You’ve started GLP-1 injections. Now what?

For some people, starting a GLP-1 medication changes something they have spent years struggling with. Hunger becomes quieter.

The feeling that food is constantly occupying mental space can diminish. Portions may become easier to manage. The effort involved in trying to eat less can feel completely different. For someone who has spent years dieting, this can be a profound experience.

It can also create a slightly misleading impression that the difficult part is over.

GLP-1-based medicines have changed the treatment landscape for obesity. They act on biological pathways involved in appetite and energy regulation and, in clinical trials, can produce substantial and sustained weight loss while treatment continues. That is an important therapeutic effect, particularly for a condition in which biology can strongly resist weight loss.

There is still breakfast before work. There are supermarket aisles, family dinners, holidays, celebrations, bad days, good days and evenings when the easiest option is the one that has always been easiest.

A medication can alter appetite.

It does not rearrange the kitchen cupboards.

It does not automatically change how someone shops, cooks, eats at a restaurant, responds to stress or thinks about movement. Those behaviours have usually been developing for years.

This distinction becomes particularly important when we look at what happens after treatment stops.

The STEP 1 extension study followed people after they discontinued semaglutide. Within a year, participants regained around two-thirds of their previous weight loss, accompanied by a reversal of many of the improvements in cardiometabolic risk factors.

The SURMOUNT-4 trial found a comparable pattern with tirzepatide.

Participants who continued treatment maintained or increased their weight loss, while those switched to placebo regained a substantial amount of weight.

These findings are sometimes interpreted as evidence that people simply cannot maintain weight loss without medication.

The more important lesson is: that obesity involves powerful biological mechanisms regulating appetite, energy balance and body weight. When treatment is removed, those mechanisms do not disappear. Weight regain is therefore not evidence of personal failure. It is part of the biology of a chronic condition.

This is one reason it makes little sense to create an artificial opposition between medication and lifestyle.

The medication can be extraordinarily useful but it’s just a tool; what someone builds around it, is the useful part.

Imagine that someone who has spent years feeling driven by hunger suddenly has some breathing space. That can be an opportunity to discover what eating feels like when appetite is less dominant. It can be a chance to learn how to build satisfying meals, recognise fullness, establish routines and find forms of movement that support strength and metabolic health rather than functioning as punishment.

It can also be an opportunity to understand what food has been doing emotionally.

For some people, eating has long been connected to stress, reward, boredom, loneliness, trauma or exhaustion. A quieter appetite may reduce the intensity of the behaviour but the underlying situation can still be there. That becomes particularly relevant if the medication dose changes, side effects appear, access is interrupted or treatment eventually stops.

The goal is not to assume that everyone should eventually come off medication. For many people, long-term treatment may be appropriate. The decision belongs with the prescribing clinician.

The point is that behaviour change has a place while the medication is working, it creates room and what happens in that room matters to avoid regaining weight after treatment.

Perhaps that is the most interesting way to think about GLP-1 treatment.

The Ciao Change perspective

At Ciao Change, I see my role as sitting alongside medical treatment rather than competing with it.

The prescription, clinical assessment and monitoring belong with the healthcare professional. My role is the everyday part and unpacking what brought there: helping someone turn the opportunity created by treatment into sustainable changes that fit their life.

That might involve food, movement, routines, stress, sleep, habits or the way someone responds to setbacks. It might also involve something more fundamental: changing the story a person has been telling themselves after years of unsuccessful attempts to lose weight.

I don't believe someone needs to earn their medication by becoming “good” at lifestyle change. Nor do I believe medication makes behaviour change irrelevant. Both can have a place, weight is only one measure of health.

What someone learns about caring for themselves while treatment is working may be one of the most valuable parts of the journey to solve the issue once and for all and start living the desired life fully for the years to come.

Sources and further reading

Wilding, J.P.H. et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 24(8), 1553–1564. DOI: 10.1111/dom.14725.

Aronne, L.J. et al. (2024). Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA, 331(1), 38–48. DOI: 10.1001/jama.2023.24945.

NICE. Overweight and obesity management (NG246). Updated 2026.

 "Disclaimer: This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of Ciao Change Ltd unless specified under “The Ciao Change perspective” section."