When appetite is controlled by medication, what happens to the person when the medication stops?
These are my thoughts, shaped by more than 25 years of experience helping people lose weight, change their relationship with food and regain confidence in their ability to manage their health.
We are living through an extraordinary period in weight management.
GLP-1-based medicines such as semaglutide and tirzepatide have changed what is medically possible. They can substantially reduce appetite, improve blood-glucose control and produce levels of weight loss that were previously difficult to achieve without surgery.
The benefits should not be dismissed. In the SELECT trial, semaglutide reduced major cardiovascular events by 20% among people with established cardiovascular disease who were overweight or living with obesity but did not have diabetes. That is a meaningful medical achievement.
The benefits should not be dismissed. In the SELECT trial, semaglutide reduced major cardiovascular events by 20% among people with established cardiovascular disease who were overweight or living with obesity but did not have diabetes. That is a meaningful medical achievement.
But acknowledging what these drugs can do should not prevent us from asking an equally important question:
Do they create lasting health—or do they create results that remain dependent on continuing treatment?
My concern is not that GLP-1 medicines are ineffective.
They are clearly effective for many people.
My concern is that when medication becomes the entire weight-management strategy, it may suppress the problem without necessarily educating, strengthening or empowering the individual.
That is why I believe lifestyle medicine is approaching its defining moment.
The Difference Between Losing Weight and Learning Health
Weight loss is a physical outcome.
Health is a learned way of living.
A medication can reduce hunger, slow stomach emptying and influence the biological signals that regulate appetite and food intake. It may give someone welcome relief from relentless hunger or “food noise.”
However, medication does not automatically teach a person:
These abilities are not contained in an injection.
They must be taught, practised and eventually owned by the individual.
That does not make medication wrong. It means medication and education perform different functions.
Medication may quiet the appetite.
Education teaches people what to do with that opportunity.
ILLUSTRATION: TWO PATHWAYS
Medication-only pathway
Appetite suppression
↓
Reduced food intake
↓
Weight loss
↓
Ongoing dependence on treatment
↓
Treatment stops
↓
Hunger and food pressures may return
↓
Weight regain becomes more likely
Education-and-empowerment pathway
Awareness
↓
Nutrition education
↓
Structured real-food eating
↓
Accountability and support
↓
Repeated healthy decisions
↓
Greater confidence
↓
Skills that can be used for life
The two pathways do not have to compete. Medication may be used as a tool within the second pathway—but it should not replace it
What the Withdrawal Studies Tell Us
The real test of a weight-loss intervention is not simply what happens while a person is following it.
The real test is what remains when the intervention is reduced or removed.
In the STEP 1 extension study, participants who had received semaglutide regained approximately two-thirds of their previous weight loss during the year after treatment ended.
Many of the cardiometabolic improvements also began moving back towards their starting levels.
The SURMOUNT-4 trial produced a similar warning.
Participants initially lost an average of 20.9% of their body weight during 36 weeks of tirzepatide treatment. Those who continued the medication lost a further 5.5% during the following year. Those switched to placebo regained an average of 14%—despite continuing to receive counselling about diet and physical activity.
These findings do not prove that the medicines failed.
They show that the medicines continued to perform an important biological function while they were being taken.
When that function was removed, the biological pressures favouring weight regain re-emerged.
This is precisely why GLP-1 medicines are increasingly described as long-term treatments rather than short courses.
But that creates a major question for individuals and health systems:
Is lifelong pharmaceutical appetite control the only maintenance plan we intend to offer?
The Long-Term Cycle
For some people, the experience may develop into the following cycle:
1. Weight gain creates concern
The individual becomes worried about appearance, mobility, blood pressure, blood glucose or future disease.
2. Medication provides rapid hope
Appetite decreases. Portions become smaller. The scales begin moving.
The person may feel that something has finally worked.
3. Weight falls—but education may remain limited
Because hunger is quieter, the person may eat less without necessarily understanding why previous eating patterns developed.
They may lose weight without learning a sustainable food structure, building strength or addressing emotional triggers.
4. Treatment becomes difficult to continue
This may occur because of cost, adverse effects, availability, treatment fatigue, changing circumstances or a personal desire to live without ongoing medication.
5. Appetite returns
The person is once again exposed to old habits, food environments, emotional pressures and biological hunger—but may not possess a strong behavioural maintenance system.
6. Weight begins to return
The individual may interpret this as personal failure.
But the medication had been performing much of the appetite-regulation work. When it was removed, the underlying pressures returned.
7. The person restarts treatment
Confidence in personal ability may decline while dependence on the external solution increases.
The cycle then begins again.
ILLUSTRATION: THE REVOLVING DOOR
Start medication → Lose weight → Stop medication → Regain weight → Restart medication
This revolving door may be commercially sustainable for a pharmaceutical company.
It may be medically justified for some patients.
But it is not the same as teaching a person to become a capable guardian of their own health.
Self-Control Is Not Shame
Whenever self-control is mentioned in a discussion about obesity, some people assume it means blame.
That is not what I mean.
Obesity is complex. Genetics, hormones, sleep, stress, medications, trauma, social circumstances, income, food availability and an environment saturated with highly processed food can all influence weight.
The World Health Organization describes obesity as a complex, chronic and relapsing disease requiring comprehensive, lifelong care.
Therefore, telling someone to “just use more willpower” is neither compassionate nor adequate.
But it is equally unhelpful to suggest that people have no agency at all.
Self-control is not a moral verdict.
It is a collection of trainable skills: