GLP-1 and eating behavior: what the medication does not resolve

GLP-1 agonists are legitimate medications with solid evidence behind them, and for many people they represent a real change in the management of obesity and other metabolic conditions.

I do not work against this treatment. I work alongside it.

What I see in practice is that these medications act powerfully on the signals of hunger and fullness, but they do not resolve a difficult relationship with food. The medication helps with the physical change, but emotional and behavioral change also has to be worked on, and that work happens in therapy.

Which medications we are talking about

In the Dominican Republic two are best known.

Semaglutide, sold as Ozempic. It acts on the GLP-1 receptor.

Tirzepatide, sold as Mounjaro. It acts on two receptors, GIP and GLP-1.

Retatrutide is also circulating, often called "Reta". An important precision is needed here: retatrutide is not approved by any regulatory agency. As of August 2026 it remains an investigational medication, and its manufacturer expects to file for FDA approval in 2027 [1].

What these medications do

Without going into pharmacological detail, these medications imitate hormones the body produces naturally. They slow gastric emptying and act on the brain centers that regulate the sense of fullness.

The effect people describe is not only physical. As well as feeling full much faster than before, it helps with the mental noise around food. Mental noise is the constant thinking about what you are going to eat, when and how much. Many patients describe it as a silence they had not felt in years.

That silence is real and it is valuable. For patients who had spent months giving a large part of the day over to thinking about food, that silence is peace and it is worth a great deal.

What the medication does not change

The medication intervenes on appetite. It does not intervene on the relationship with food, nor on the eating behaviors a patient may have developed.

If eating was your main way of handling anxiety, boredom, loneliness or anger, that need does not disappear because appetite dropped. It is left without its usual outlet.

This is why psychological support is needed alongside the medication: to build habits and behaviors around food, to work through anything unresolved, and to develop the tools needed to return to life without the medication.

Three moments where support matters

Before starting

A history of eating disorders is rarely asked about before prescribing, and that omission matters.

For someone with a previous or subclinical restrictive pattern, a medication that suppresses appetite is not neutral. It makes easier what they already tended toward, and it supplies a medical justification.

Restricting on prescription is still restricting. If there is a history of anorexia, bulimia, bingeing or repeated extreme dieting, that should be on the table before starting, so we can judge whether starting is prudent.

During weight loss

Losing weight does not automatically improve how you see your body. It is common to reach the goal and still see the same thing, or worse, because body image does not recalibrate on its own. I develop that in the inner voice that judges what you eat.

On stopping treatment

Regaining part of the weight after stopping the medication is common [2]. That produces an anticipatory anxiety almost nobody talks about.

The fear of stopping can be intense enough to shape medical decisions. And if no independent regulation tools were built during treatment, that fear is well founded, and it can turn into long-term emotional dependence on the medication.

What we work on in session

Psychological work does not compete with medical treatment or question it. It handles what the medication cannot do:

• Assess eating-behavior history before or during treatment.
• Build emotional regulation tools that do not depend on food or on the medication's effect.
• Work on body image, which does not change through weight alone.
• Prepare the transition, so that stopping treatment is not a step into nothing.
• Detect warning signs: excessive restriction, compensatory behaviors, social withdrawal around food.

For prescribing physicians

The most useful question before prescribing takes ten seconds. Has this person previously had a difficult relationship with food, extreme diets, binge episodes, or behaviors to compensate for what they eat?

An affirmative answer does not necessarily contraindicate treatment. It does indicate that psychological support should run alongside it.

References

1. Eli Lilly and Company. Retatrutide remains in clinical investigation; an FDA filing is expected in 2027. Status as of August 2026. Report
2. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes, Obesity and Metabolism. 2022;24(8):1553-1564. PubMed