Ozempic for Weight Loss: What Have We Learned After Several Years of GLP-1s?
By now, you probably know someone taking a weight-loss injection like Ozempic.
Maybe they've lost weight.
Maybe they've told you their food noise has disappeared.
Maybe you've wondered if it could help you too.
I believe in body autonomy. Whether you choose to take a GLP-1 medication or not is your decision.
My goal isn't to tell you what to do. It's to help you understand the full picture beyond the weight-loss headlines.
So, now that we've got several years of research and real-world experience, what have we actually learned?
First, a quick clarification
When most people say "Ozempic", they're often referring to GLP-1 medications in general.
Ozempic contains semaglutide and was originally approved to help manage type 2 diabetes.
Wegovy contains the same medication at a higher dose and is licensed specifically for weight management.
By now, we have several years of clinical trial data and real-world experience with semaglutide. That means we're moving beyond the early excitement and can start looking at what happens over the longer term.
1. Yes, semaglutide can lead to significant weight loss
One of the largest long-term studies followed adults with overweight or obesity for 104 weeks (2 years).
Participants taking semaglutide lost an average of 15.2% of their starting body weight compared with 2.6% in the placebo group.
That's a substantial difference.
It's also important to remember that averages don't tell us what will happen for every individual. Some people lose more weight. Some lose less. Some stop treatment because of side effects.
The reality is more complicated than the dramatic before-and-after photos often shared online.
2. Weight loss doesn't continue forever
One of the biggest misconceptions is that weight loss should continue indefinitely.
The longer-term research suggests otherwise.
Most people reach a point where weight loss slows down and eventually stabilises.
This isn't a sign that the medication has stopped working.
It's a normal part of how the body responds.
Unfortunately, many people interpret a plateau as failure and respond by becoming more restrictive with food.
For anyone with a history of dieting, this can quickly pull them back into old patterns of food rules, guilt and binge eating.
3. Stopping the medication is where things get more complicated
Perhaps the most important thing we've learned is what happens when treatment stops.
Researchers followed participants for a year after discontinuing semaglutide.
The results showed that people regained around two-thirds of the weight they had previously lost.
Many of the improvements in health markers also moved back towards their starting levels.
This doesn't mean the medication "doesn't work."
What it tells us is that obesity is a chronic condition and the effects of semaglutide may not continue once treatment ends.
This raises an important question that isn't discussed enough:
What is the long-term plan?
Before starting any medication, it's worth thinking about:
How long you expect to take it
Whether it is financially sustainable
What support you have if appetite increases again
How you will manage if weight regain occurs
4. The benefits go beyond weight loss
One criticism of GLP-1 medications is that conversations often become entirely focused on the scale.
But weight loss is not the only outcome that matters.
The SELECT trial followed more than 17,000 adults with overweight or obesity and established cardiovascular disease.
Researchers found that semaglutide reduced the risk of major cardiovascular events such as heart attack and stroke compared with placebo.
This is important because it shows that these medications may have benefits beyond changes in body weight alone.
5. Food noise often decreases
This is the reason many people with binge eating become interested in GLP-1 medications.
People frequently describe:
Thinking less about food
Feeling satisfied sooner
Reduced cravings
Less urge to snack constantly
Less mental energy spent negotiating what to eat
For some people, this can feel like an enormous relief.
When you've spent years feeling consumed by thoughts about food, experiencing less food noise can be life-changing.
But there is an important distinction.
Less food noise does not automatically mean a healed relationship with food.
6. What about binge eating?
This is where the conversation becomes more nuanced.
Early research suggests semaglutide may reduce binge eating symptoms for some people.
As a binge eating dietitian, I completely understand why that feels hopeful. Many of the people I work with are exhausted from feeling consumed by thoughts about food and are looking for relief.
The medication sounds promising. However, the evidence is still limited.
Most studies have been small, and researchers continue to call for larger, higher-quality trials before GLP-1 medications can be considered an established treatment for binge eating disorder.
At the moment, the research simply isn't strong enough to conclude that these medications treat the full complexity of binge eating.
7. Appetite suppression isn't the same as recovery
This is the piece I think often gets missed. Binge eating is rarely just about hunger.
For many people, it is also connected to:
Years of restrictive dieting
Skipping meals
Emotional regulation
ADHD and impulsivity
Body dissatisfaction
All-or-nothing thinking
Shame around food
A medication may reduce appetite and it may reduce cravings. It may make it easier to stop eating when you're physically full.
But it doesn't necessarily help someone:
Trust their body
Stop labelling foods as "good" and "bad"
Cope with difficult emotions
Challenge perfectionism and the all-or-nothing mindset
Feel comfortable eating previously feared foods
You might binge less because you're less hungry.
That's meaningful.
But it isn't always the same thing as recovering from binge eating.
8. For some people, restriction may become easier
This is an area researchers are paying increasing attention to.
If someone already has a history of restrictive eating or disordered eating behaviours, appetite suppression can sometimes reinforce old patterns.
For example:
Skipping meals because you're "not hungry"
Eating far less than your body needs
Feeling rewarded for ignoring hunger
Becoming increasingly fearful of appetite returning
That doesn't mean GLP-1 medications are harmful for everyone.
It simply means that nutritional support and monitoring remain important.
9. Eating less isn't automatically eating well
Many people taking semaglutide report eating significantly smaller portions.
While this can be helpful for some, it can also make it harder to consume enough:
Protein
Fibre
Vitamins and minerals
Fluids
Overall energy
This becomes even more important if nausea, early fullness or digestive symptoms are present.
Eating less food doesn't automatically mean your nutritional needs are being met.
Questions I'd encourage you to ask yourself
Something like:
What am I hoping this medication will change?
If my appetite decreases, how will I make sure I'm still eating enough?
What support do I have if my relationship with food doesn't improve in the way I hoped?
What is my plan if I stop taking the medication?
Am I looking for weight loss, freedom from food thoughts, better health, or all three?
This would make the article more actionable and gives readers something practical to reflect on.
So, are GLP-1 medications good or bad?
I don't think that's the most useful question.
What we've learned after several years is that GLP-1 medications are neither a miracle cure nor a disaster.
For some people they can:
Reduce food noise
Support significant weight loss
Improve metabolic health
Lower cardiovascular risk
Improve quality of life
For others they may bring challenges such as:
Side effects
Nutritional concerns
Anxiety around stopping treatment
Weight regain after discontinuation
A return of old dieting behaviours
The most important thing is understanding what the medication can and cannot do.
If you struggle with binge eating, a GLP-1 medication may change your appetite.
It may even reduce binge episodes.
But it doesn't automatically heal the beliefs, fears and behaviours that often sit underneath binge eating.
A quieter appetite can be incredibly helpful.
A healthier relationship with food still matters too.
References
Rubino D, et al. Two-year effects of semaglutide in adults with overweight or obesity (STEP 5). Nature Medicine. 2022. Average weight loss of 15.2% at 104 weeks. New England Journal of Medicine
Wilding JPH, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism. 2022. Participants regained approximately two-thirds of prior weight loss after treatment withdrawal. PubMed
Lincoff AM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT Trial). New England Journal of Medicine. 2023. Semaglutide reduced major cardiovascular events in adults with overweight or obesity and cardiovascular disease. New England Journal of Medicine
Marso SP, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. New England Journal of Medicine. 2016. Early evidence of cardiovascular benefits of semaglutide in people with type 2 diabetes.
Ready To Break Free From Binge Eating?
Hi, I'm Toni, The Binge Dietitian.
I help women who are stuck in the cycle of dieting, binge eating, and starting over every Monday build a calmer, more balanced relationship with food.
Together, we'll work on reducing binge eating, letting go of food rules, and helping you feel more confident around all foods without relying on willpower, restriction, or another diet.
If you're tired of thinking about food all day and ready for a different approach, I'd love to support you.
