It’s a demoralising cycle that’s all too familiar to most people who have lost weight.
At first, delighted with your new, lighter self, you revel in activities you can enjoy, clothes that now fit and a renewed sense of purpose about life.
But then you notice that a couple of pounds have crept back, followed by a few more. Slowly but surely, as the months slip past, the lost weight returns. Before you know it, you’re back to square one.
This scenario is common to crash-dieters – and research shows it’s also becoming a familiar story for many who’ve slimmed down using weight-loss jabs.
GLP-1 medications such as Mounjaro, Wegovy and Ozempic lead to transformational weight loss for many people, yet the results are often short-lived, unless you commit to taking them long-term.
What’s happening in your mind is constantly being played out in your body and eating patterns
One study showed that participants regained about two-thirds of their weight loss within 12 months of stopping treatment.
Indeed, earlier this year Oxford University researchers found that people who come off weight-loss injections such as Mounjaro or Wegovy can regain lost pounds four times faster than those who stop conventional dieting and exercise – leading experts to warn that millions of Britons may need to stay on the jabs for life.
Weight regain can even happen with people who undergo bariatric surgery. An estimated one-fifth of patients regain more than 15 per cent of their body weight five years after surgery; some studies suggest around three-quarters experience weight regain within six years.
This is because of a vital fact that’s often overlooked: although it might appear to be a physical problem, obesity is fundamentally rooted in psychology.
What’s happening in your mind is constantly being played out in your body and eating patterns.
Interestingly, rates of alcoholism increase by 33 per cent after bariatric surgery, suggesting that when one source of comfort is taken away people often find another, whether it’s alcohol, shopping or gambling.
Dr Max Pemberton has joined forces with chartered psychologist Dr Courtney Raspin to design a practical step-by-step psychological guide
GLP-1 agonists work by mimicking natural hormones produced by the body, slowing stomach emptying, creating a sense of satiety in the brain and slowing dopamine release in the brain’s reward centres so that sugary and high-fat foods become less appealing.
This helps silence ‘food noise’, the clamour of food-related thoughts that incessantly play in many people’s heads.
But this noise usually returns, along with the lost weight, once you stop the medication.
As a consultant NHS psychiatrist, it’s a depressing pattern I’ve often witnessed with my own patients.
But the good news is that there is a solution: addressing the underlying psychological issues that lie at the root of your weight problems.
That’s why I’ve joined forces with chartered psychologist Dr Courtney Raspin, an expert in treating eating disorders and body image, to design a practical step-by-step psychological guide to help you step off the weight-loss rollercoaster for good.
Our essential toolkit uses evidence-based strategies to help you make habit and mindset changes that will last a lifetime.
Rooted in our years of clinical experience, it forms the basis of our new book, The Weight Loss Prescription, which I am sharing with Daily Mail readers in an exclusive three-part series, starting today.
Why weight battles begin in your mind
It’s helpful to understand why so many people put on too much weight, when others don’t. A standard response is that they simply take in more calories than they use, yet it’s clear from the millions who struggle with their weight that it’s not that simple.
Genetic factors are sometimes involved: research has identified numerous genes that influence body weight, appetite regulation and metabolism. Certain hormones also play a part – including oestrogen, cortisol, thyroid hormones and insulin, which can affect appetite and fat storage.
But our environment also plays a massive role in shaping our eating behaviour, often in ways we don’t consciously recognise. Family food patterns, such as being encouraged to clear your plate as a child, can persist into adulthood. We also lead increasingly sedentary lives.
We’re constantly bombarded with contradictory messages – processed, highly-calorific foods are marketed as irresistible treats on the one hand, yet we’re encouraged to aspire to idealised, toned bodies on the other.
The diet industry contributes to black-and-white thinking, with some foods cast as ‘good’ while others are ‘bad’. This contributes powerfully to an unconscious mindset of reward and guilt where food is concerned.
Recent research reveals that highly palatable foods can hijack the brain’s reward system, creating patterns of craving and consumption that feel almost involuntary.
Brain changes that occur with repeated exposure to highly rewarding foods can persist long after eating patterns change, which explains why some people struggle with food cravings despite making conscious efforts to eat differently.
Dr Max Pemberton’s new book called The Weight Loss Prescription, which he is sharing with Daily Mail readers in an exclusive three-part series, starting today
Another issue is that everyone’s body has a ‘set point’, a weight it considers ‘normal’ and strives to maintain. If you’ve been overweight for a while, your body assumes this is your normal weight so resists weight loss, triggering hunger pangs.
This explains why gradual, sustained weight loss is often more successful than rapid weight loss, as it gives your body time to adjust.
GLP-1 medications appear useful in this regard, as they help override some biological mechanisms that defend against weight loss.
The hidden patterns keeping you stuck
Most problems with weight loss stem from unconscious mental patterns.
This was illustrated by one of our patients who was on weight-loss medications and was planning a holiday to the Maldives – a trip he’d saved towards for years. Before departing, he announced he’d decided to stop his injections because the holiday was all-inclusive and he wanted to ‘get my money’s worth’.
He would be in one of the world’s most beautiful destinations, with unlimited snorkelling, pristine beaches, sunset sailing and world‑class diving. Yet what he valued was the opportunity for unlimited eating.
This demonstrates clearly how food can become the primary lens through which we measure enjoyment even without realising it.
Another issue we regularly see is that a person’s weight can become their identity.
One patient with severe mobility issues and diabetes, who’d had stroke warnings from his doctor, wanted to discontinue his medication because of sulphuric burps and mild diarrhoea. Numerous practical and effective ways of dealing with his relatively mild side-effects were suggested but all were dismissed.
Through our conversations, it emerged that his weight was serving psychological functions he wasn’t aware of. It had become his explanation for why certain relationships hadn’t worked out, why he’d avoided pursuing career opportunities and why he stayed at home rather than socialising.
Unconsciously he was trying to sabotage success because that would mean confronting other, difficult issues for which being overweight provided a convenient excuse.
Getting started
Our clinical experience has taught us that long-term weight loss boils down not to how much you want it, but whether you believe you will succeed.
That’s why this toolkit focuses on gradually building your confidence using tried-and-tested psychological approaches to help you understand your own eating patterns and how they relate to your thoughts and feelings. But you can’t change what you don’t notice, which is why the first step is learning how to self-monitor. Commit to tracking your food, weight and activity levels in a daily log.
A food diary is a powerful basic way to understand how your eating patterns are linked to your feelings. Start a new page every day and make a note of what time you ate or drank and what you had (a simple description like ‘chicken wrap’ is fine).
Where were you when you ate? Jot down anything else that was going on – were you hungry or bored, for instance. Did you have any other thoughts such as ‘I shouldn’t eat this?’ or ‘This feels good’? Finally, make a note about how you felt after eating – were you comfortably full or still hungry? Were you satisfied? Did you have any other body signals, such as bloating, sleepiness or energy boost?
This diary is not about judging your food choices, it’s about understanding what drives you towards certain foods at certain times.
You can find an online food diary and also an interactive weight tracker at the book’s website: theweightlossprescription.com
You should also weigh yourself regularly to track your progress. But only do this once a week, as daily weigh-ins can quickly become a frequent ritual of judgement; it doesn’t take long for the number on the scales to decide the kind of day you’re going to have, affecting what you eat, whether you exercise and how you feel.
Monitoring activity levels is also important – keep a daily note of what activities you do, how long for, how you felt and any successes or challenges you had.
Exercise can be a struggle if you’ve been overweight for a while. Carrying excess weight puts strain on your joints, particularly knees, hips and ankles, so even a short walk can be uncomfortable.
Many people also see exercise as punishment. Meanwhile, the fitness world tends to celebrate slim bodies, so you can feel like an intruder in a gym if you don’t fit this description.
Some people also struggle with an all-or-nothing mindset. We often hear patients say there’s no point in going for a ten-minute walk as it’s ‘not real exercise’. Yet small, consistent efforts are more effective and sustainable than a big session that leaves you sore, exhausted and discouraged.
You may not initially be able to manage the 150 weekly minutes recommended by the NHS, but just make a start. Even ten minutes a day is a win. Aim for progress not perfection – and vigorous activities like gardening or dancing also count.
Reframe exercise as something you do for your body and not to it.
Recognising different eating patterns
Your relationship with food is shaped by many things, including your upbringing and emotional experiences. Once you understand your own eating style, you can begin to reshape it with compassionate self-management.
Food is central to socialising, but on such occasions we often eat regardless of hunger
Here are some common patterns:
Emotional eating is when you eat in response to a feeling, such as reaching for chocolate to cheer yourself up. It can also be a form of self-punishment.
We all eat in response to feelings from time to time, but it’s a problem if it’s a persistent pattern or becomes your ‘go-to’ response to difficult emotions. Persistent emotional eating is linked with serious eating disorders such as binge eating disorder and bulimia nervosa.
Habitual eating occurs when you eat automatically in response to a learned cue and not because you’re hungry. We all have habits: they are short cuts our brains create to free up mental energy.
Habitual eating happens when you learn to associate places (e.g. the cinema) or activities (such as making a cup of tea) with eating, because that’s what you normally do. This can lead to cravings – you automatically want a biscuit because the kettle’s boiling. Reactive eating is when something prompts us to eat right away. This might be something around us, such as the delicious aroma of fresh bread, or an internal feeling, such as boredom.
Then there is social eating. Food is central to socialising, but on such occasions we often eat regardless of hunger. This may be because we feel obliged to eat, to avoid feeling excluded or to show appreciation.
Sometimes we simply do it because of physical hunger (physiology-driven eating). Our bodies use hunger to signal that we need to replenish energy stores, usually three or four hours after the last meal or snack.
However, some people who have been emotionally eating for a long time may find it hard to differentiate between physical hunger signals and other feelings.
And if genuine hunger builds for too long (if you’re on a restrictive diet, for instance), then you’re much likelier to make poor food choices, grabbing the quickest option.
What kind of eater are you?
Now that we’ve explored what drives you to eat, it’s helpful to understand the rhythms you may have fallen into. Do you recognise yourself in any of these common patterns?
Feast-or-famine eating involves long periods of minimal consumption followed by a period of overeating and is often the result of a highly-restrictive diet or a stressful life.
Do you recognise yourself in any of these common patterns?
For example, you may have a coffee for breakfast and light salad for lunch but find yourself starving, so eat continuously from dinner until bedtime. What starts as a simple response to hunger can quickly become a ‘what the ‘hell’ mentality – you decide you may as well carry on eating as you’ve already failed.
Grazing is where you eat continuously throughout the day, often in small amounts with no defined meals. It can easily happen if we don’t prioritise eating in a hectic day.
Constant grazing can make you lose touch with what, and how much, you are eating – but small amounts add up significantly. This type of eating also denies your body the important rhythms of fullness and emptiness vital for proper digestion.
Carefree eating – consuming what you want whenever you feel like it – may sound appealing but is not the healthiest approach.
We need to give some thought to what we put into our bodies to fuel them properly. Being completely carefree can follow on from not worrying at all about weight or as a reaction to feeling helpless.
Obsessing over every mouthful is clearly unhealthy, but thoughtful eating is an important part of self-care.
Intuitive eating – when you do so according to your body’s hunger and fullness signals – is key to rebuilding a healthy relationship with food.
In this type of eating, decisions are guided by internal physical cues and overall health, rather than by rigid dietary rules or environmental triggers.
Intuitive eating involves rejecting a diet mentality, acknowledging and honouring your hunger and stopping eating when you are comfortably full, not when your plate is empty. It enables you to enjoy the pleasure of eating without guilt.
Intuitive eating is difficult for people taking GLP-1s as the medication deliberately interferes with natural hunger signals, but it’s a goal to aim for after you stop taking the medication.
Weight-loss jabs aren’t a magic fix on their own
GLP-1s offer an opportunity to lose weight and reset your relationship with food, but only if you’re prepared to do the necessary psychological work.
This programme provides tools to address the root causes of weight struggles during and after medication.
However, GLP-1s have side-effects and aren’t suitable for everyone. Consider the following crucial questions.
GLP-1s have side-effects and aren’t suitable for everyone. Consider the following crucial questions
CAN YOU AFFORD THEM? If paying privately, factor in long-term costs. You’ll likely need treatment for at least a year, but we recommend 18-24 months, to properly establish lasting habits.
CAN YOU DO THE PSYCHOLOGICAL WORK? The exercises and self-reflection in this programme are essential for maintaining weight loss. Without examining your relationship with food, challenging your eating patterns and developing new coping strategies, medication alone won’t succeed. Address serious mental health conditions such as depression before starting.
WHAT’S YOUR MOTIVATION? These are serious medical treatments that work best when driven by genuine long-term health concerns, not quick fixes.
DO YOU REALLY NEED MEDICATION? Medication should be for those who are struggling despite genuine previous efforts with dietitians or NHS programmes; it should not be a first resort.
ARE YOU PREPARED FOR THE SIDE EFFECTS? Many experience nausea, vomiting, diarrhoea, and constipation, especially initially.
HOW WILL YOU FEEL ABOUT INJECTING YOURSELF? Most find it less uncomfortable than expected, but some find it genuinely distressing. Be realistic.
WHAT ARE YOUR EXPECTATIONS? GLP-1s aren’t magic. They reduce food noise, but they won’t eliminate the need for conscious decisions or automatically transform your relationship with food.
ARE YOU PREPARED FOR OTHERS’ REACTIONS? Some may judge your decision to take these drugs. Consider how you’ll handle this.
ARE THEY MEDICALLY SUITABLE? GLP-1s are typically prescribed for those with a BMI (body mass index) of 30+ (or 27+ with weight-related conditions like type 2 diabetes or high blood pressure). They’re inappropriate for pregnant women, people with eating disorders, children, and those with a history of gallstones, thyroid cancer or pancreatitis.
GLP-1s should be taken only under proper medical supervision from a doctor or prescribing pharmacist who can assess suitability, monitor side-effects and adjust dosage appropriately.
No, obesity is not a disease
Over recent years there’s been a move to classify obesity as disease.
While some argue this would reduce stigma and encourage people to seek medical treatment, we disagree.
People struggling with their weight deserve compassion and support. But we can be kind without claiming they have a disease
In our view, framing obesity as a disease implies people are powerless over their biology and encourages them to focus on pharmaceutical solutions, removing personal responsibility.
To do so ignores the vital importance of psychological change in helping people make lasting changes.
Seeing obesity as the result of choices – however inadvertent – is, in fact, empowering. It opens the door to the possibility of making other decisions, with better outcomes.
Adapted from The Weight Loss Prescription, by Dr Max Pemberton and Dr Courtney Raspin (Thorsons, £16.99), to be published February 26. © Max Pemberton and Courtney Raspin 2026. To order a copy for £15.29 (offer valid to March 7, 2026); UK P&P free on orders over £25), go to mailshop.co.uk/books or call 020 3176 2937.
