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Semaglutide kept cutting calories after hunger relief faded
A 60-week trial in 120 adults measured what people actually ate. Those on semaglutide still ate around 270 fewer calories at week 60, even though the appetite benefits they reported had gone.
Based on a 60-week, double-blind randomized controlled trial in 120 adults with overweight or obesity, with laboratory meal testing at four time points
- A 60-week randomized trial measured real meals in a lab, not just what people reported.
- The semaglutide group ate about 292, 240 and 270 fewer calories at weeks 20, 40 and 60.
- Reported appetite and hunger improved at week 20 but no longer differed by weeks 40 and 60.
- So the eating change outlasted the feeling of it, which is the point of the study.
- Only 120 people took part, and lab meals are not the same as eating at home.
A year into taking a weight-loss drug, plenty of people report the same thing: it does not feel like it did at the start. The food noise is back. The meals feel normal again.
A trial in the American Journal of Clinical Nutrition set out to check whether that feeling matches what people are actually eating. It does not.
What the semaglutide trial measured
Most of what is known about semaglutide and appetite comes from short studies. As the authors put it, studies of 20 wk or less have demonstrated reductions in energy intake, appetite, and food reward with the drug, and those brief studies could not assess whether semaglutide has long-term effects on eating that keep the weight off.
So this one ran for 60 weeks. It randomly assigned 120 adults with overweight/obesity to semaglutide or a placebo injection, with neither participants nor researchers knowing which.
Four times over the trial, at weeks 0, 20, 40 and 60, participants came into a laboratory. They rated their appetite when fasting and for 4 h after a standardized breakfast, then were given lunch and allowed to eat as much as they wanted while the amount was recorded.
That last part is the important one. It measures behavior rather than opinion.
How much less the semaglutide group ate
The reductions were substantial and they held.
The semaglutide group had significantly larger reductions from baseline in ad libitum energy intake than placebo at every assessment, eating roughly 292 fewer calories at week 20, 240 fewer at week 40, and 270 fewer at week 60.
Read those three numbers as a line rather than three points. The effect at 60 weeks is essentially the effect at 20 weeks. Nothing wore off.
What the semaglutide group stopped noticing
The feeling of it.
At the first assessment, the drug did what people describe. Semaglutide-treated participants had significantly greater increases from baseline in appetite suppression after the standardized breakfast, reported less hunger over the previous week, and reported less preoccupation with food.
By the later assessments that had gone. The groups did not differ significantly in appetite outcomes at weeks 40 or 60.
One thing in between held longer. The semaglutide group had greater reductions in responsiveness to the rewarding value of food at weeks 20 and 40, measured by a questionnaire about how much the pleasure of food pulls at a person.
So the sequence is: eating drops and stays down; reported hunger improves then returns to normal; the pull of food weakens and then fades too.
Why the appetite gap matters for anyone on semaglutide
This is the part with a practical edge, and it runs against how people judge their own treatment.
If someone measures whether a drug is working by whether food feels different, this trial says they will get the wrong answer at around a year. The subjective signal disappears while the behavior does not.
The authors read it as evidence about mechanism: their conclusion is that reduced energy intake is a central mechanism by which semaglutide both induces and maintains weight loss. That is a claim about how the drug keeps weight off after the initial drop, which has been an open question.
What a lab lunch cannot tell you about real eating
Three limits, and they are real.
The trial had 120 people in it, which is small for a 60-week study and means the estimates carry wide margins. A measured lunch in a research laboratory is also not a normal day of eating: portion, setting and the knowledge of being watched all differ from a kitchen at home.
And this was designed to explain a mechanism, not to test an outcome. It measured what people ate, not how much weight they kept off, so the link between the two is inference rather than demonstration here.
What it does establish is worth carrying: at a year, the drug is still changing what people eat, whether or not it still feels that way.
People also ask
What did this trial measure that others have not?
How much people actually ate, over a long period. Previous studies of semaglutide and appetite ran 20 weeks or less, which the authors note could not assess whether semaglutide has long-term effects on eating that support the maintenance of lost weight. This trial ran 60 weeks with laboratory assessments at weeks 0, 20, 40 and 60.
How was food intake measured?
Participants rated their appetite while fasting and for four hours after a standardized breakfast, then ate an ad libitum lunch, meaning a meal where they could eat as much as they liked while the amount was measured. Food reward was assessed with the Power of Food Scale, a questionnaire about responsiveness to the pleasure of eating.
What were the intake numbers?
Against placebo, the semaglutide group ate a mean of 291.9 +/- 64.4, 240.2 +/- 87.8, and 269.5 +/- 83.6 kcal less at weeks 20, 40 and 60 respectively. The reduction at week 60 was essentially the same size as at week 20, which is the finding.
What faded, then?
The subjective side. At week 20 the semaglutide group reported greater appetite suppression after the standardized breakfast, less hunger over the past week, and less preoccupation with food. By weeks 40 and 60 the groups did not differ significantly in appetite outcomes. Responsiveness to the rewarding value of food was still reduced at weeks 20 and 40.
Why does that gap matter?
Because it separates the drug's effect from the experience of it. Someone a year into treatment may notice that food no longer feels different, and conclude the medicine has stopped working. On this evidence the reduction in what they eat is still there. It also suggests appetite ratings are a poor way to judge whether treatment is working.
How much should this change anyone's thinking?
Modestly. This is 120 people, and a measured lunch in a research lab is not a day of eating at home. It is also a mechanistic study rather than a weight-outcome trial. The value is in explaining why the weight loss persists, not in adding a new reason to take the drug. Prescribing decisions belong with a doctor.
References
- Tronieri, J. S., Allison, K. C., DeRouen, K., et al. Short- and long-term effects of semaglutide 2.4 mg on energy intake, appetite, and food reward: a 60-week, double-blind randomized controlled trial. American Journal of Clinical Nutrition, 2026.
- National Institute of Diabetes and Digestive and Kidney Diseases. Prescription Medications to Treat Overweight and Obesity. US National Institutes of Health.