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Weight loss jabs like Ozempic, Wegovy and Mounjaro, are considered by many to be miracle drugs. People using GLP-1s typically lose between 15 to 20 per cent of their body weight, while around a third of patients experience roughly 10 per cent of body loss. So, it’s easy to imagine when embarking on the treatment that the pounds will melt away – just like that.
For a significant portion of users, this isn’t the reality. As many as one in five people won’t lose weight on the medications. This can be chalked up to a myriad of reasons, including other conditions, like sleep apnea, which can prevent weight loss, or additional medicines like anti depressants, steroids and contraceptives, that can also inhibit the effectiveness.
Menopause, too, can have an impact, with lower estrogen changing the way in which women’s bodies store fat, burn calories and process glucose. Poor sleep and stress can also work against people, so weight loss jabs might reduce appetite, but not combat disruptive symptoms like night sweats and energy. Some research has shown that postmenopausal women treated with GLP-1 medication therefore have more noticeable results when combining weight loss jabs with HRT (hormone replacement therapy).
But arguably the most important denominator is often overlooked: obesity is a disease that stems from the brain. So, if your nervous system isn’t on your side to control and regulate your metabolism by sending signals to your organs, you may face an uphill battle to lose fat while your body is surviving each day in fight or flight mode.
A lot of women thought that GLP-1s were the magic solution and they haven’t been for everyone.
Naomi Holbrook
With or without weight loss jabs, research suggests that higher levels of stress can make successful weight loss more difficult, while people with lower baseline stress tend to achieve greater weight loss during behavioural weight-loss programmes.
“It means that the body doesn’t feel safe enough to be able to release fat,” explains nutritionist Naomi Holbrook, who’s known as The Unconventional Weightloss Coach thanks to her focus on emotional health and wellbeing over strict regimes and workout plans. She gets proven results, with one recent client shedding 100 pounds over the past year.
Holbrook has worked with many women who are secretive about using weight loss injections due to shame. This March, a survey published in the European Medical Journal found that two thirds of patients using weight loss drugs hide their treatment from some or all of their friends and family, with women (70 per cent) more likely to hide treatment than men (50 per cent).
“They hide them from their family, their children, their partners,” she says. “That creates more shame and more stress.” This is only exacerbated further when results fail to appear, while others around them shrink. “It’s a significant emotional toll,” says Holbrook. “A lot of women thought that GLP-1s were the magic solution and they haven’t been for everyone.”
Whether her clients are on GLP-1s or not, Holbrook’s ethos is to always identify and unpack the root cause that has given her patient an issue with food. There have been, for example, instances where people feel wasteful if they don’t finish what’s on their plate.
One in five people won’t lose weight while taking GLP-1s (Getty/iStock)
“So many people have a conditioning from childhood around food,” she says. “A lot of people in Gen X were told to ‘think of the starving children in the world’ – that becomes part of your identity.” Additionally, there’s a lot of reprogramming that needs to take place for those who were raise on the idea of “good” and “bad” foods, which can lead to yo-yo dieting, restricted and then overeating and binge eating.
On the flip side, over the past four decades, home-cooked food has declined in UK households, while processed and convenience foods have become more prominent, with food eaten outside of the home contributing significantly to calorie intake. Interestingly, a study for the Institute for Fiscal Studies found that while there has been an increase in calories from restaurants, fast food, soft drinks, and confectionery, there has been an overall decrease in total calories purchased. However, this decline in calories hasn’t led to weight loss, it has been significant weight gain which can be partially rationalised by the rise of UPFs as well as the decline in the strenuousness of work and daily life, and increasingly sedentary lifestyles.
Although GLP-1s notoriously treat food noise, so-called emotional eaters may find deep-seated cravings override the physical fullness signals that the medications provide. This can also be caused by missed injections, lack of sleep, and small, low-fibre, non-nutrient-dense meals that lead to stronger hunger later in the day for some.
While there is treatment available on the NHS for binge eating disorder (BED) where sufferers experience recurrent episodes of overeating that leads them to feel out of control and uncomfortably full, or bulimia, where someone is trapped in a cycle of binging, vomiting or over exercising, emotional eating can be subtler and less extreme – but still lead to obesity and all of the health conditions accompanying medical issues.
“I don’t tell my clients to stop having biscuits, eating chocolate, or having a glass of wine,” says Holbrook. “It’s not about restricting; it’s about helping them to understand and help the food noise in order to stop those habits becoming the automatic response to stress or unhappiness. So, we look at the physical aspects: sleep, stress, metabolism, hormones – and then the psychological and the identity part. There are so many threads.”
I’ve had women come to me and say that the food noise has become even worse than before they were on weight loss jabs
Naomi Holbrook
Those who stop weight loss injections tend to regain what they’ve lost in roughly 20 months, four times faster than traditional dieters, according to research by the University of Oxford. Half of people who stop taking weight loss drugs do so due to cost, or reaching their goal weight, studies have found. But without having made necessary lifestyle changes and developing motivation to maintain them, results can vanish in as little as 20 months of stopping the jabs.
Since these findings, experts have called for robust support for people using jabs to prevent them from regaining the weight that they’ve lost. However, a holistic approach alongside the drugs, could prove effective as a dual approach. Indeed, Holbrook believes those who work through their mental health struggles with food in therapy, possibly alongside antidepressants, don’t have to resign themselves to a lifelong use of the medication.
“I’ve had women come to me and say that the food noise has become even worse than before they were on weight loss jabs,” Holbrook says of the after effects. “It’s been silenced for a while but, unless you do the work on the root cause – why those signals get fired up originally – then they won’t just go away.”
For anyone struggling with the issues raised in this article, eating disorder charity Beat’s helpline is available 365 days a year on 0808 801 0677.
NCFED offers information, resources and counselling for those suffering from eating disorders, as well as their support networks. Visit eating-disorders.org.uk or call 0845 838 2040.