEAKER_02 29:40

Thank you. Thank you so much for listening to this week's episode of the GLP One Hub Hub podcast. I have been wanting to have Henrik on for a long time because I came across his study and was absolutely fascinated by it. Also, I want to let you know that in our GLP One Hub membership, we are gonna be running a three-week meal confidence challenge where we will teach you how to create a nutrition framework for yourself that doesn't rely on food lists, meal plans, trying to follow somebody else's perfect diet. So you can address any situation, restaurant meals, vacations, anything like that, feeling confident about what you're eating, and it's gonna help you reach your goals. And you can get that for just five dollars. Try out the three week trial. And if you want more information, make sure you're on the Steady State newsletter, which is the newsletter that I send out every Tuesday. You can find the link below in the show notes, and we get started on August 17th. And I'll see you in the next episode.