By now, you’ve likely heard of medications such as Ozempic, Wegovy, Zepbound—all brand names for what are known as glucagon-like peptide-1 receptor agonists, or GLP-1 drugs for short. These medications have offered hope for people battling obesity who haven’t found success with traditional approaches like diet and exercise. For some, they seem to be a miracle weight-loss option.
But then there are those who don’t find success even with these so-called miracle drugs. It leaves many frustrated people thinking: Why?
It’s not because the GLP-1s aren’t working—instead, it has to do with the root cause of a person’s struggle with their weight.
Consider how GLP-1s work:
- These drugs mimic your body’s natural GLP-1 hormone that prompts your pancreas to release insulin and transport glucose from your bloodstream to your cells for energy. This is why GLP-1s can help people with type 2 diabetes, who either do not produce enough insulin or their body is resistant to it.
- While the GLP-1 drugs are encouraging your body to produce more insulin, there are also other benefits: They reduce thoughts of hunger in your brain, and they delay stomach emptying so you stay fuller longer.
- In addition to improved insulin dynamics, the reduced hunger, increased satiety, and delayed stomach emptying mean GLP-1 drugs can boost weight-loss efforts, which is why they’re prescribed for people with obesity.
If you struggle with your weight because of poor appetite regulation, poor satiety signaling, or reward-driven eating (that is, you’re always feeling a want to eat, you rarely feel full even after eating, or you crave foods that make you feel good emotionally), then GLP-1 drugs could address these problems.
On the other hand, obesity could be caused by other problems unrelated to appetite:
- Hormonal problems, such as cortisol, menopause, or hypothyroid
- A naturally low resting metabolism (known medically as adaptive thermogenesis)
In these cases, GLP-1s might not work as well. There’s also the chance that your body is more responsive to weight loss—it lowers its basal energy expenditure and increases its metabolic efficiency as you lose weight. Now that you’re smaller, your body needs even fewer calories, which makes weight maintenance harder.
Plus, remember that GLP-1s might reduce your appetite, but they won’t eliminate learned behavior. It’s still easy to take in liquid calories if you’re not hungry, or your favorite foods might still be easy to overeat even if you aren’t constantly craving them.
Does this mean GLP-1s “failed” if someone is still struggling with their weight? Not at all—the drugs are likely working. It just means there’s another cause that needs to be addressed.
