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Why am I still hungry on Mounjaro? Many patients taking Mounjaro (tirzepatide) expect significant appetite suppression, yet some continue to experience hunger despite treatment. Mounjaro is a dual GIP and GLP-1 receptor agonist licensed in the UK for type 2 diabetes and weight management. Whilst reduced appetite is a common effect, individual responses vary considerably. Persistent hunger may relate to early treatment phase, current dose, hydration status, dietary factors, or medication interactions. Understanding why hunger persists—and when it warrants medical review—helps ensure your treatment is optimised safely and effectively.
Quick Answer: Persistent hunger on Mounjaro may occur due to early treatment phase, suboptimal dosing, medication interactions, dehydration, or dietary factors, though the medication's glucose-lowering effects may still be working effectively.
Mounjaro (tirzepatide) is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for the treatment of type 2 diabetes mellitus and, more recently, for weight management in adults with obesity or overweight with weight-related comorbidities. The medication works through multiple mechanisms to help regulate blood glucose levels and body weight, with appetite suppression being a key therapeutic effect.
Mechanism of action on appetite centres: Tirzepatide acts on receptors in the brain's hypothalamus and brainstem, areas that control hunger and satiety signals. By mimicking natural incretin hormones, it slows gastric emptying—meaning food remains in the stomach longer—which promotes feelings of fullness after meals. This gastric-emptying effect may attenuate somewhat over time (tachyphylaxis). Additionally, the medication influences neural pathways that regulate appetite, potentially reducing food cravings and the desire to eat between meals. Clinical trials have shown that many people report reduced appetite during treatment, though the onset and extent vary between individuals.
The dual-agonist nature of Mounjaro distinguishes it from single GLP-1 receptor agonists. The GIP component may contribute to the overall clinical effects, including glycaemic control and weight reduction. However, individual responses vary considerably. Factors including baseline metabolic rate, hormonal balance, psychological relationship with food, and concurrent medications all influence how effectively tirzepatide affects appetite in any given patient.
It is important to understand that whilst reduced appetite is common, it is not universal. Some patients report minimal changes in hunger levels, particularly in the early stages of treatment or at lower doses. This variability does not necessarily indicate treatment failure, as Mounjaro's glucose-lowering effects may still be clinically beneficial even without pronounced appetite suppression.
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Several physiological and practical factors can explain why some patients continue to experience hunger whilst taking Mounjaro, even when the medication is working effectively on blood glucose control.
Early treatment phase: During the initial weeks of therapy, your body is adjusting to the medication. Appetite suppression often develops gradually rather than immediately. According to the Mounjaro Summary of Product Characteristics (SmPC), dose increases occur at intervals of at least 4 weeks, and appetite and weight changes may develop progressively during this titration period. Patience during this adjustment phase is essential.
Dose-dependent effects: Mounjaro is typically initiated at 2.5 mg weekly and gradually increased. At lower maintenance doses (5 mg or 7.5 mg), appetite effects may be less pronounced than at higher doses (10 mg, 12.5 mg, or 15 mg). Your current dose may simply not yet be optimal for achieving the appetite effects you expect, though it may be appropriate for glycaemic control.
Adaptation over time: Some patients notice changes in the appetite-suppressing effects over time. This may relate to the known attenuation of gastric-emptying effects that can occur with GLP-1 receptor agonists. However, the glucose-lowering benefits typically persist. There is limited evidence regarding complete loss of appetite suppression with continued treatment, but individual variation is recognised.
Hydration status: Dehydration can be misinterpreted as hunger. If you experience gastrointestinal side effects like vomiting or diarrhoea, you may become dehydrated. The NHS recommends drinking 6-8 cups or glasses of fluid daily, and you may need more if you're experiencing side effects. Ensuring adequate hydration may help distinguish true hunger from thirst.
Medication interactions: Certain medications, including corticosteroids, some antipsychotics (such as olanzapine), and some antidepressants (such as mirtazapine), can increase appetite and potentially counteract Mounjaro's appetite-suppressing effects. If you're taking these medications, discuss this with your prescriber.
Psychological versus physiological hunger: Emotional eating, stress-related food seeking, or habitual eating patterns may persist independently of the medication's physiological effects on appetite centres. Mounjaro addresses biological hunger signals but does not directly modify learned eating behaviours or psychological drivers of food consumption.
Persistent hunger despite adequate time on Mounjaro may suggest that dose optimisation is required, though this must be carefully evaluated in the context of your overall treatment response and tolerability.
Subtherapeutic dosing: If you remain at the initial 2.5 mg dose beyond the recommended 4-week titration period, or if dose escalation has been delayed due to supply issues or administrative factors, you may not be receiving a therapeutically adequate dose for appetite suppression. According to the Mounjaro SmPC, the maintenance dose for type 2 diabetes typically ranges from 5 mg to 15 mg weekly, with clinical trials showing dose-dependent effects on weight reduction. However, dose increases must be balanced against the risk of gastrointestinal adverse effects, which are also dose-dependent.
Titration schedule: Rapid dose escalation can cause intolerable nausea and vomiting, potentially leading to treatment discontinuation. Conversely, overly cautious titration may leave patients on suboptimal doses for extended periods. The SmPC recommends increasing the dose by 2.5 mg at intervals of at least 4 weeks if tolerated, monitoring both glycaemic control (HbA1c) and patient-reported outcomes including appetite and weight changes.
Individual variation in response: Whilst the SmPC indicates no clinically relevant impact of renal impairment on tirzepatide exposure (no dose adjustment required), individual responses to the medication vary. Factors including body weight and concurrent medications may influence the overall clinical effect. However, there is limited evidence for specific predictors of appetite response.
When to consider dose adjustment: If you have been on a stable dose for at least 8 weeks, are tolerating the medication well without significant gastrointestinal side effects, but continue to experience unchanged appetite and minimal weight loss (if weight reduction is a treatment goal), discuss dose escalation with your prescriber. However, if HbA1c targets are being met, dose increases solely for appetite suppression require careful consideration of the risk-benefit balance through shared decision-making with your healthcare team.
Even with effective pharmacological appetite suppression, dietary composition and lifestyle habits significantly influence hunger levels and overall treatment success with Mounjaro.
Macronutrient balance: Protein intake is important for satiety. Including moderate amounts of protein (approximately 0.8-1.2 g per kilogram of body weight daily) may help you feel fuller for longer. If you have kidney disease, discuss appropriate protein intake with your healthcare team or dietitian. Fibre consumption also promotes fullness by slowing digestion and stabilising blood glucose. The NHS recommends aiming for at least 30 g of fibre daily from vegetables, fruits, whole grains, and legumes. Conversely, diets high in refined carbohydrates and added sugars can cause rapid glucose fluctuations that trigger hunger shortly after eating.
Meal timing and frequency: Irregular eating patterns or prolonged gaps between meals can override medication-induced satiety signals. Whilst Mounjaro reduces appetite, skipping meals entirely may lead to excessive hunger and subsequent overeating. Regular, balanced eating patterns help maintain stable energy levels and prevent compensatory hunger. If you're also taking insulin or sulphonylureas, regular meals are particularly important to reduce hypoglycaemia risk.
Sleep and stress: Poor sleep quality (less than 7 hours nightly) disrupts hunger-regulating hormones, particularly increasing ghrelin (the 'hunger hormone') and decreasing leptin (the 'satiety hormone'). Chronic stress similarly affects appetite regulation through cortisol elevation, which can increase cravings for energy-dense foods. Addressing sleep hygiene and stress management may enhance Mounjaro's appetite-suppressing effects.
Physical activity: Regular exercise influences appetite through complex mechanisms. Moderate-intensity activity may temporarily suppress appetite, whilst very intense or prolonged exercise can increase hunger. Finding an appropriate activity level that supports your treatment goals without triggering excessive compensatory eating is important.
Alcohol consumption: Alcohol provides 'empty' calories without promoting satiety and can impair judgement around food choices. It may also interfere with blood glucose regulation, potentially affecting hunger signals.
For personalised dietary advice, consider asking your GP for a referral to an NHS dietitian, or access resources from Diabetes UK or the British Dietetic Association.
Whilst some variation in appetite response to Mounjaro is normal, certain situations warrant medical review to ensure optimal treatment outcomes and exclude underlying issues.
Timeframes for seeking advice: If you have been taking Mounjaro at a stable maintenance dose (5 mg or above) for more than 12 weeks and experience no reduction in appetite whatsoever, contact your GP or diabetes specialist nurse. Similarly, if you initially experienced appetite suppression that has completely disappeared despite continued treatment, this merits discussion. However, if you are within the first 8 weeks of treatment or have recently had a dose increase, allow adequate time for effects to develop before seeking dose adjustment.
Associated symptoms requiring prompt attention: Seek medical advice urgently if persistent hunger is accompanied by:
Unexplained weight gain despite medication adherence
Worsening glycaemic control (if you monitor blood glucose at home)
Excessive thirst and urination (possible signs of inadequate diabetes control)
Severe, persistent abdominal pain (especially if radiating to the back, with or without vomiting) which could indicate pancreatitis
Right upper abdominal pain, fever or yellowing of the skin/eyes which might suggest gallbladder disease
Signs of hypoglycaemia (shakiness, confusion, sweating)—particularly if taking Mounjaro alongside insulin or sulphonylureas
New or worsening visual symptoms which should be reported promptly due to potential retinopathy concerns
For severe symptoms, contact your GP urgently, call NHS 111, or seek emergency care as appropriate.
Treatment review considerations: Your GP may assess whether:
Dose optimisation is appropriate and safe
Alternative or additional glucose-lowering medications should be considered
Referral to a dietitian for structured nutritional support would be beneficial
Underlying conditions (such as thyroid disorders or polycystic ovary syndrome) are contributing to persistent hunger
Psychological support for eating behaviours might complement pharmacological treatment
Realistic expectations: It is important to maintain realistic expectations about Mounjaro's effects. Whilst many patients experience significant appetite reduction, the medication is not a complete appetite suppressant. Some degree of hunger is physiologically normal and necessary. The goal is improved glycaemic control and, where appropriate, modest weight loss—not complete elimination of hunger signals. Open communication with your healthcare team ensures your treatment plan is optimised for your individual circumstances whilst maintaining safety and tolerability.
If you experience any side effects from Mounjaro, report them via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).
Appetite suppression with Mounjaro typically develops gradually over several weeks rather than immediately. Most patients notice changes during dose titration, which occurs at 4-week intervals, though individual responses vary considerably.
Yes, dehydration can be misinterpreted as hunger, particularly if you experience gastrointestinal side effects like vomiting or diarrhoea. The NHS recommends drinking 6-8 cups or glasses of fluid daily, potentially more if experiencing side effects.
Dose increases should only occur after discussion with your GP or diabetes specialist. If you've been on a stable dose for at least 8 weeks, tolerate it well, but experience unchanged appetite, your prescriber may consider escalation—balancing appetite effects against glycaemic control and side effect risk.
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DisclaimerThis content is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any medical questions or concerns. Use of the information is at your own risk, and we are not responsible for any consequences resulting from its use.
