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Feeling hungry whilst taking Saxenda (liraglutide 3.0 mg) can be frustrating and may raise concerns about whether the medication is working effectively. Saxenda is a GLP-1 receptor agonist licensed by the MHRA for weight management in adults with obesity or overweight with weight-related comorbidities. Whilst clinical trials show most patients experience reduced appetite, some individuals report persistent hunger despite treatment. Several factors may explain continued hunger, including dose titration phase, individual variation in drug response, psychological versus physiological hunger, and inadequate lifestyle modifications. Understanding why Saxenda may not be controlling your appetite and knowing when to seek medical advice is essential for optimising your weight management journey.
Quick Answer: Persistent hunger whilst taking Saxenda may occur due to insufficient dose duration, individual variation in drug response, psychological eating patterns, incorrect injection technique, or inadequate lifestyle modifications alongside treatment.
Saxenda (liraglutide 3.0 mg) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed by the MHRA for weight management in adults with obesity or overweight with weight-related comorbidities, and in adolescents aged 12-<18 years with obesity. Whilst clinical trials demonstrate that most patients experience reduced appetite and increased satiety, some individuals report persistent hunger despite treatment. This can be frustrating and may lead to concerns about treatment efficacy.
Several physiological and practical factors may explain continued hunger on Saxenda:
Dose titration phase – Saxenda requires gradual dose escalation over five weeks to reach the maintenance dose of 3.0 mg daily. During the initial weeks at lower doses (0.6 mg to 2.4 mg), appetite suppression may be minimal or absent.
Individual variation in drug response – Not all patients respond equally to GLP-1 receptor agonists. Biological differences between individuals can influence how effectively Saxenda modulates appetite-regulating pathways.
Psychological versus physiological hunger – Saxenda primarily addresses physiological hunger signals but may have limited impact on emotional eating, stress-related food cravings, or habitual eating patterns that are not driven by true hunger.
Inadequate lifestyle modifications – Saxenda is licensed as an adjunct to a reduced-calorie diet and increased physical activity. Without appropriate dietary changes, the medication's appetite-suppressing effects may be insufficient to create the energy deficit needed for weight loss.
Understanding these factors is essential for setting realistic expectations and working with your healthcare team to optimise treatment outcomes. According to the Saxenda SmPC and NICE guidance (TA664), treatment should be discontinued if at least 5% of initial body weight has not been lost after 12 weeks on the 3.0 mg daily dose.
Saxenda works by mimicking the action of GLP-1, a naturally occurring incretin hormone released by the intestine in response to food intake. GLP-1 receptor agonists like liraglutide act on multiple pathways to promote weight loss, with appetite regulation being a primary mechanism.
The medication influences appetite through several physiological processes:
Central nervous system effects – Liraglutide appears to act on GLP-1 receptors in the hypothalamus and brainstem, regions that control satiety and food intake. This leads to increased feelings of fullness and reduced hunger between meals.
Delayed gastric emptying – Saxenda slows the rate at which food leaves the stomach, prolonging the sensation of fullness after eating. This effect may be most pronounced during the initial weeks of treatment and could diminish somewhat with continued use.
Reduced food cravings – Many patients report decreased preoccupation with food and fewer intrusive thoughts about eating, which can help reduce snacking and portion sizes.
In clinical trials (SCALE Obesity and Prediabetes), patients taking Saxenda 3.0 mg lost an average of 8% of their initial body weight over 56 weeks, compared to 2.6% with placebo, when combined with lifestyle intervention. Many participants reported improved appetite control on validated assessment scales, though individual responses varied considerably.
Expected timeline for appetite effects:
Many patients begin noticing appetite suppression within the first two to four weeks of treatment, with effects typically becoming more pronounced once the full 3.0 mg maintenance dose is reached. However, individual responses vary considerably, and some patients may require several weeks at the maintenance dose before experiencing significant appetite reduction. If you have not noticed any change in appetite after reaching the full dose for four weeks, this warrants discussion with your prescribing clinician.
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When Saxenda fails to adequately suppress appetite, several specific factors should be considered. Identifying the underlying cause is crucial for determining the appropriate next steps in your weight management journey.
Medication-related factors:
Insufficient dose duration – Some patients expect immediate appetite suppression but have not yet reached or maintained the full 3.0 mg dose for an adequate period. NICE guidance suggests assessing response after 12 weeks at the maintenance dose, with discontinuation if less than 5% of initial body weight is lost.
Injection technique issues – Saxenda must be administered subcutaneously (under the skin) in the abdomen, thigh, or upper arm. Incorrect injection technique or repeated use of the same injection site may affect drug absorption and efficacy.
Storage and handling problems – Saxenda must be stored in a refrigerator (2°C to 8°C) before first use and can be kept at room temperature (below 30°C) for up to one month after opening. Do not freeze or expose to excessive heat or direct sunlight, as this may reduce the medication's effectiveness.
Physiological and metabolic factors:
Hormonal imbalances – Conditions such as hypothyroidism, polycystic ovary syndrome (PCOS), or Cushing's syndrome can interfere with appetite regulation and weight loss, potentially diminishing Saxenda's effectiveness.
Medication interactions – Certain medications, including some antidepressants, antipsychotics, corticosteroids, and diabetes medications, can increase appetite or promote weight gain, counteracting Saxenda's effects. If you have diabetes and take insulin or sulfonylureas, there is an increased risk of hypoglycaemia when using Saxenda.
Sleep deprivation – Inadequate sleep disrupts hormones that regulate hunger (ghrelin and leptin), leading to increased appetite regardless of Saxenda treatment.
Dietary and lifestyle factors:
Highly processed diet – Consuming ultra-processed foods high in refined carbohydrates and added sugars can cause rapid blood glucose fluctuations, triggering hunger shortly after meals despite Saxenda treatment.
Inadequate protein or fibre intake – Diets low in protein and fibre may not provide sufficient satiety signals, even with GLP-1 receptor agonist therapy.
Dehydration – Thirst is sometimes misinterpreted as hunger, and inadequate fluid intake can exacerbate feelings of hunger.
A thorough review of these factors with your healthcare provider can help identify specific issues that may be limiting Saxenda's appetite-suppressing effects.
If you continue to experience persistent hunger despite taking Saxenda as prescribed, there are several practical steps you can take in consultation with your healthcare team.
Immediate actions to consider:
Review your injection technique – Ask your prescriber, practice nurse, or pharmacist to observe your injection technique to ensure proper subcutaneous administration. Rotate injection sites systematically to prevent tissue changes that might affect absorption.
Verify medication storage – Check that your Saxenda pen has been stored correctly and has not been exposed to temperature extremes. If you suspect the medication may have been compromised, contact your pharmacy.
Keep a food and hunger diary – Document your meals, snacks, hunger levels (on a scale of 1-10), and timing of Saxenda injections for at least one week. This provides valuable information for your healthcare provider and may reveal patterns you hadn't noticed.
Dietary and lifestyle optimisations:
Increase protein intake – Aim for adequate protein distributed across meals. Protein enhances satiety and helps preserve lean muscle mass during weight loss. If you have kidney or liver disease, consult a dietitian for personalised recommendations.
Prioritise fibre-rich foods – Include vegetables, fruits, whole grains, and legumes to increase meal volume and promote fullness. Target at least 30 g of fibre daily.
Improve sleep hygiene – Aim for 7-9 hours of quality sleep per night, as sleep deprivation significantly impacts appetite-regulating hormones.
Manage stress – Chronic stress elevates cortisol, which can increase appetite and promote abdominal fat storage. Consider stress-reduction techniques such as mindfulness, regular physical activity, or cognitive behavioural therapy.
When to contact your healthcare provider:
You should arrange a review with your prescribing clinician if:
You have been taking the full 3.0 mg dose for more than four weeks without any reduction in appetite
You have lost less than 5% of your initial body weight after 12 weeks of treatment at the maintenance dose (NICE recommends discontinuing Saxenda if this threshold is not met)
You experience concerning side effects alongside persistent hunger
You suspect an underlying medical condition may be affecting treatment response
Seek urgent medical advice if you experience:
Severe and persistent abdominal pain, possibly radiating to your back (potential sign of pancreatitis)
Right upper abdominal pain, fever, or yellowing of skin/eyes (possible gallbladder problems)
Persistent vomiting or signs of dehydration
Symptoms of low blood sugar if you take diabetes medications, especially insulin or sulfonylureas
If you are pregnant, planning pregnancy, or breastfeeding, you should stop Saxenda and consult your healthcare provider immediately, as it is not recommended during these periods.
Alternative treatment options:
If Saxenda proves ineffective despite optimisation efforts, your clinician may consider:
Alternative GLP-1 receptor agonists – Semaglutide (Wegovy) is now NICE-approved (TA875) for weight management in the NHS. Some patients respond better to different medications in this class. Note that co-administration with other GLP-1 receptor agonists is not recommended.
Other weight management medications – Orlistat is another NICE-approved option for weight management. Combination pharmacotherapy is generally not recommended in routine NHS practice.
Referral to specialist weight management services – Tier 3 or Tier 4 services can provide multidisciplinary support, including dietetic input, psychological therapy, and consideration of bariatric surgery for eligible patients.
Discontinuation and lifestyle-focused approach – If pharmacotherapy is not providing benefit, focusing resources on intensive lifestyle intervention may be more appropriate.
It is important to remember that weight management is complex and multifactorial. Saxenda is a valuable tool for many patients, but it is not universally effective. Working collaboratively with your healthcare team to identify barriers and explore alternatives will help you find the most effective approach for your circumstances.
Report any suspected side effects to the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk).
Many patients begin noticing appetite suppression within two to four weeks of treatment, with effects typically becoming more pronounced once the full 3.0 mg maintenance dose is reached after five weeks of gradual dose escalation. Individual responses vary considerably, and some patients may require several weeks at the maintenance dose before experiencing significant appetite reduction.
NICE guidance recommends discontinuing Saxenda if less than 5% of initial body weight is lost after 12 weeks at the 3.0 mg maintenance dose. Arrange a review with your prescribing clinician to discuss alternative weight management options, which may include different GLP-1 receptor agonists like semaglutide (Wegovy), other medications, or referral to specialist weight management services.
Yes, Saxenda must be administered subcutaneously (under the skin) in the abdomen, thigh, or upper arm for proper absorption. Incorrect injection technique or repeated use of the same injection site may affect drug absorption and reduce the medication's effectiveness in suppressing appetite.
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