@mariam.zabu's GLP-1 appetite claims need context

What does this video actually claim?

Mariam (@mariam.zabu) suggests she "eats everything" offered to her despite being on GLP-1 medication. The implication is that her appetite remains largely unchanged, which contradicts what most people expect from these drugs.

This claim is worth examining because appetite suppression is the primary mechanism through which semaglutide and tirzepatide work. The STEP 1 trial (Wilding et al., NEJM, 2021) showed 14.9% weight loss at 68 weeks precisely because participants ate less due to reduced appetite and delayed gastric emptying.

Her experience, if accurate, would be unusual but not impossible given individual variation in GLP-1 receptor sensitivity.

Do GLP-1 drugs always suppress appetite?

No, but they do for most people at therapeutic doses. The STEP trials consistently showed appetite reduction as the primary driver of weight loss with 2.4mg semaglutide weekly.

In the SURMOUNT-1 trial (Jastreboff et al., NEJM, 2022), participants on 15mg tirzepatide weekly reported significant appetite suppression that lasted throughout the 72-week study. About 89% of participants experienced at least 5% weight loss, suggesting appetite suppression was working for the vast majority.

However, individual responses vary. Some people don't respond well to standard doses, while others might be taking subtherapeutic doses or haven't reached their maintenance dose yet. Starting doses of 0.25mg semaglutide or 2.5mg tirzepatide often don't provide much appetite suppression.

What about tolerance?

Some patients do develop tolerance over time. A small subset in long-term studies showed diminished appetite suppression after 12-18 months, though this wasn't the majority experience.

What could explain her experience?

Several factors could account for Mariam's claim that she still eats everything offered. She might be on a low dose, experiencing tolerance, or have genetic variations affecting GLP-1 receptor function.

Dose matters enormously. Many people start on 0.25mg semaglutide and don't feel appetite changes until reaching 1.0-2.4mg. The STEP 1 trial used 2.4mg as the target dose because lower doses showed minimal weight loss effects.

Timing also matters. If she's eating shortly after injection day, the appetite suppression might be stronger than later in the week. Some patients report cyclical appetite patterns on weekly injections.

She could also be interpreting "eating everything offered" differently than viewers assume. Maybe she's eating smaller portions of everything rather than avoiding foods entirely.

What should you actually know?

Most people on therapeutic GLP-1 doses will experience significant appetite reduction. Mariam's experience, while possible, isn't typical based on clinical trial data.

The STEP program across four trials showed consistent appetite suppression leading to substantial weight loss. In STEP 1, participants lost an average of 14.9% body weight over 68 weeks specifically because they ate less due to the medication's effects on satiety hormones.

If you're not experiencing appetite suppression on a GLP-1 medication, talk to your prescriber about dose adjustment. You might need a higher dose or a different medication in this class. Don't assume your experience will match any single person's social media posts.

Individual variation is real, but the clinical data is clear about what happens for most people at appropriate doses.