Overeating on Saxenda can be a frustrating experience for individuals seeking effective weight management. Saxenda (liraglutide 3.0 mg) is a GLP-1 receptor agonist licensed in the UK to reduce appetite and support weight loss when used alongside diet and exercise. However, some patients continue to experience episodes of overeating or inadequate appetite control despite treatment. This may occur due to individual variation in medication response, psychological eating triggers, suboptimal dosing, or insufficient lifestyle modification. Understanding why overeating persists and how to address it is essential for optimising treatment outcomes and achieving sustainable weight management goals.

What Is Saxenda and How Does It Work?

Saxenda (liraglutide 3.0 mg) is a prescription-only injectable medicine licensed in the UK for weight management in adults with a body mass index (BMI) of 30 kg/m² or above, or 27 kg/m² or above with weight-related comorbidities such as type 2 diabetes or hypertension. It is administered once daily via subcutaneous injection and is intended to be used alongside a reduced-calorie diet and increased physical activity.

Saxenda belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. Liraglutide mimics the action of the naturally occurring hormone GLP-1, which is released from the gut in response to food intake. By binding to GLP-1 receptors in the brain—particularly in areas that regulate appetite and food intake—Saxenda helps to reduce hunger, increase feelings of fullness (satiety), and slow gastric emptying. These combined effects typically lead to a reduction in overall calorie intake and support gradual, sustained weight loss.

The treatment follows a specific dose titration schedule: starting at 0.6 mg daily, then increasing by 0.6 mg weekly until reaching the target dose of 3.0 mg daily. This gradual increase helps minimise gastrointestinal side effects. If you miss doses for 3 or more consecutive days, you should restart at a lower dose and re-titrate according to your healthcare provider's guidance.

Clinical trials have demonstrated that Saxenda, when used as part of a comprehensive weight management programme, can lead to clinically meaningful weight loss. However, individual responses vary considerably. While Saxenda is licensed for weight management, NHS funding follows specific NICE criteria which may be narrower than the licence conditions.

Importantly, Saxenda should not be used during pregnancy and is not recommended during breastfeeding. Patients should be monitored regularly for potential side effects, including pancreatitis, gallbladder disease, and increased heart rate.

Why Overeating May Still Occur on Saxenda

Despite Saxenda's appetite-suppressing mechanism, some individuals continue to experience episodes of overeating or find that their appetite is not adequately controlled. There are several reasons why this may occur, and understanding these factors is essential for optimising treatment outcomes.

Individual variation in response is a key consideration. Not all patients respond equally to GLP-1 receptor agonists. Some individuals may experience only modest appetite suppression, particularly if they have longstanding patterns of overeating or significant metabolic dysregulation.

Psychological and behavioural factors also play a substantial role. Overeating is often driven by emotional triggers, stress, boredom, or habitual patterns rather than true physiological hunger. Saxenda primarily addresses the biological component of appetite regulation but does not directly alter the psychological drivers of eating behaviour. Individuals who eat in response to emotional cues or environmental triggers may continue to overeat despite reduced hunger signals.

Weight-loss plateau can occur over time in some patients. Additionally, if the dose escalation schedule is not followed correctly or if the maximum therapeutic dose (3.0 mg daily) is not reached, the appetite-suppressing effects may be suboptimal.

Inadequate lifestyle modification is another critical factor. If dietary habits remain unchanged—particularly consumption of energy-dense, highly palatable foods—overeating can persist. External factors such as sleep deprivation, alcohol consumption, sugary drinks, and ultra-processed foods can all undermine appetite control. Saxenda is designed to work synergistically with calorie restriction; without this, its effectiveness is significantly diminished.

Certain medical conditions or medications that affect appetite or metabolism may interfere with Saxenda's action. Medications such as corticosteroids, some antipsychotics, certain antidepressants (e.g., mirtazapine), and sodium valproate can promote weight gain. For people with diabetes, hypoglycaemia (particularly if taking insulin or sulfonylureas) can trigger hunger and overeating, potentially counteracting Saxenda's effects.

Managing Appetite and Eating Habits While Taking Saxenda

Successfully managing appetite and preventing overeating while taking Saxenda requires a multifaceted approach that combines pharmacological treatment with structured lifestyle interventions. The following strategies can help optimise outcomes:

Adhere to a structured eating plan: Work with a dietitian or healthcare professional to develop a balanced, reduced-calorie diet that emphasises nutrient-dense foods. Focus on:

• High-protein foods (lean meats, fish, eggs, legumes) which promote satiety

• High-fibre vegetables and whole grains to increase fullness and slow digestion

• Adequate hydration, as thirst is sometimes mistaken for hunger

• Regular meal timing to establish consistent eating patterns and prevent extreme hunger

Practise mindful eating techniques: Pay close attention to hunger and fullness cues. Eat slowly, without distractions such as television or mobile devices, and pause between bites. This allows the brain adequate time to register satiety signals, which can take 15–20 minutes after eating begins.

Address emotional and behavioural triggers: Consider cognitive behavioural therapy (CBT) or counselling if emotional eating is a significant issue. Keeping a food and mood diary can help identify patterns and triggers. Developing alternative coping strategies for stress—such as physical activity, relaxation techniques, or social support—can reduce reliance on food for emotional comfort.

Monitor portion sizes: Even when eating nutritious foods, portion control remains important. Use smaller plates, measure servings, and avoid eating directly from large packages.

Ensure correct medication use: Follow the prescribed dose escalation schedule carefully (starting at 0.6 mg daily and increasing by 0.6 mg weekly to 3.0 mg), and take Saxenda at the same time each day. If you miss doses for 3 or more days, you'll need to restart at a lower dose and gradually increase again. To manage gastrointestinal side effects, try eating smaller, more frequent meals, avoiding high-fat foods, and staying well-hydrated. If side effects are significant, your healthcare provider may recommend delaying dose increases.

Incorporate regular physical activity, as recommended by NICE guidelines, to support weight management and improve overall metabolic health. Your GP may refer you to NHS weight management services (Tier 3) for additional multidisciplinary support if needed.

When to Speak to Your GP About Saxenda Effectiveness

It is important to maintain open communication with your GP or prescribing clinician throughout your treatment with Saxenda. There are specific circumstances in which you should seek medical advice regarding the medication's effectiveness or your ongoing symptoms.

Insufficient weight loss is a key indicator that warrants discussion. NICE guidance states that treatment with Saxenda should be discontinued if a patient has not lost at least 5% of their initial body weight after 12 weeks at the 3.0 mg daily dose (or maximum tolerated dose). If you are not achieving meaningful weight loss despite adherence to the medication and lifestyle modifications, your GP can assess whether Saxenda is the appropriate treatment for you or whether alternative options should be considered.

Persistent overeating or lack of appetite control despite reaching the therapeutic dose is another important reason to consult your GP. This may indicate that Saxenda is not providing adequate appetite suppression for you individually, or that other factors—such as psychological, hormonal, or metabolic issues—require investigation.

Intolerable side effects that prevent you from reaching or maintaining the therapeutic dose should be discussed promptly. Common adverse effects of Saxenda include nausea, vomiting, diarrhoea, and constipation. While these often improve over time, severe or persistent gastrointestinal symptoms may limit treatment effectiveness.

New or worsening symptoms such as severe abdominal pain (which could indicate pancreatitis), persistent nausea and vomiting, signs of gallbladder disease (right upper abdominal pain, fever, jaundice), or symptoms of depression or suicidal ideation require urgent medical attention. Prolonged vomiting can lead to dehydration and potential kidney problems, so seek medical help if you cannot keep fluids down.

If you have diabetes and take insulin or sulfonylureas, speak to your GP about adjusting these medications to reduce the risk of hypoglycaemia. If you become pregnant while taking Saxenda, stop the medication and contact your healthcare provider immediately, as it should not be used during pregnancy. It is also not recommended during breastfeeding.

If you have a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2, this should be discussed with your prescriber before starting or continuing treatment.

You can report any suspected side effects to the MHRA through the Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

Alternative Approaches If Saxenda Isn't Controlling Your Appetite

If Saxenda does not provide adequate appetite control or weight loss despite appropriate use and lifestyle modification, several alternative approaches may be considered. Your GP or specialist can help determine the most suitable option based on your individual circumstances, medical history, and treatment goals.

Alternative pharmacological treatments are available for weight management. Other GLP-1 receptor agonists, such as semaglutide (available as Wegovy for weight management), may be considered. Semaglutide is administered once weekly and has demonstrated greater weight loss efficacy in clinical trials compared to liraglutide, though individual responses vary and NHS access follows specific NICE criteria. Orlistat, a lipase inhibitor that reduces fat absorption, represents a different mechanism of action and may be suitable for some patients, though it requires strict adherence to a low-fat diet to minimise gastrointestinal side effects.

Intensive behavioural and psychological support is crucial, particularly if emotional or habitual eating patterns are prominent. Referral to a specialist NHS weight management programme (Tier 3 services) can provide structured support including dietetic input, psychological therapy, and supervised physical activity programmes. Cognitive behavioural therapy (CBT) specifically targeting eating behaviours has strong evidence for improving outcomes in weight management.

Bariatric surgery may be appropriate for individuals with severe obesity (BMI ≥40 kg/m², or ≥35 kg/m² with significant comorbidities) who have not achieved adequate weight loss with non-surgical interventions. NICE recommends considering bariatric surgery as a treatment option in these circumstances, with assessment typically occurring through Tier 3 services before referral to Tier 4 (surgical) services. Earlier assessment may be considered for people with recent-onset type 2 diabetes, and lower BMI thresholds may apply for certain ethnic groups. Procedures such as gastric bypass or sleeve gastrectomy can produce substantial, sustained weight loss and improvement in obesity-related conditions.

Addressing underlying medical conditions is essential. Conditions such as hypothyroidism, polycystic ovary syndrome (PCOS), Cushing's syndrome, or medication-induced weight gain should be identified and managed appropriately. Your GP can arrange relevant investigations if an underlying cause is suspected. Ultimately, a personalised, multidisciplinary approach offers the best chance of achieving sustainable weight management and improved health outcomes.

Frequently Asked Questions