Understanding metabolic adaptation and the ‘set point’
The ‘set point’ theory suggests that our brain has a level of body fat it’s happy with. This is a level of body fat it will ‘defend’ and protect.
This body fat level is determined by the communication between hormones in the body, specifically leptin, and the hypothalamus in the brain.
Leptin is produced in our fat cells and tells the hypothalamus how much body fat we have stored.
When we lose weight and body fat, our leptin levels fall. When the brain senses the lower leptin levels, it triggers a series of physiological adaptations designed to defend against what it perceives as a threat to survival.
This process, known as metabolic adaptation, involves multiple systems working together to preserve energy stores.
Research shows that total daily energy expenditure (TDEE) decreases when we eat in a calorie deficit and lose body fat. This means the amount of energy (calories) we burn each day decreases.
Additionally, hormonal changes occur that influence hunger and appetite:
- Increased ghrelin: Ghrelin is our hunger hormone
- Decreased leptin
- Reduced GLP-1 and PYY: These are our fullness/satiety hormones
These hormonal changes are to encourage us to eat more to regain the body fat lost and return us to our ‘set point’.
Weight-loss injections help counteract these adaptations by maintaining a high level of GLP-1 in the blood, helping us feel fuller for longer.
By maintaining these changes for an extended period while developing sustainable habits, it may be possible to establish a new ‘defended’ weight range.
So, by losing weight on weight-loss injections and maintaining healthy habits for long enough, we can reset our ‘set point’ to a new lower level of body fat, and our hormonal balance and energy expenditure should return.
However, not everyone will be able to come off weight-loss injections, and some people may have genetic predispositions to obesity, such as higher levels of ‘food noise’, that require weight-loss medication to manage.
What are food noise and hedonic hunger?
Many people experience what’s known as ‘food noise’ – a constant preoccupation with food and eating that exists beyond physical hunger.
Research suggests this phenomenon relates closely to hedonic hunger, where individuals frequently think about and desire palatable foods beyond their physical requirements.
Weight loss medications like Wegovy and Mounjaro work by targeting the brain’s reward centre, effectively lowering this background ‘noise’ around food.
By mimicking hormones that regulate hunger and satiety, these medications help reduce the constant thoughts about food that many people experience, making it easier to eat in response to genuine hunger rather than psychological/hedonic drives.
For individuals who’ve lived with high levels of food noise throughout their lives, coming off these medications can feel daunting.
The research on hedonic hunger suggests that some people may be more susceptible to strong appetitive drives, particularly in our modern food environment.
Human clinical trials investigating how to lower food noise are lacking. Still, a combination of psychological strategies like CBT and healthy habits will likely help to lower food noise naturally.
Alongside lifestyle changes, weight-loss injections may potentially reduce food noise directly by interacting with the brain’s appetite centre and reward pathway to lower food-seeking behaviours that can drive eating beyond physical need.
How to come off weight-loss injections
Stopping weight-loss injections should be gradual and personalised to the individual’s goals, preferences, and clinical situation.
Here’s an example titration schedule for Wegovy:
For Mounjaro, the schedule might look like:
When reducing your medication dose, you may notice gradual changes in hunger and appetite signals.
These changes are normal physiological responses as your body adjusts to lower medication levels.
During the titration period, some people may experience:
- Subtle increases in hunger, particularly between meals
- Changes in energy levels throughout the day
- Variations in how quickly you feel full during meals
- Temporary side effects similar to when starting the medication
It’s important to understand that feeling hungry is a normal human experience. The goal isn’t to eliminate hunger entirely but to develop sustainable strategies to manage it effectively.
Food noise and hunger, while related, need to be viewed separately as we may be able to address hunger through a change in diet, while food noise can remain.
So, while many of the approaches we recommend are likely to lower physical hunger, it’s challenging to be sure that food noise won’t return when coming off the medication.
For individuals with high levels of food noise, remaining on weight-loss injections for longer may be necessary.
How to lower hunger naturally
While research on coming off weight-loss injections is limited, we can take inspiration from existing research on approaches that:
- Lower the hunger hormone ghrelin
- Increase satiety/fullness hormones like GLP-1, PYY, and CCK
Focusing on these two areas to lower hunger and food noise makes us more likely to manage life after weight-loss injections.
Here are five evidence-based ways to lower hunger naturally to help come off weight-loss injections:
1. Optimise protein intake
Consuming adequate protein (25-30% of your daily calories) helps preserve muscle mass and increases satiety. Include protein-rich foods like eggs, dairy, lean meats, fish, or plant-based alternatives at each meal.
25-30% of your calories will equate to roughly 25-50g of protein in each meal. This will look like a protein portion the size of an open hand, like 150g of chicken breast or 150g of salmon.
2. Focus on fibre-rich foods
High-fibre foods help slow digestion and promote feelings of fullness. Ensure 50% of your meals are non-starchy vegetables like kale, broccoli, and other leafy greens.
Include 1-3 servings of fruit in your diet each day alongside your meals, like berries with breakfast or an apple with your lunch.
Foods like chia seeds and flaxseed (linseed) are rich in fibre and are a source of fat and protein. Add these to your breakfast to boost fibre, protein, and fat.
3. Eat three balanced meals a day
Establishing consistent meal times helps regulate hunger hormones. This doesn’t mean rigid scheduling but rather developing a reliable pattern that works for your lifestyle.
If you need to, include protein-rich snacks in between meals such as tinned fish on rye crackers, or apple with peanut butter.
4. Prioritise a good sleep routine
Research shows that poor sleep can increase hunger hormones and affect food choices. Aim for 7-9 hours of quality sleep each night by maintaining a consistent sleep schedule.
The best ways to support good sleep are by going to bed at the same time every night, avoiding screen times before bed, and getting sunlight exposure in the morning to help set your internal clock.
5. Incorporate resistance training
Regular strength training helps preserve muscle mass, which plays a crucial role in maintaining metabolic health. Even basic bodyweight exercises can make a significant difference.
Increasing muscle mass will also help to boost our metabolism and improve the signals from the body to the brain to manage hunger levels.
Take home message
Coming off weight loss injections requires a thoughtful, gradual approach and sustainable lifestyle changes.
While research shows that weight regain is possible without proper planning, newer evidence suggests that slow titration and healthy habits can help maintain weight loss in the long term.
Being able to come off weight-loss injections successfully depends on:
- Working closely with your healthcare team
- Following a structured titration schedule
- Implementing evidence-based lifestyle strategies
- Understanding that occasional hunger is normal
- Maintaining consistent healthy habits
Remember that everyone’s journey is different; what works best for you may take time to discover.
Focus on developing sustainable habits you can maintain for life rather than seeking quick fixes or extreme approaches.
Second Nature’s medication programmes
Second Nature has two medication-supported programmes: a Wegovy weight-loss programme and a Mounjaro weight-loss programme.
Why should you choose Second Nature over other medication providers if you’ve decided to try Mounjaro or Wegovy (assuming you’re eligible)?
For peace of mind.
Second Nature has worked with the NHS for over 6 years, providing weight-loss programmes across the UK.
While our Wegovy and Mounjaro weight-loss programmes are private and not currently used by the NHS, we’ve built the programmes focusing on scientific evidence, patient safety, and data security.
We hope that our 6+ years of working with the NHS and building a track record of effective weight-loss results will give you peace of mind to give us a try.
