When Hunger Goes Quiet

 For Dr Kesava Reddy Mannur, Clinical Director of Metabolic & Bariatric Surgery, the change he sees in patients taking GLP-1 drugs is unmistakable. “They aren’t just eating less,” he says. “They’re thinking about food differently. Patients describe a hush where a constant internal tug once lived. The mental chatter around eating—now widely called food noise—begins to fade. The shift is quiet, but profound,” says Dr Kesava.

GLP-1 medications were developed to regulate blood sugar by slowing digestion and increasing insulin secretion. Their role in weight loss emerged later, almost incidentally. “What few anticipated was their effect on the brain. As millions adopt drugs like semaglutide for diabetes and obesity, many report fewer cravings, reduced impulsive behaviour, and—unexpectedly—improvements in anxiety and addictive tendencies. This tells us we’re not dealing with willpower,” Dr Kesava says. “We’re dealing with neuro-hormonal pathways.”

Obesity, redefined

That insight is reshaping medicine’s understanding of obesity itself. Long framed as a failure of discipline, it is increasingly recognised as a chronic, biologically driven disease. The evidence has been hard to ignore—especially after large trials showed GLP-1 therapies significantly reduce heart attacks and strokes. Cardiovascular risk,” Dr Mannur notes, “it stops being cosmetic medicine. It becomes preventive cardiology.”

The brain on GLP-1s

Endocrinologists are seeing similar patterns. Dr Ravi Sankar Erukulapati, Consultant Endocrinologist at Apollo Hospitals, points out that GLP-1 receptors are not confined to the gut. “They’re present in brain regions that regulate reward, motivation, and mood,” he explains. That may be why patients report fewer compulsive urges — not only around food, but alcohol, smoking, and even impulse spending.

Researchers are now testing GLP-1 drugs for binge-eating disorder, substance dependence, and other impulse-control conditions. “Early findings suggest these medications influence dopamine signalling — the brain’s reward currency — potentially dampening the cycle of craving and reinforcement that defines addiction,” says Dr Ravi. Patients often describe the effect not as restraint, but relief. “There’s a sense of mental quiet,” Dr Ravi says. “People feel less driven by urges, more deliberate.” That neurological calm may also explain why some experience improved emotional regulation—though responses vary widely.

Promise, with caveats

Caution runs alongside optimism. Long-term data on psychological effects remain limited, and side effects—from gastrointestinal distress to emotional blunting—are not uncommon. “Some patients feel emotionally better,” Dr Ravi cautions. “Others don’t. And we don’t yet know what happens after years of use—or after stopping.”

Dr Kesava is direct about that uncertainty. “If semaglutide is stopped, weight often returns,” he says. “That’s not patient failure. It’s proof that obesity behaves like any other chronic disease.”

Access and overuse

In India, access complicates the picture. High costs, limited insurance coverage, and uneven prescribing practices keep these drugs out of reach for many. Their rapid uptake in urban clinics has also raised concerns about overuse—particularly when lifestyle support and long-term monitoring are inconsistent.

Not drugs versus surgery

As a bariatric surgeon, Dr Kesava does not see GLP-1 drugs as replacing surgery, but redefining the treatment landscape. For some patients, medication may delay or eliminate the need for surgery. For others, it improves metabolic health enough to make surgery safer and more effective. “The future,” he says, “is not drugs versus surgery. It’s personalised care.”

A quieter reckoning

As GLP-1 therapies surge in popularity, their unexpected psychological effects are forcing a broader reckoning. They challenge the belief that desire is purely a matter of choice—and suggest instead that biology sets the volume on hunger, impulse, and control. “What we’re witnessing may be a paradigm shift,” Dr Erukulapati says. “But until long-term evidence is clear, these drugs must be prescribed thoughtfully and followed closely.” For now, GLP-1 medications sit at a crossroads—offering promise, provoking debate, and quietly reshaping how we understand the relationship between the gut, the brain, and the choices we believe are our own.

More Than Weight Loss:

· Biology over willpower: Rethinking obesity as a neuro-hormonal disease

· Brain effects: Reduced hunger, cravings, and compulsive behaviour

· Beyond weight loss: Potential role in addiction and impulse disorders

· Cardiovascular impact: Proven reduction in major cardiac events

· Not a cure: Weight regain underscores obesity as a chronic disease

· Integrated future: Medication and surgery increasingly work together