GLP-1 Medications: What No One Tells You

Ozempic. Wegovy. Mounjaro. Zepbound. If you've been anywhere near a conversation about weight loss in the last two years, you've heard these names. GLP-1 medications have become the most talked-about development in weight management since calorie counting.

And I understand the appeal. Completely. Because I almost went on one myself.

I was at a point where nothing was working. Perimenopause, an underactive thyroid, years of metabolic dysfunction, and a relationship with food that I'd been fighting since I was 14. I seriously considered lying about my BMI and hiding my eating disorder history to get a prescription. That's how desperate I was.

I didn't go through with it. Instead, I did the hard work of figuring out what was actually going on in my body. But I'm not telling you that to say “I'm better than you for not taking them.” I'm telling you because that experience gave me a perspective on GLP-1s that most coaches and most prescribers don't have.

“I'm not anti-GLP-1. I'm not pro-GLP-1. I'm pro-honesty. And there are things about these medications that deserve a more honest conversation than they're currently getting.”

What GLP-1 medications actually do

GLP-1 stands for glucagon-like peptide-1. It's a hormone your body produces naturally. It helps regulate blood sugar, slows gastric emptying (so food stays in your stomach longer), and signals to your brain that you're full.

GLP-1 medications mimic this hormone at much higher levels than your body naturally produces. The result is reduced appetite, quieter food noise, and for many people, significant weight loss.

For type 2 diabetes, which is what these medications were originally developed for, the evidence is strong and well established. The benefits for blood sugar regulation, cardiovascular health, and metabolic markers are real.

The conversation gets more complicated when we talk about using them purely for weight loss in people without metabolic conditions.

The part most people don't hear

The clinical trials for GLP-1 medications are impressive. Significant weight loss. Improved metabolic markers. Reduced cardiovascular risk. But the follow-up data tells a different story.

A 2026 systematic review published in the BMJ, led by researchers at the University of Oxford, analysed 37 studies involving over 9,000 adults. They found that after stopping GLP-1 medications, weight increased by an average of 0.4kg per month. For newer medications like semaglutide and tirzepatide specifically, the regain was faster: about 0.8kg per month. At that rate, researchers estimated most people would return to their starting weight within 18 months to 2 years.

A separate 2025 meta-analysis published in eClinicalMedicine found that people with obesity who stopped GLP-1 treatment regained an average of 5.63kg, with semaglutide users regaining more than liraglutide users.

Perhaps most importantly, the Oxford study found that weight regain after stopping medication was faster than after ending behavioural weight loss programmes like diet and exercise support. The researchers suggested this may be because people using drugs don't need to consciously practise changing their diet to lose weight, so when they stop the medication, they haven't developed the practical strategies to keep it off.

This matters because roughly half of people who start GLP-1 medications stop within 12 months, often due to cost, side effects, or access issues.

What the medication doesn't build

GLP-1s are effective at doing one thing: making it easier to eat less. They quiet the food noise. They reduce appetite. They create a window of calm that many people, especially those who've been fighting food noise for years, have never experienced.

But they don't build metabolic health. They don't address insulin resistance at its root. They don't build muscle (in fact, studies suggest 15–60% of weight lost on GLP-1s can be lean muscle mass). They don't fix your sleep. They don't manage your stress. They don't repair your relationship with food.

And they don't address why you were struggling in the first place.

For someone with binge eating patterns, food noise driven by years of restriction, or emotional eating rooted in trauma, a GLP-1 medication can feel like a miracle. The noise stops. The compulsion eases. But the underlying drivers are still there. The biology of hunger signalling, the neuropeptide imbalances from years of dieting, the dopamine pathways, the cortisol patterns, the unresolved relationship with food. All of it is waiting when the medication stops.

This is the part that concerns me most. When someone with an undiagnosed or unacknowledged eating disorder goes on a GLP-1, the medication silences the symptoms. They believe the problem was simply that they ate too much. The deeper issue goes unaddressed. And when the medication stops, the patterns come back, often harder than before, now with the added shame of “even the medication didn't work for me.”

Who GLP-1 medications are genuinely designed for

GLP-1 medications were developed for type 2 diabetes. That's evidence-based medicine doing what it should. The benefits for people with genuine metabolic conditions are well established and supported by decades of clinical data.

The expansion into weight management has helped many people. But it's also created a situation where medications are being prescribed, and increasingly purchased online, without adequate screening for eating disorders, without psychological support, and without any plan for what happens after.

The missing conversation

The conversation that almost nobody is having is this: what are you building underneath?

If you're on a GLP-1 medication and you're losing weight, that's a window of opportunity. The reduced appetite and quieter food noise give you space to do the foundational work that will determine whether your results last.

That means building muscle through resistance training to protect against the lean mass loss that comes with rapid weight loss.

It means learning to eat properly, not just less. Adequate protein. Real food. Stable blood sugar.

It means working on your sleep, your stress, and your relationship with food.

It means developing an exit strategy, so that when or if you come off the medication, you have a metabolic foundation that holds. This is one of the most common questions I get asked — and it's covered in detail in the services FAQ.

Without that work, you're essentially renting results. And as the Oxford researchers pointed out, when the rental agreement ends, the weight comes back faster than it would have with behavioural change alone.

Where I stand

I work with people at every stage of the GLP-1 journey. Considering it. Currently on it. Coming off it. My position is simple: the medication can be a useful tool, but it's not a plan. The plan is what you build underneath. If you're wondering what working with a GLP-1 support coach actually looks like in practice, the services page has the detail.

I don't judge anyone for choosing medication. I almost chose it myself, and I understand the desperation that drives that decision. What I do care about is making sure people have the full picture before they start, and that they have support for the parts the medication can't do.

If you're on a GLP-1 and losing weight but your foundation isn't changing, your sleep isn't improving, your muscle mass is dropping, and nobody has asked about your relationship with food, that's a gap worth closing. Sooner rather than later.