There Is No Spoon
I stayed on my GLP-1 for over four years, but the weight still started coming back in year 3. Did it “stop working” or did I “fall off the wagon” and not really learn “good habits”? I dug into the science for answers.
This three-part series follows the GLP-1 journey past the point where most stories stop, into the years when the body starts fighting back, the trials stop watching, and patients start blaming themselves again. By the end, I want you to see regain differently and know exactly what to ask your doctor. And I have a call to action for our providers and even the manufacturers to improve upon this issue.
The “Lucky” Trash Panda Phenomenon
Everybody knows someone who eats like a trash panda and never gains a pound. Yet no one points at their body as proof of discipline. We call them lucky and joke about their metabolism, but when someone gains weight easily, we skip right past biology and go looking for a flaw in their character.
Researchers tested this decades ago by having identical twins live together in a supervised dorm and overfeeding every man the exact same extra food. Some men gained three times as much as others, yet each twin landed close to his brother, so the difference seemed to follow their DNA.¹ Another study looked at identical twins who grew up in different homes, and they still ended up carrying their weight much like each other.²
Every man ate the same amount of food, and their bodies wrote very different stories, so I struggle to understand why we still blame the person when we see the science. And it’s not just people without obesity blaming us; we blame ourselves too. But WHY? It’s there in black and white from the same people who used to swear it was only about eating less and moving more!
I was never the “lucky” one metabolically. At eight years old, I stood next to my mom’s spaghetti, fighting with myself over thirds while another part of my brain told me I was not supposed to want that much food. I did not know the phrase food noise yet, but I knew food kept calling me back, and the advice never changed: eat less, try harder, push the plate away, or put the fork down.
I must say I’d love to see twin studies for those taking GLP-1, especially with time as the variable. What happens when they are off the meds in terms of regain, and what happens when they are on the meds past the time many studies track…the 3-5 year mark of “maintenance”.
I tried everything
I have lived with obesity for as long as I can remember, and I have been on every diet on the planet. I had a type of bariatric surgery called a Lap-Band only to regain almost all of it by year 5. When GLP-1s came along, I started with Saxenda, moved to Ozempic, then switched to Mounjaro back in the days when many of us were on the Eli Lilly savings card making TikToks about our journeys. Three years later, I had lost around 100 pounds. But now I’m midway through year 4, and something is changing.
But during those first 3 years, for the first time in my life, food stopped running the show, and I felt like Neo in The Matrix. The bullets were hyper palatable and processed foods, and I would just hold up my hand and watch them drop like they were nothing. It was SO EASY not to choose them. And I soon found I wanted foods like Brussels sprouts instead. It was INSANE! And I knew when the food noise turned off…it wasn’t my fault.
Then the bullets came back
Around year three, foods I used to turn down without a thought started pulling at me again, harder and harder, even though I do not love them or think they taste amazing. I feel drawn to them and far less in control, and the white knuckling I thought I left behind is back. So is some of the weight, and even though I never stopped my medicine, people assume I am eating more. And sometimes I am.
I felt like Neo in The Matrix, holding up my hand and watching the food bullets drop. Around year three, that changed.
What left me curious
For three years, I have chased questions like these by interviewing experts on The Plus SideZ Podcast, and when my regain started, I kept thinking about Season 1, Episode 5, “Fat and Lazy,” with bariatric surgeon Dr. Daniel Rosen.³
He explained he read a peer reviewed article about how people had come in with type 2 diabetes to have bariatric surgery and they were showing in remission before they even left the hospital and before they had lost much weight at all. It seems we got it wrong. The weight wasn’t causing the diabetes, the disease of obesity was.
Our bodies make natural GLP-1 at the bottom of the intestine, and surgery reworks the gut so that GLP-1 bursts. Those levels go down over time, and many patients regain weight three to five years later, so I could not stop wondering whether the same thing was happening to me on GLP-1s.
A lot of the creators I met on TikTok during the Mounjaro savings card days started regaining some too, and they blamed themselves with “fell-off-the-wagon” lines in their videos like “I haven’t really been counting calories.” So I took my questions back to my podcast guests, and again and again, I heard some version of “We really just don’t know yet. It’s so complicated.”
They also told me what they do know:
Genetics play a big role, and willpower is not the answer.
The brain regulates hunger and body weight, and it defends the weight it has learned to protect: The Set Point Theory.
Insulin resistance and leptin resistance are common with obesity, making it harder for the body to use energy well and for the brain to hear that it has had enough.
A calorie deficit matters for weight loss.
After major weight loss, the body becomes more efficient and burns less energy.
Stress, perimenopause and other factors affect hunger and probably regain.
Nutrition and exercise matter for loss and maintenance of the loss, but they do not treat the disease of obesity.
Staying on the medicine gives you the best chance of avoiding regain or keeping it small.
The body adapts metabolically, on the medicine and off it.
Many of the doctors on my show recommend switching agonists or adding in an older anti-obesity medication like Contrave with the GLP-1 you are on.
Over millions of years, our bodies evolved to protect us from starvation, and they still fight weight loss as if a famine is coming, so treatment will likely need to change as the body adapts. GLP-1s do not cure obesity, and while they often can put it in a well-managed state for at least awhile, anyone who understands this disease knows it can come knocking again.
The phases nobody explains
Obesity medicine physician Dr. Ali Novitzki told me that weight loss on treatment moves in three phases:⁴
Phase one: weight comes off fairly fast while you learn to manage side effects and what to eat.
Phase two: loss steadies, then stalls for four to six weeks at a time with no movement on the scale, often several times.
Phase three: you maintain your loss or work on the last 10 or 20 pounds, which can take years.
In my opinion, two phases are missing, so I added them myself: phase zero, which comes before the first shot when you are researching or too scared to take the medicine sitting in your fridge, and phase four, the year 3-5 problem we rarely hear about. The food noise returns some and regain begins.
Phase four lines up with the window Dr. Rosen described after bariatric surgery, when the typical gastric bypass patient has regained about a quarter of the weight they lost by year six.⁵ The longest tirzepatide study we have found shows that people hit their lowest weight just before the two-year mark, and by about three and a half years, roughly 3 in 10 had regained 5% of their body weight while still taking the medicine. Then the study ended, right when the plot gets interesting.⁶
Since Mounjaro came out in 2022, those of us in the first wave on Tirzepatide in market are living phase four right now with almost no research following us. Nobody prepares us for it, so we blame ourselves when it arrives, and some of us pull back from our care. Diet culture runs thick in our psyche. This is when we may say, “screw it” and want to quit. But people with obesity have so much grit. So…we keep seeking answers and try again.
Those of us in the first wave are living phase four right now with almost no research following us.
The disease keeps moving
Obesity is a chronic, progressive disease that often progresses to type 2 diabetes, which roughly 7 in 10 people with severe obesity develop in their lifetime.⁷ I do not think GLP-1s are a weight loss tool, I’ve learned too much. Nobody calls chemo a tool for cancer, because it treats a disease with remission as the goal, and so do GLP-1s. I think people who call it a tool don’t really think it’s a disease. Nutrition, movement, sleep and stress management are my tools, and GLP-1s treat the biological dysfunction I can’t control.
But we don’t talk enough about metabolic adaptation. I suspect that explains why so many of us move up in dose as hunger creeps back, the deficit gets harder to maintain, and the scale stalls for months while we do all the “right things.”
What nobody told us
I believed this time was the last time, and nobody told me otherwise, nor the hundreds of GLP-1 patients I talk with each week. Sure, thin GLP-1 naysayers warned that the medicine would “stop working” or that we would regain if we quit, but nobody mentioned it might become less effective or what would come next if that happened…until it started happening.
And in year 4 I am definitely eating different. Somewhere between how I ate in year 1-3 and how I used to eat before. I switched back to semaglutide to see if it would be more effective. I am back to tracking and feeling miserable about it. The odd thing is, this all started when I was still not eating enough and exercising every day. Crazy, right?
This is a very complicated disease! It’s honestly like the ocean. We know some things but there’s so much more to explore. So much we still don’t know or understand.
There is no spoon
Clearly, I love the movie The Matrix, and I love the scene where Neo tries to bend the spoon with his mind. It goes something like this:
Spoon Boy: Do not try and bend the spoon. That's impossible. Instead... only try to realize the truth.
Neo: What truth?
Spoon Boy: There is no spoon.
Neo: There is no spoon?
Spoon Boy: Then you'll see, that it is not the spoon that bends, it is only yourself.
For me, the spoon is full control over our weight and body size. We desperately want to believe GLP-1s gave us that control, that the medicine cures us and our regain days are over. But treating obesity is like treating a moving target. We’ll have to adapt treatment as our body adapts.
After all, why would the drug manufactures be creating so many other variations of this class of medicine if we all stuck with our habits, stayed thin and were cured? In my opinion, they wouldn’t, and their own studies show we’re going to need more medical intervention.
Our genes explain 40 to 70% of the differences in body weight,⁸ and with medical conditions, hormones, and a bodega on every corner, our bodies still run a famine plan in a world full of snacks. I own the choices I make about food, but what drives them? Those choices cannot control all the forces inside my body.
So…what can I control and how? Let’s explore in part 2 and follow the science. We can’t bend the spoon because there is no spoon. So seek to better understand and bend ourselves.
Don’t miss Part 2
If this sounds like your story, subscribe so Part 2 lands in your inbox, and tell me in the comments what year you are in and what changed for you.
In Part 2, I dig into why the body pushes back even on the medicine, from a brain that defends its weight to the insulin and leptin signals working against us.
If you know someone in year three, four or five who has been blaming themselves, send this to them so they can see the science and stop blaming themselves all over again.
Mid-way through year four here, but tirzepatide for the first 11 months only. Moved onto other options (maybe you don’t acknowledge that people do this, and that’s fine) that seem to be ridiculously effective at lower doses for 2-1/2 years now. So it’s possible that the next generation of GLPs will be the answer - and this space is evolving at a ridiculously rapid rate. Seems like a rollercoaster that we’re stuck on, for sure, but having lost 115lbs, I know what you’re talking about. I don’t want go back to where I was before.
I’ve lost 90 pounds and am happy at this weight. Began July 2024. If the meds ever stop working, I do not know what I will do. I like having good bloodwork, good mobility and the ability to easily buy clothes that fit.