Navigating Your Health Journey on a GLP 1

Food Noise Over Time on GLP 1s

While GLP1 medications are remarkable in their weight loss results, in clinical practice, durable outcomes are hampered by high discontinuation rates. While it is easy to blame cost for this, the truth is that it is probably a lot more complex than that. Since discontinuation is a marker of dissatisfaction with the treatment, let’s look a little closer at why it may be happening.

Side Effects, Cost, Contraindications

Let’s agree that there are a few straightforward reasons why a treatment is discontinued: side effects, access, or something changes in their health and it is no longer appropriate. These are reasons for discontinuation that are common to any medication. Side effects are more likely at the beginning of a medication course because it is simply not a good fit.  Access to a medication can happen with brand name medications most often because insurance never approved it, or insurance changed and the new insurance does not cover it, or a deductible resets and the out of pocket cost increases significantly. Changes in health conditions that lead to discontinuation tend to be things like pregnancy, cancer diagnosis, or other. Things like this happen with all medications types, and adherence to medications like blood pressure or cholesterol medications are not perfect, either. But, with the GLP1 medications, there is this situation where more than half of people are discontinuing them at one year even though they seem to be working great; why is that? 

Weight Loss Expectations

Discontinuation was the topic of a speaker of Obesity Week in Atlanta 2025. The prevailing theme was that a person was more likely to discontinue the medication if they felt it was not working. They measured this by surveying people on their “goal weight”, “satisfied weight”, and “disappointed weight.”  They then compared these expectations to the typical weight loss on these medications. What they found was that oftentimes, the typical weight loss predicted by studies was in the “disappointed weight” range and that for every additional pound lost, a person was less likely to discontinue the medication. The conclusion was that it is important to assess expectations and goals of care and address them before and during treatment. Average weight loss is 14-21% depending on the drug and formulation chosen, but results vary significantly. Assessing an individual’s goals, monitoring their weight loss curve, and addressing any issues along the way, can help ensure to optimize durable health outcomes. 

Food Noise 

The predominant mechanism of action of these medications is to reduce food intake.  Studies show that effects on satiety, satiation, and appetite suppression are profound, but do vary among individuals and, most importantly, evolve over time in the same individual. For the majority of people, the appetite reduction and enhancement of satiety and satiation (also known as food noise:), is a welcome change. Occasionally, however, it ventures into a food aversion, in which a person finds it hard to eat. 

Hedonic vs. Nutritive Eating

These medications also tend to change a person’s desire for the type of the foods they desire. People find less drive for hedonic eating (eating for pleasure, often highly palatable foods), and a predominance in a drive for nutritive eating (eating for nutrition).  They may find they crave whole, unprocessed foods predominantly. Again, this transition from hedonic eating to nutritive eating is typically welcomed, although occasionally there may be psychosocial aspects that complicate things. As always, it is important to respect the individual’s health journey and navigate what comes. 

Evolution of Effects

The reduction of food noise and appetite often lessens over time while remaining on a GLP 1 medication, even though weight loss does not. This can cause uneasiness that the medication is no longer working and the fear that weight regain will happen. This is understandable, since this is the first time we have actually had an effective and durable treatment for excess weight. In the past, many people have followed weight loss plans to the letter, or taken earlier generation weight loss medications, only to experience weight recurrence despite their efforts. However, with these GLP 1 medications, while the desire to eat may increase over time, the weight management effects are durable as long as a patient consistently takes the medication. Studies on this phenomenon are mostly observational, meaning they describe it but do not establish the cause of it.  The terms dynamic and stable phases are used. The dynamic phase is the weight loss phase and the stable phase is the weight maintenance phase. In the dynamic phase, there is a calorie deficit and the body is in a catabolic state, burning stored calories for part of its energy. In the stable phase, intake is more isocaloric. Weight loss may be subtle, and body composition changes can certainly continue, but weight loss is not as dramatic and cravings and hunger have started to return. However, my theory is that it may be a normal reflection of energy storage and energy needs in the body.  The body is meant to drive hunger and calorie intake based on energy needs and energy stores in order to maintain homeostasis. In the disease of overweight/obesity, this balance is “off”, leading to less regulated food noise. When they are initiated, the food noise is quieted, and excess adipose tissue is catabolized for energy. However, as excess energy stores are depleted and energy demands continue, and potentially increase in physical activity and exercise is increased, it is necessary for calorie intake to increase. In this theory, it is beneficial if the suppression of appetite reflects the phase in which a person’s energy balance is at the time. In this situation, reassurance and an increase in calorie intake leads to body composition stabilization. This is in contrast to intrusive thoughts of hunger during weight loss, when a dosage increase or looking for other causes of hunger, such as sleep apnea or a medication that causes weight gain, is needed. Therefore, it is important to look at each individual and see which is needed: increase in calorie intake (protein, fiber and water?) in the stable phase of weight management, or increased intensity of treatment in the dynamic phase of weight management. If we get it wrong, people tend to discontinue treatment or have excessive loss of lean body mass or subcutaneous adipose, both of which are detrimental to their health. 

Navigating Your Health Journey

These medications are powerful tools, and, like any powerful tool, their real power lies in using them wisely. Currently, high rates of discontinuation likely reflect the need for additional research and models of care to better meet the needs of people living with the chronic metabolic condition of overweight/obesity. With discontinuation rates of 50% or higher at one year, we are yet in the infancy of navigating the course, but the future is bright. Having a guide with tools, training, perspective and expertise with whom to partner can help. Let's keep working together.

Take Back Your Health Journey, 

Valerie Hope-Slocum Sutherland, MD