Why emotional eaters may not lose weight even with drugs like Mounjaro: Experts explain the reason

What are the different types of eating behaviours?

The study looked at three different eating behaviours. One, external eating, which is triggered by external cues such as appetising smells, visually good-looking foods, or seeing others eating. This behaviour has been consistently linked with weight gain, especially in an environment where different types of foods are readily available.

Two, emotional eating, which is triggered by negative emotions such as anxiety or sadness rather than actual hunger. This behaviour is linked with the excessive consumption of calorie-dense foods.

Three, restrained eating, which is basically conscious restriction of foods for weight loss purposes. This behaviour, while linked to weight loss in moderation, may lead to disinhibited eating when done in excess.

What did the study find?

The study followed 92 diabetics, who were put on these GLP-1 drugs, for a year. Researchers tracked their progress at the time of initiation of treatment, at the three-month mark and at the 12-month mark. They collected data on the body weight and composition of participants, their diet and several blood markers, including blood glucose and cholesterol levels.

The researchers reported that the medicine did lead to reductions in body weight, body fat percentage and HbA1c levels (average blood glucose levels over a three month period). However, the researchers noticed differences in results based on people’s eating habits.

The researchers found that the behaviours associated with external eating went down at both the three- month and 12-month follow up. There was a reduction in emotional eating behaviours at the three-month mark but returned to baseline by the year end. And, when it comes to restrained eating, the researchers found an increase in the restrained eating behaviours at the three-month mark and a similar return to the baseline at the one-year mark.

“One possible explanation is that emotional eating is more strongly influenced by psychological factors which may not be directly addressed by GLP-1 receptor agonist therapy. Individuals with prominent emotional eating tendencies may require additional behavioural or psychological support,” said one of the authors, Dr Takehiro Kato of Gifu University.

The study also said: “The transient increase in restrained eating observed for three months may reflect an initial motivational surge following GLP-1RA initiation, which dissipated by 12 months, returning scores to baseline levels.”

Importantly, the researchers found that the greater the external eating behaviours at the initiation of the treatment, the greater the weight-loss the participants experienced.

What does it mean for people who want to get on the drug?

Dr Ambrish Mithal, chairman of diabetes and endocrinology at Max Healthcare, said that the study provides clues to a very important question — who are the responders and who are the non-responders for GLP-1 treatment.

“One of the key answers that we still do not have is that why do some people respond to the treatment but others either do not respond at all or respond poorly — losing less than five per cent of their body weight. Yet, this instinctively makes sense,” said Dr Mithal. He said that this aligns with the observations from his clinic. “While we do not have any data on it, we can sort of tell who is likely to respond really well to the treatment. Those who have a hay-wire lifestyle, enjoying and eating whatever they feel like, respond really well to the GLP-1 drugs,” he added.

This would not mean that people who are emotional eaters will not be prescribed the medicines at all. “It would just mean setting realistic goals. We have to tell them that they may not respond too well but they are still likely to lose some weight with the drugs.”