The recent surge in the use of the GLP-1 injection medications have shown how effective these agents can be , safe (at least in the short term), and very effective but very expensive. At present, there are no established guidelines for how long these medications can be used. Present potential side effects may involve the digestive track, causing nausea, vomiting, constipation, and abdominal discomfort; the pancreas, potentially causing pancreatitis a serious inflammation of the pancreas; and the thyroid gland, associated with medullary thyroid cancer. However, there is also the concern about their long term use and serious side effects developing many years in the future, and the longer they are used the more likely side effects will begin to appear. Many companies, for example RO, use heavy marketing campaigns to promote the sale of ‘weight loss injectables’ that may be different and divergent from the FDA approved injectables and provide for less than adequate and appropriate medical evaluations before their use. There is nothing wrong with marketing, but marketing healthcare is different and more complex than marketing products. And there is a concern about the long term use of these medications without addressing many of the underlying issues and causes that are associated with overeating, especially when overweight individuals want to rely on a passive approach to weight management with medications rather than an active change in their eating lifestyle behaviors. The GLP-1 medications can help you to get started on a weight loss journey, but changing what and how you eat will keep you successfully on that journey. When overweight individuals question whether they need to remain on the GLP-1 medications for life, unless they are able to make the necessary eating behavioral changes that are needed for establishing a healthy weight stability. The answer may be yes. When you stop using these injectables whether it be with intermittent use or continuous use, you must not return to your prior eating and drinking habits, or your weight will then return. Stopping the GLP-1 injections of and by itself will not cause a weight gain, but eating and drinking extra calories will definitely result in a weight gain. Also, the effectiveness of these medications may wane and diminish over time and potential side effects may surface to be detrimental and harmful. Because your lower intestine produces a hormone during digestion that is functionally identical to the GLP—1 agent, you can by eating more slowly, 15-30 minutes, to finish your meal and eating more vegetables and protein, use your own naturally produced GLP-1 to help give you the sense of fullness and reduced hunger that you desire. Long term ,this behavioral eating change may be just as effective, safer, and much less expensive.Peter Vash, MD, MPH