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Uh-oh. Was it too good to be true all along? An academic review has just stuck a pin in the GLP-1 bubble, concluding that those who stop taking the weight-loss drugs regain the pounds faster than those who slim down through traditional methods.
Researchers at the University of Oxford looked at existing studies for people who had been taking Wegovy and Mounjaro for at least a year and found what most of us already dreaded (but suspected): 12 months after stopping, they had regained most of their original weight and were projected to be back at square one after 18 months. That’s almost four times quicker than the weight regain after you quit a standard diet or exercise regime. Any associated health boosts, such as drops in blood pressure, cholesterol and blood sugar levels, also pinged back.
So what to make of the findings? Susan Jebb, the professor of diet and population health at the University of Oxford and chair of the Food Standards Agency, who co-authored the study, tells me they are “pretty obvious”. Yet with about 1.5 million people in the UK now using weight-loss jabs and 90 per cent paying for them privately at a cost of up to £350 a month for the higher dose, it’s worth spelling out. Not least as more than half of people using them stop within a year.
“They’re expensive and you need to be fully informed, so you can really consider whether they’re value for money for you,” Jebb says. “I don’t discourage people from taking these medications because they are very effective. I just don’t want them to be seduced by the idea that they’ll be two stone lighter ever after.”
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Clearly, the drugs work — that isn’t in question. GLP-1s suppress our appetites by mimicking the natural gut hormones that signal to our brains when we’re full and slowing our stomachs from emptying. The problem is that, when you come off them, your appetite returns. Not only that, but your metabolic rate will have dropped while on the jabs — a smaller body needs fewer calories to feel satiated — so you might burn calories more slowly than before, while needing to eat more.
“If we wanted evidence that obesity has got a biological basis, these drugs are it,” Jebb says. “When you boost up these natural appetite-suppressing hormones in the body, people are able to successfully manage their weight, but the moment you stop, biology takes over again and people put weight back on.”
There are, broadly, two categories of GLP-1 users. The first is those classed as clinically obese and for whom the treatment offers a host of health benefits alongside weight loss, changing their lives for the better. The other? We probably all know someone whose paunch has mysteriously disappeared, or who seems to have dropped a couple of dress sizes and is being cagey about it on WhatsApp. Everyone from Oprah to Stephen Fry, Robert Jenrick and Prue Leith has tried them (although the latter told me, for this newspaper, that Mounjaro hadn’t worked for her).
Jebb’s research only applies to the first group and there hasn’t been any data collected on people paying for weight-loss jabs privately. Nonetheless, she says “it’s hard to imagine” the weight regain phenomenon would not hold true for casual users too.
“I would express great caution about people who are not overweight taking these drugs, because we don’t know the effects,” she says. “The slimmer you are to start with, the more muscle you tend to lose, and so if people are taking these to improve their physique, this is probably not the right way to do it. These are a treatment for obesity, they’re not about changing the way you look.
“Taking it for a few weeks to lose a bit of weight, say before a holiday, and then coming off it, with likely a very high chance of regaining the weight, doesn’t seem to me a sensible plan.”
The bottom line, Jebb says, is that when you stop taking the medication, “you’re going to have to work extra hard to keep the weight off. That’s the message.”
Might that mean never ordering a Deliveroo again or going on something like the 5:2 intermittent fasting diet for good? “Finding a diet that will help you keep the weight off is definitely sensible,” Jebb says. “For some, the 5:2 is a good maintenance strategy because they have two days to go on a really strict diet and then not worry about it the rest of the week. Most people who struggle with their weight know what their vulnerabilities are. They know that they’re tempted by fast food. It’s important to work out how you’re going to deal with it. If you have a plan, there’s a chance you’ll succeed.”
The frustrating thing, Jebb adds, is that scientists don’t know exactly what that plan should look like. “We don’t know what you need to do and we’re just falling back on, ‘Well, in general healthy diets and more physical activity are beneficial.’ But the evidence at the minute shows that’s probably not enough.”
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The unavoidable truth, then, is that “the most reliable way of keeping the weight off is to stay on the medication,” Jebb says. After all, the drugs have been safely used for diabetes, at a lower dose, for years — and, she adds, it’s better for your body than constantly crash-dieting.
“If you keep taking the medications, you appear to be able to maintain most, if not all, of that weight loss, so that’s great. It means we have to change the way we think about obesity. This isn’t a problem you have and then you fix it and it’s gone. It’s a problem that you are going to have to manage for the rest of your life.”
To that end, she adds, the NHS — which is slowly rolling out weight-loss drugs — must make a long-term commitment to GLP-1 patients and offer behavioural change programmes, echoing advice from the National Institute for Health and Care Excellence, which recommended post-treatment support for at least 12 months. The government needs to tackle the constant food noise and advertising that makes it so hard for many of us to eat healthily. “In the end, preventing people from becoming overweight in the first place is definitely the most sustainable option.”
So would Jebb take the drugs herself, knowing the likelihood of regaining the weight? “If I was living with obesity and I hadn’t been able to manage it through seeking support — doing it on your own is almost impossibly difficult — then I would. Would I recommend it to family and friends who were in that position? Yes, I would.
“It isn’t a single magical solution, but if 20 years ago somebody had told me that we’d have a treatment where people could lose 15 per cent or more of their body weight, I would have thought it was incredible.”
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How I’ve kept my post-jab weight loss off
Harriet Walker used the pen to lose a few pounds. She’s had no relapse
I’m not your average GLP-1 user. I only wanted to lose a stubborn half-stone that had settled around my midriff after two babies. I took a starter dose for six weeks last December, lost a stone and haven’t put it back on, give or take a couple of kilos that come and go depending on cycle and booze intake. Unlike before, they do always go again.
Post-jabs, I’m the least bonkers about eating I ever have been. I’d been on a diet since the age of 12, with so many food groups marked “forbidden” I spent most of my time thinking about them. It wasn’t only that my clothes didn’t fit, I was constantly avoiding, craving, then falling off whatever restrictive plan I was on. I was prescribed Mounjaro privately — and legally — for what the internet calls “food noise”.
Those six weeks not only rewired my appetite but also what I want to eat. Feeling properly full for the first time in years meant I noticed reaching for “treats” out of habit rather than hunger, usually when I was stressed, anxious, lonely or sad. Still now, acknowledging which I’m feeling is enough to stop me snacking and deal with that instead.
I didn’t eat terribly before but my microdose course worked as a circuit-breaker with sugar, which was probably the root cause of never feeling full. I’m not off it completely but I now see Haribo the same way I do Marlboro Lights. I still drink less than I used to and losing weight helped clear up my post-pregnancy sciatica, so I do more exercise too. GLP-1s are proven to combat inflammation as well; my lifelong eczema disappeared while on the injections and, perhaps because I eat less processed food now, it remains nowhere near as bad. I still have a sweet tooth but am more discerning — dates with peanut butter are my favourite sofa treat.
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Also, nothing is off-limits: I eat pizza, pasta, bread, chocolate if that’s what I really want, but it often isn’t. The absence of mad rules around carbs and cakes has removed some of their lustre — I’m more aware of not feeling great after eating them. I’m not puritanical, though; I had a very treaty Christmas and felt none of the guilt or panic I might once have done.
What I crave now tends to be things that fill me up and make me feel good: lentils, sweet potato, full-fat yoghurt. I put seeds on top of everything because I like food that crunches rather than melts like something designed in a lab to make you want more. For me, weight-loss jabs were a sort of cold turkey from the processed foods I didn’t even realise were keeping me hungry. Low-fat this, fibreless that.
I do know how annoying I sound. Sometimes it all seems too good to be true and I worry there’s a giant relapse ahead. Would I go back on the pen again in that case? Absolutely.
