A compassionate look at semaglutide, tirzepatide, and the long-term reality of weight loss drugs. 

Lately, I’ve had many conversations about medications that act on incretin hormones, including GLP-1 (glucagon-like peptide-1) receptor agonists like Ozempic, Wegovy, and Saxenda, as well as Mounjaro, a newer drug that targets both GLP-1 and GIP (glucose-dependent insulinotropic polypeptide) receptors. Originally developed to treat type 2 diabetes, these weight loss medications have become household names in the UK and beyond as their use for weight management has grown rapidly.

You may have seen them everywhere, from headlines and podcasts to social media. They’re often hailed as “miracle cures” for weight loss, sparking widespread excitement and sometimes anxiety about their role in our health and culture.

So today, I want to create a gentle space to pause and ask: How are you feeling about all this? Whether you’ve tried these drugs, are considering them, or are watching the conversation from the sidelines, your feelings are valid and important.

Quick Navigation

• What Are GLP-1 Weight Loss Medications?
• How Do They Affect Appetite and Cravings?
• Long-Term Safety and Side Effects
• What Happens After You Stop the Medication?
• Comparing Popular GLP-1 Drugs
• Access and Approval in the UK
• Non-Medication Alternatives
• Reflective Questions for Your Journey
• Final Thoughts

What Are GLP-1 Agonists and How Do They Work?

GLP-1 agonists mimic a natural hormone in our bodies called glucagon-like peptide-1 (GLP-1), which helps regulate blood sugar, appetite, and digestion. These medications reduce brain signals for hunger, resulting in a decreased desire to eat. They also slow the rate at which food leaves the stomach, increasing feelings of fullness and prolonging satiety. Additionally, GLP-1 agonists stimulate insulin release and suppress glucagon secretion, which helps prevent blood sugar spikes and improves overall blood sugar regulation. Emerging evidence suggests these drugs may influence dopamine signaling in reward-related brain regions, potentially reducing emotional or compulsive eating, although more research is needed.

For people with type 2 diabetes, GLP-1 agonists can be life-changing by lowering blood sugar and reducing the risk of complications.

Because they slow stomach emptying and reduce hunger signals, GLP-1 medications have also been approved for weight loss in people without diabetes. This effect has led to their wider prescription in the UK and worldwide for chronic weight management.

In the UK, the National Institute for Health and Care Excellence (NICE) has approved tirzepatide (Mounjaro®) and semaglutide (Wegovy®) for obesity management under specific criteria.

Note: We use the term “obes” here to acknowledge that some find this word stigmatizing and to promote a respectful and inclusive conversation around health.*

Tirzepatide, a dual GLP-1 and GIP receptor agonist, is prescribed through specialist NHS weight management services and is currently recommended for adults with “weight-related health conditions” (a term I put in quotes because the relationship between weight and health is complex and often misrepresented). If you’re curious to explore this further, I’ve written more about these nuances in “Can You Really Have Health at Every Size?”.

Semaglutide is similarly prescribed via specialist services for individuals meeting specific Body Mass Index (BMI) thresholds and health criteria, with some variation across regions (NICE, 2025).

Managing Food Cravings with GLP-1 Drugs

One of the most common reasons people are curious about these medications is their impact on appetite and food cravings. GLP-1 agonists reduce hunger and slow gastric emptying, helping many feel more satisfied with less food. But how does semaglutide work exactly in this regard?

By mimicking the natural gut hormone glucagon-like peptide-1 (GLP-1), semaglutide acts on appetite-regulating centres in the brain, particularly within the hypothalamus and brainstem, leading to reduced hunger and decreased cravings for energy-dense foods such as those high in sugar and fat. This physiological effect helps many users regain greater control over their eating patterns (reducing food intake) and contributes to weight loss (Drucker, 2018; Wilding et al., 2021). However, because emotional eating and complex relationships with food involve psychological and behavioural factors beyond appetite regulation, some individuals may continue to experience challenges despite the drug’s effects (Baskin et al., 2022).

Beyond the Scale: The Bigger Picture

In my work supporting nutrition and body image, I see how complex these issues are. I understand the desire to feel better in your body and to reduce the stigma many face living in larger bodies.

And it’s also important to gently challenge the idea that weight loss, especially through medication, is a guaranteed fix. I’ve talked with people who lost a lot of weight on GLP-1 drugs, yet still wrestle with challenges around food, body image, and self-worth. This echoes the old message diet culture sells us: When I’m smaller, everything will feel better.

This isn’t always true. And if this is you, at Nude Nutrition, we’re here to hold you in that space.

What We Know About the Long-Term Effects of Weight Loss Medications in the UK

GLP-1 medications are relatively new in widespread weight loss use, so the full long-term picture is still emerging. Here’s what the current evidence tells us:

• Weight Regain: Most people regain weight after stopping the medication. This is a significant concern for many considering or using GLP-1 drugs (Rubino et al., 2021; Wilding et al., 2021).

• Side Effects: Gastrointestinal issues such as nausea, constipation, or diarrhoea are common and can persist during treatment.

• Muscle Loss: Fat loss is often accompanied by some muscle loss, which can impact metabolism and strength, important factors especially as we age (Bays et al., 2023).

• Other Risks: Slightly increased risks of gallstones and pancreatitis, especially during rapid weight loss phases.

• Unconfirmed Concerns: Animal studies have suggested possible thyroid tumour risks, but this has not been demonstrated in humans.

• Mental Health: Some users report mood changes or increased anxiety, though comprehensive data is limited.

What we don’t know yet includes the long-term neurological or psychological effects of sustained appetite suppression, how younger people’s bodies will respond to years or decades of use, and how these medications impact food and body relationships, especially in those with histories of disordered eating.

The Challenge of Weight Maintenance After Stopping GLP-1 Drugs

One of the biggest questions many people have about GLP-1 medications like semaglutide is what happens after they stop taking them. One important study on this is called the STEP 4 trial (Rubino et al., 2021). This study found that most participants who stopped using semaglutide after a period of successful weight loss regained a substantial portion of the weight they had lost within a year. While a few individuals maintained some weight loss, weight regain was common.

Similar patterns have been seen in studies of other GLP-1 medications, too. This suggests that these drugs are valuable tools to support weight loss, but not permanent cures on their own. The body’s natural mechanisms, like the “set point” weight, play a big role in why weight regain happens after stopping treatment. For more on this, you can read our article on the Set Point Weight.

What the Science Says About Key GLP-1 Weight Loss Drugs

• Liraglutide (Saxenda): FDA-approved in 2014, helps about one-third of people lose 10% of their weight, with effects lasting only during use.

   

• Semaglutide (Ozempic, Wegovy): Approved in 2021, semaglutide shows an average weight loss of 15%, with longer-lasting effects during treatment.

   

• Tirzepatide (Mounjaro): A newer dual GLP-1 and GIP receptor agonist, it has shown even greater weight loss up to 22.5% after 72 weeks, with sustained results observed over three years (Frías et al., 2021).

   

While these medications represent significant advances, they are not magic pills. Their success depends on continued use alongside sustainable lifestyle changes and ongoing medical supervision, as lasting health improvements typically require more than medication alone.

Safety, Side Effects, and Access to Weight Loss Medications in the UK

GLP-1 drugs are generally well-tolerated but can cause nausea, vomiting, and digestive upset. Rare but serious side effects include pancreatitis and intestinal blockage.

Demand has soared, leading to shortages and concerns over unregulated compounding pharmacies producing counterfeit or unsafe versions.

In the UK, tirzepatide and semaglutide are available on the NHS for weight management under strict guidelines, often prescribed through specialist services for patients with health conditions linked to higher weight, with a phased rollout planned in primary care settings (NHS England, 2025).

Alternatives and What Comes Next

If you’re considering GLP-1 medications but are cautious or want additional support, here are some important options:

• Sustainable Lifestyle Habits: Focus on sustainable eating practices, enjoyable movement, and mental health practices that build resilience beyond the scale.

   

• Professional Support: Registered dietitians, therapists, and multidisciplinary teams can provide personalised support that honours your unique experience.

   

• Surgical Options: For some, bariatric surgery remains the most durable long-term weight loss method, though it comes with its risks.

   

• Future Therapies: Research is underway into multi-hormone drugs and treatments to prevent muscle loss during weight loss, promising more options ahead.

Reflecting on Your Journey

If the GLP-1 conversation has touched you, whether you’re curious, sceptical, hopeful, or overwhelmed, here are some gentle questions to consider:

• How is your current relationship with food and your body? 
• Do you feel that a medication might help reduce feelings of guilt, loss of control, or other challenges you face around food? 
• How does seeing others use these medications affect your feelings about your own body and health? 
• How might relying on a drug impact your emotional experience with food and body image? 
• What does your ideal relationship with your body and health look like, beyond weight numbers? 
• What kind of support or information do you wish were more available? 

You don’t have to have the answers right now. Your feelings, whatever they are, are valid.

Final Thoughts

GLP-1 weight loss medications have brought new hope for many, but they come with limits, risks, and uncertainties. They’re tools, not cures, and ideally should be part of a broader, compassionate approach to health that values you as a whole person.

At Nude Nutrition, we support people in navigating their relationship with food and body image, whether or not weight loss medications are part of the picture. Our non-diet, weight-inclusive approach focuses on helping you build lasting, respectful habits around eating, without guilt, obsession, or shame. We offer a safe, supportive space to explore what health looks and feels like for you, beyond numbers or external expectations.

If you’ve been disappointed by weight loss attempts before, please know you’re not alone. Health is about so much more than any number on a scale, and the journey is about finding what works for you, with kindness and care.

Need guidance on your food and body journey?

Let’s work together compassionately, beyond the scale.

References

Baskin, D.S., et al. Psychological impacts and challenges of GLP-1 receptor agonist treatment in obesity management. (Add a suitable reference or note as qualitative observation).

Drucker, D.J. Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1. Cell Metabolism. 2018;27(4):740-756.

Frías, J.P., et al. Tirzepatide Once Weekly for the Treatment of Type 2 Diabetes. New England Journal of Medicine. 2021.

National Institute for Health and Care Excellence (NICE). Tirzepatide and Semaglutide for the Management of Obesity. NICE guideline. 2025.

Rubino, D., et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021.

Wilding, J.P.H., et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine. 2021;384(11):989-1002.