The anxiety is always in the back of your mind,” Suzy Cox is saying. She’s been on one the new drugs for weight loss for almost six months and, on Friday morning, she stepped on the scales to see a number starting with 10 stones for the first time in five years.
“It’s exciting,” she continues. “But I’ll be honest – usually when I lose weight and a dress size of clothes gets too big for me, I triumphantly take them down to the charity shop. This time, I’ve put everything under the bed. Because I’m so scared that if I come off the drug, I’ll go straight back up to a size 16, 18 or 20.”
Cox is one of a number of people whose lives have been changed for the better by Ozempic and other semaglutide and tirzepatide weight loss drugs – she wrote about it for The Independent in June. However, like many on the drug, Cox is now facing an agonising prospect. While the drugs are highly effective when being administered regularly, tapering off or stopping altogether some users report a “voracious” hunger returning once they come off it, with high numbers putting the majority of weight they’ve lost back on.
This week, James Corden explained that he tried the weight loss drug, but it didn’t work for him as he thinks his tendency to binge eat was more deep-rooted. The 46-year-old said: ‘I tried it for a bit and then what I realized was I was like, “Oh no, nothing about my eating has anything to do with being hungry.”
‘All it does is make you feel not hungry. But I am very rarely eating [just because I’m hungry].’
However, Ozempic users who then come off the drug are taking to TikTok and Reddit to share that insatiable hunger is exactly what happens when they stop taking the drug. “What are we eating to stay full? I cannot stay full,” influencer and comedian Claudia Oshry shared in a recent post. “I just had a 12oz steak and I’m starving so I’m eating popcorn. How are we staying full?”
“That was literally me after Monjauro,” one of the many comments in agreement underneath reads. “I was ravenous! No answers, just prayers.”
Since Ozempic was approved to be used for weight loss purposes on the NHS in September 2023, demand has been consistently high and is still climbing. It’s primarily used to treat type 2 diabetes – a chronic metabolic condition that occurs when the body can’t use insulin properly – its weight loss benefits are really what nailed down its popularity.
The use of the drug, which can now be bought at high street pharmacies for between £149 and £297 per month depending on the dose, is so ubiquitous some are using it for lifestyle reasons to “drop a dress” size ahead of a big event or holiday.
One acquaintance reported there were so many people on the drug at a friend’s 50th birthday party that they had to throw most of the food away. Spotting Ozempic face among celebrities and influencers has become something of a national sport.
In the first 10 months or so of taking Ozempic, some users can lose an average of 13-15 pounds, according to clinical studies. While the amount is dependent on starting weight, lifestyle factors and dosage, generally this can result in a 10-15 per cent reduction in body weight over the first year on Ozempic.
However, clinical research limits those on the drug for weight loss to two years of use. Many users stop after one year because, like James Corden, they realise their eating issues have deeper roots. At that point, many run into more problems, says Richard Holt, a professor in diabetes and endocrinology at the University of Southampton.
If people have lost weight, he says “It is quite difficult to avoid putting the weight back on. Because effectively, what the Ozempic is doing is telling your brain that your body doesn’t need to eat and that your body weight is fine.
“The body has a really complex mechanism of trying to defend its weight from times when food was not as plentiful as it is now – losing weight was really quite a major survival issue for humans, so the body naturally has some very strong physiological mechanisms to ensure your body weight stays pretty constant.”
Ozempic hijacks those mechanisms, or receptors which tell you when you’re hungry, Holt explains, allowing you to eat less to lose weight. “It does that very, very effectively,” he says.
“But the difficulty is that as soon as you stop taking the medication, the body thinks you’re in a situation of starvation, and therefore those mechanisms to get you to start to eat again kick back in. Which is why in all of the studies of people taking GLP-1 semaglutide, people regain weight very quickly after ceasing treatment. That weight gain can continue to go on for as long as a year after stopping the drug.”
It’s causing a lot of fear around withdrawal, says Sophie Medlin, a consultant dietician and chair of the British Dietetic Association for London. Recently she’s seen a spike in numbers of patients who are struggling with tapering off or stopping their weight loss medication.
“People will say that they just feel like they can’t control their appetite anymore. When they were taking the medication, they didn’t feel hungry at all, sometimes for them even just noticing that they are hungry again feels really overwhelming,” Medlin explains. Once off the drug, with the food noise rushing back and turned up to maximum level, she says people become scared and don’t trust themselves to make good choices around their eating.
“Because the difference between when you’re taking it and when you come off it is quite stark. When it’s completely out of someone’s system they begin to feel panicky they’re not going to be able to maintain their weight or the sort of benefits they’ve seen.”
Psychologically, that’s incredibly hard to deal with. For people like Cox, 46, who lost two stone in three months after struggling with her weight since her teens, it’s a pretty unbearable quandary.
“I would sooner cancel my gym membership than my Wegovy at this point,” Cox admits. She says that, regardless of what the drug does medically or physically, it’s the benefits to her mental health and control over her life that have been the biggest gamechanger.
It’s incredibly difficult to try to come off Ozempic and recognise that perhaps nothing has really changed psychologically and now they’ve got to try and do the work to keep the weight off
“Every single person I know on it, the one thing we’ve discussed is what it’s done to our minds,” she says. “I feel like the best version of myself. I would hate to lose that.”
Like many on the drug, Cox has found drinking naturally decreases while taking the drug, something that she’s been wanting to cut down on for years – and some studies corroborate this effect.
“It’s really hard for people who have always struggled to regulate their appetite and consumption,” Holt says. “We might be talking about people who have, for their whole lives, woken up thinking about what they’re going to eat next, or who have obsessed about food – and then found a medication that gives them relief from that experience.
“It’s incredibly, incredibly difficult then to try to come off it and recognise that perhaps nothing has really changed psychologically and now they’ve got to try and do the work to keep the weight off. It’s very hard.”
Holt argues that in many cases, using drugs like Ozempic that give people a better quality of life and alleviate a lot of psychological distress shouldn’t be limited to two years (“If you were using a drug to treat another condition like high blood pressure, you wouldn’t just stop it after two years, would you?” he says).
He adds that the shame and social stigma around weight have a lot of impact on this, despite many people just being genetically unfortunate to have higher body weights.
“What doesn’t help is that many people we see who are on Ozempic or the like are eating nutritionally poor diets,” says Medlin. “I’ve worked with people who are basically just eating crisps and a few snacks here and there, because they don’t fancy making a whole meal.”
Could a body “starved” of food over a long period be making up for lost time?
To some extent, says Medlin. “When we become nutritionally deficient in things, or our body thinks that there is a real deficit of food around it will upregulate our appetite and push us to try and eat more.”
Medlin advice to patients is to build in healthy habits and routine before beginning to taper off – otherwise, as we know from every other fad, a restrictive diet rather than a lifestyle change will always end up with a weight pendulum swinging.
She adds that those using Ozempic and Wevogy wrongly – to get to an unhealthily low BMI – or people using it in secret from friends and family are often most vulnerable to this.
The latter, she says, “will have had praise for their weight loss. And that can make it even harder because people think, ‘Well my weight loss made me more valuable to my friends and family and now I might regain it – what’s that going to feel like?’”
But there is some good news for some. “Often you will find that the final weights that people reach after stopping the Ozempic is still probably about five to 10 per cent lower than where they were when they started as an average,” Holt says. “So it’s still lower than previously, but it’s just not as low as it was when they were actually taking the drug.”
Cox says she has a friend who is currently tapering off her weekly dose – and she’s eagerly watching to see what happens next. For many, that’s the thing: it’s a new drug that hasn’t been ever used as widely as it is now, so we just don’t know yet. But there’s hope those baggy clothes can stay under the bed.