What does GLP-1 do to the brain’s reward system, and how does that affect health behavior change?

GLP-1 medications like semaglutide (Ozempic, Wegovy) work on receptors found not only in the gut but also in the brain, particularly within the reward circuitry that governs motivation, desire, and the experience of pleasure. The primary mechanism discussed in clinical contexts is the reduction of appetite and the slowing of gastric emptying. What receives far less attention is how these drugs interact with the dopamine-linked reward system that drives behavior broadly, including motivation for social connection, professional drive, physical activity, and emotional engagement.

Anhedonia, a term from psychology referring to the reduced ability to experience pleasure or reward, has been reported anecdotally by some people taking GLP-1 medications. The concern from a behavioral science perspective is that the same system being dampened for food appetite may also be dampening motivation across other domains of life. This is not yet well-studied. As of mid-2026, there is minimal published research examining GLP-1’s effects on the brain’s reward architecture beyond appetite suppression, and even less on what happens to motivation and psychological wellbeing when these medications are discontinued.

From a health behavior change perspective, this raises significant questions. Behavioral science frameworks like COM-B (Capability, Opportunity, Motivation-Behavior) identify biological motivation as a driver of automatic behavior. If a medication is altering that biological motivation, any behavior change built during that window may not be sustained once the drug stops and the biology returns to its prior state. The popular framing of GLP-1 as a ‘behavioral kickstart’ assumes that motivation-independent habit formation is possible at scale. The evidence for that assumption is thin.

For health professionals working with individuals navigating GLP-1 decisions, the most important contribution right now may be helping people identify what a rich and meaningful life looks like independent of body size, and building the psychological foundations — self-compassion, values-based living, nervous system regulation — that are not contingent on biology being temporarily altered. These are the areas where weight-neutral, psychologically informed practice has the most to offer in the Ozempandemic era.

Transcript 

Stephanie: [00:00:00] Welcome to the podcast, Olivia.

Olivia: Hi, Stephanie. It’s great to be here.

Stephanie: I’m gonna introduce you to the listener, and then we’ll get right into my opening question. So you are a chartered health psychologist, a senior behavioral science specialist, a nutritionist, and you specialize in weight-neutral health and psychologically informed approach to health. I’m excited to have this conversation because that’s my zone of expertise. That’s what I do, right? With body image and behavior change, so this is kind of a treat for me, for myself.

Olivia: Oh, how lovely. [00:01:00]

Stephanie: So I’m gonna open this up on a kind of a broader question. So you’ve been — this has been your career, the intersection of health psychology, behavioral science, nutrition. What do you think about this GLP-1 era? What are we missing from your angle of expertise?

Olivia: Well, oh, I mean, it’s fascinating, isn’t it? Um, firstly, I wanna say I’ve seen the work you’re doing and, you know, thank you because it’s just brilliant and I love seeing this work globally. I think it’s so important. Um, and probably like me, you’ve noticed that the momentum of GLP-1s is just shining a light on so much, but also is leading to so many questions.

Olivia: [00:02:00] So for me, the reason that I got into behavioral science and the reason I went into psychology is, going right back, I never really understood — well, personally, when I was younger, I just never understood why dieting didn’t work. I’m like, “If you change your behavior, why don’t you lose weight and why doesn’t it stay off?” And I was really cynical that we could ever do things to make a difference to our health. And then I noticed that it was the same thing for everybody. Like everybody’s being told to do these behaviors, take these actions, and nothing’s working.

Olivia: Um, and so I sort of went through this through nutrition and psychology. If it wasn’t the nutrition, maybe it’s the psychology and, you know, then I realized that actually I had that epiphany moment that so many of us in this space have, which is, “Oh, hang on, there’s weight-critical science here, and actually weight management is probably harmful, and oh dear, what have I been exploring all these years? And how could I have got it so wrong and why haven’t I learnt this earlier? Why haven’t I realized that it’s not about trying to lose weight? And that’s why are we focusing on that when all of the forces are against us?” And then I met people like Angela Meadows, who I know you’ve spoken with. [00:03:00]

Olivia: And I realized that actually it’s our biology. We’re not programmed to change our behavior to do certain things. It won’t work. But what fascinates me about GLP-1s really is what it’s shining a light on in terms of behavior. So the behavioral science fascinates me because I think it lets us ask questions that are really quite simple, and it lets us ask the questions that we feel we should already know the answers to and we’re a bit too frightened to ask, but nobody is asking the questions and nobody has the answers, really.

Olivia: So I’m really interested in it from a behavioral point of view, the behavior of the individual, which I think we’re gonna talk a bit about today in terms of what are GLP-1s showing us in terms of have we been asking behavior to do biology’s job all along, and is that what we’ve been getting wrong? So why aren’t we looking at biological motivation rather than behavioral motivation or automatic motivation?

Olivia: [00:04:00] The other thing that I think it shines a light on is the behavior of systems. So we’ve got our systems are basically cause and cure. So we’ve got a food system that spent billions hacking our biology and hacking our neuroscience, hacking our brains to make us eat food that was delicious and fed into our reward system. And then it tried to cure the problems that it caused — not fatness, but like metabolic dysfunction, dysregulated metabolism, metabolic disease, whatever that might be, whether it’s diabetes or whatever. Um, so then the drugs came out. So we’ve got this system that isn’t prevention, even though it tries to be. It’s cause and cure.

Olivia: Um, and then we’ve got this really interesting one at the moment, which I think is the one that is fascinating, and that is the behavior of healthcare. Because we have in healthcare, everybody goes into healthcare wanting to do a good job. We all want to improve the health of individuals. We don’t go into it for any other reason. And what GLP-1s arrived to do is no longer what they’re being co-opted to do. So I don’t know about in Canada, but in the UK, healthcare providers are commissioning GLP-1s as a weight loss drug, but that’s not what [00:05:00] they were designed to do in the first place.

Olivia: And the language and the momentum of the adoption of these drugs and the language being used around it is fascinating. It’s as if we have this weight-centric health paradigm, and suddenly the answer to fix everything that the weight-centric health paradigm wants to fix has come along, and everyone’s taking a big sort of sigh of relief, but it might not be the right thing and it’s not what the drugs were designed to do in the first place.

Olivia: So behavior of individuals, the system, and of healthcare at the moment are just giving me so many questions. More questions than answers. So I might be asking more questions today than answers, but that’s sort of where I sit as a behavioral scientist. I think we’ve got a lot of work to do, but I do think that it’ll be really interesting.

Olivia: [00:06:00] Uh, oh, and the one final one is the food system. So if we are going to use these drugs, what’s that gonna mean for the behavior of the food system? Because if nobody wants the food anymore, well, how’s the food system gonna respond to that?

Stephanie: It’s very interesting. What is it gonna do to the food system? A week ago, I saw a food industry analyst in Canada having those observations — it’s disrupting the food industry, at least in Canada, that the sales of certain categories of product are down, and he was at a conference of the food industry, and they were strategizing and brainstorming how they can create GLP-1-friendly foods.

Olivia: [00:07:00] No. Oh, I mean, I don’t know, but I have — someone hinted this at me, but I mean, how have we not learnt from the commercial motivations in the past? Because what does that mean? You know, how they spent billions discovering the bliss point, right? So that we would want to eat those foods that aren’t necessarily gonna be best for our bodies from a health point of view. And what happens if that no longer is — what if we don’t have that reward pull anymore, and those bliss point foods aren’t at all interesting? What will the alternative be, and will it do the same thing or worse?

Stephanie: We know for a fact, I mean, we can get into politics, but I mean, it’s a capitalist industry. So if they’re losing money in certain food categories, I am telling you they’re gonna create a new way of making money. That’s the fundamental nature of a capitalist industry.

Olivia: Yeah. Well, it’s fascinating.

Stephanie: [00:08:00] So we have a limited amount of time, and I wanna get into the hot topic. We’ve covered GLP-1 in this series — you can go back to past episodes on what it does metabolically to the body, like insulin release and glucagon and gastric emptying. What I’m interested to know from you is what do we know as of today, June 2026, of what it does to our brain? Can you walk us through that?

Olivia: Oh. Well, I mean, just to caveat this with I’m not medical, and so whenever I have these conversations with people, I’ve arrived here because I’m a psychologist, and I’m fascinated by how any drug or anything really affects the way people respond psychologically. And as a health psychologist, I’m really fascinated by how our physical health affects our mental health and vice versa. [00:09:00]

Olivia: And I know we all talk about it, but we very rarely believe it. And sometimes I work with inpatients, and you can see that when they’re having an acute physical condition, their mental health deteriorates, their cognition deteriorates. So I’m fascinated by it. Um, but I don’t know the neuroscience, but I have done a lot of reading around it because I’m so interested in this loss of — well, anhedonia, as you called it — this sort of loss of enjoyment.

Olivia: And I’ve spoken to lots of people about it anecdotally, just out of interest. And also I follow a few groups on social media of GLP-1 users. And what I’m gathering is that this is a drug that stops you feeling that reward pull. So historically, we would have that reward pull or motivation so that we could find food, shelter, et cetera, et cetera. We know all of that. And we live in a very different world now, of course, but our reward pull still serves us. [00:10:00]

Olivia: So we still want to be motivated to hang out with our friends. We want to be motivated to do things socially. We want to be motivated to eat. We want to enjoy food. Surely we don’t want to not enjoy food. I mean, I’m not sure if this is true because I haven’t actually looked it up — just the other day, someone told me the word culture actually means digging the land for food. I’m not sure if that’s actually true, but if that’s true, culture is food, right?

Olivia: Um, so I feel that these drugs are potentially having an impact on people’s enjoyment full stop. Um, I had a conversation with a lady the other day who had stopped going on holiday with her friendship group because none of them were interested in going out for meals anymore. So when they went on holiday, they were just sort of maybe doing some activity, sitting on the beach. And, you know, she wasn’t being judgmental. She was just saying she loves — she’s a foodie. She goes to these places to explore the culture, and that includes food. And now they’re not spending that time together in the evening or at lunch, sitting around chatting. [00:11:00]

Olivia: They’re sort of reading books. Still doing great fun things, but it’s changed really dramatically for her, so she doesn’t go on the holidays anymore. And I thought, “Wow! That’s enormous.” That’s like shifted an entire friendship group because they’ve all stopped enjoying that sort of cultural eating moment.

Olivia: And I don’t know how I feel about that. I feel sad, actually I feel really sad about it. But what will this do long term societally and individually if people don’t have those connections? I know it’s not just about that — that’s not the only place we have connection — but eating around the table with family and friends is a huge part of our culture and always has been. Always. Uh, so yeah, I feel a bit sad about that. So in terms of what it does to our brain, I think it stops that motivation, you know, it stops our enjoyment a little bit.

Stephanie: [00:12:00] Yeah, and I think this question and your answer points to a major gap, is that there is almost, to my knowledge, no science, no research that examines what GLP-1 does to our brain. All the focus from the pharma company has been on metabolic mechanisms and very little on the brain.

Stephanie: I am not finding — I think I found one study published, it was not solid, and it was just a bunch of assumptions as we’re doing right now. I think it’s a big gap, and it’s because there’s no vested interest, in my opinion, in researching it. So we have very little data of what it does to our brain. It’s just clinical observations.

Olivia: Yes. Uh, exactly. And there is a study going on here in — so I’m in the south of England, and I know that there is a study, I think it’s being funded by Novo Nordisk, I’m not sure, on the, on GLP-1’s effect on depression. [00:13:00] Um, and I mean, that’s what led me to write one of my most recent articles because I thought, “What is this drug not going to be used for?” Uh, is it the case that in five years’ time it’s going to be used at different doses for everything? I mean, they’re exploring its use for so many things.

Olivia: And you know what, there was a massive focus — maybe eight years ago in England — on the gut-brain connection, and it was really sort of ramping up and there seemed to be something in it, in the blood-brain barrier, and there was some quite exciting work being done and it seemed really like it might make a difference to people because of the serotonin produced in your gut and what could we do and how could the vagus nerve be involved. Not just fun, really impactful. But then it sort of got dismissed as like a wellbeing trend. [00:14:00]

Olivia: And now I think GLP-1s aren’t looking at that because actually that’s where the GLP-1 is working, isn’t it? It’s in the gut and the brain. So it… Sometimes I feel like I ask questions and I think, “Are these stupid questions or is it just that people don’t want to ask them? Or why is no one looking at this?”

Stephanie: I think many of us are asking this question who are in that field. We’re seeing it, I’m asking the question, but I don’t think anybody’s answering the question. So we do know there’s GLP-1 receptor in the brain. We do know that, but we don’t know the impact of the GLP-1 medication on the individual mental, emotional, behavioral life. I think that’s where the intelligence is missing.

Olivia: Yeah. And I think that’s really on point because if we’re medicating, and we’re forgetting all the other determinants of behavior — the social, the emotional — if we’re dampening emotions. Because I also know that obviously this isn’t the case for everybody. [00:15:00]

Olivia: Um, because I said this to somebody. I said, “Well, you know, what about the fact that it dampens your desire or enjoyment of food?” And they were quite determined that actually it hadn’t dampened their desire, but that they just wanted less of it. I thought, “Okay.” Well, so it’s not happening like that for everyone.

Olivia: Everyone’s different, of course. But I thought, you know, what is this doing to us socially? What is it doing to us emotionally? Because we’ve also got this strange phenomenon going on here where people are being shamed for going on it. So it’s like you’re damned if you do, damned if you don’t, because if you go on it, it’s like you’ve cheated. Cheated what? You know, it’s like if somebody wants to go on GLP-1 because they’ve spent a lifetime feeling shamed and stigmatized, and they just want to experience a different world, and it makes them feel better, we shouldn’t be shaming people for pursuing a life that society tells them they should have had all along.

Olivia: It — I mean, you can’t win, actually. That’s what they’re pointing out. You can’t really win. Um, so it’s an amazing social experiment because also I feel like we don’t know how this is gonna go. [00:16:00]

Stephanie: Yeah, and we talked with Angela about this new form of weight stigma, which is the people who are losing weight because of GLP-1 are now being victimized with a different form of weight stigma now.

Olivia: Yes.

Stephanie: It is that you can’t win.

Olivia: Yeah. And actually, she’s really good at talking about that, isn’t she? Because it’s almost like if you have your identity — if you’ve got your identity, whatever body you’re in, then you might survive that. But if you don’t, and a lot of people are really harmed by that sort of fatphobia — and if they spent a lifetime being told, “Get thin, get thin, get thin,” and here’s the silver bullet, and then someone says, “Oh, you cheated, you didn’t do it properly.” It’s like, “Oh, okay.” Take them down twice. It’s like it’s not fair. It’s just not fair.

Stephanie: [00:17:00] Let’s talk about anhedonia. What is anhedonia and where does it live in the brain, and how does it interact with GLP-1?

Olivia: Well, so I think this is the reward pull that we’re talking about. So essentially, anhedonia is when we — so the opposite of that would be when we want things or we think we want things too much. And I think that — yeah, exactly — or what people are calling food noise. Um, and I don’t love that phrase and I’m always nervous about saying things that I don’t like.

Olivia: But the reason I don’t really like food noise is just because it’s been used by diet culture to get people enlisted in programs here. Um, so I worry about it as a marketing ploy. Um, but I have real sympathy for people who really do ruminate over food and have disordered eating. And you, in your work, will come across this loads, I’m sure. [00:18:00]

Olivia: Um, so that’s the sort of opposite of it, is when you just think about it and you want things too much. And I feel like it’s not surprising that a lot of us really crave things in the modern world, because there’s so much available. We’re constantly overstimulated. And then I think anhedonia, really the best way I would talk to people about it, is that when they then don’t want things enough or nothing feels rewarding anymore.

Olivia: And I’m not sure that that changes over time, but I would liken it slightly to some forms of antidepressants that basically just mean — you know, if you take antidepressants and you cry, you cry a lot and you’re having sort of that release, that emotion, but also you feel really happy sometimes, and then you start taking antidepressants. You just don’t have the extremes anymore. [00:19:00]

Olivia: Um, so again, I don’t think there’s enough research on GLP-1s to show that they do this. But if it’s stopping people from wanting things, is it that it’s stopping people from wanting things enough? Because one of my concerns is if you don’t want something, and you then don’t eat enough — you know, so maybe you don’t eat enough for six months whilst you’re on it, and then you come off it — well, that’s a starvation diet that’s gonna result in greater weight gains. And also, what’s it doing to you mentally? So if you didn’t want anything, and then suddenly you come off it, what happens to your thoughts and your drive and your desires?

Olivia: Do they return with added emphasis, or do they not return? Or — but I worry that we haven’t got enough evidence to support people when they’re coming off them. And I also worry about the dosages that we’re using. I also worry about if we’re giving people really high doses, and they really have no motivation or desire for anything particularly, what will happen when they — if they come off it really quickly — what happens to that reward sensation? Does it come back [00:20:00] or doesn’t it?

Olivia: I don’t know. I genuinely don’t think we have enough research on this.

Stephanie: Well, and again, it’s just exposing the state of our intelligence on GLP-1. Someone like you should have this information in your field of expertise, but it doesn’t exist. So right now we’re just sharing observations — which is all we can do.

Olivia: Well, yeah. Exactly. Because I feel that there is going to be work for you and I to be done in supporting people who have gone on it privately or whether they’ve been prescribed it, supporting them when they come off it — adjusting. Adjusting back to what life was like before. [00:21:00]

Olivia: Going full circle right to where you started in terms of when we started talking about so what is the behavior that we need to change? What are the thinking processes that we need to really adjust? Because it’s not just about behavior change, it’s about accepting some of those thoughts, feelings, and emotions we’ve got and working out how to work with them. Um, we’re gonna need a plan to support people alongside behavior change. It’s not just about behavior change, it’s about that motivation, that reward pull towards those behaviors.

Stephanie: [00:22:00] And here’s one thing when we talk about anhedonia that I’d love your opinion on since we don’t have the science, but to me, if for an individual GLP-1 does reduce the pull, does reduce the reward in the brain, it does not do it just selectively for food. It does it for everything. Interaction with other human beings, self-care — it does it globally. It’s not selectively just the food reward circuit.

Olivia: Yeah. No, exactly. So what does that mean for people who used to be really motivated to — their drive to succeed in their professions and their careers, you know? What if suddenly people don’t care in addressing weight stigma anymore because they can’t be bothered? I mean, that wouldn’t happen. But just imagine people who are really passionate about things get less passionate about them.

Olivia: Um, and I’m with you. I wonder what it’s gonna do to everything because it’s not just — if you change your brain circuitry, like you say, surely it’s not just food that people stop wanting or having a drive for. Um, so what’s gonna happen to relationships? I mean, this being a social experiment, it just is the biggest social experiment ever, and it just… [00:23:00]

Olivia: I want to know what everyone’s studying, and I want everyone to come together and say, “This is what I’m looking at. This is how it’s changed society. This is how…” We need a study on people who are experiencing that lack of drive, that lack of drive towards anything, because that’s almost a little bit of a depressed state in itself, isn’t it? Um, so where do we go from there?

Stephanie: Well, it’s, I mean, if you’re saying that there’s research in the UK around GLP-1 and depression, I’m interested to understand — is GLP-1 supposed to help depression or cause depression? If it’s the reward circuitry in the brain, how’s that gonna help depression?

Olivia: Yeah. No, I really have no idea. I mean, I think it’s just my algorithm — everything is GLP-1s now. Um, but I’ve seen a study being done on using GLP-1s to treat bulimia nervosa. [00:24:00]

Stephanie: Let’s talk about how crazy that is.

Olivia: Well, I — yeah. And that one, in a way, if I think literally mechanically, that one potentially makes more sense to me as a non-medical person than the depression one, because I think, well, there is that element of bulimia nervosa, you know, where people genuinely just are driven to eat food. And with binge eating disorder perhaps.

Olivia: But if someone has an eating disorder, putting them on a drug that will lead to weight loss is nerve-wracking. Um, you know? I mean, unless it’s tightly controlled. I mean, I can’t make judgments on it because I don’t know what I don’t know about that. [00:25:00]

Stephanie: No, there’s one published study on a very small scale with some evidence on binge eating disorder. That’s all we found. It’s not published yet on bulimia.

Olivia: No. And I sometimes have — the feedback loop for me is really interesting because you, if you think about an individual in a food environment — in a lucky, in a privileged food environment — who basically is marketed to and sold food that food manufacturers have created to make us want to buy more of it. Well done, very clever, brilliant — and also some of it surely is good for us, and some of it’s delicious. But then some of it does cause health harms if you have too much of it. And then there are some people who are more driven towards it than others, individual differences. [00:26:00]

Olivia: And they are also maybe more predisposed to having disordered eating, so then they maybe don’t land with it as well as others. And then there’s this amazing drug that comes in and says, “Well, hang on, we can correct that.” So that thing that the food industry wanted you to do? Well, now we can make you feel better. And all the while it just goes round and round in a circle.

Stephanie: And meanwhile, the food that is overly stimulating is still being present. So we’re creating a drug — what you’re saying — to enable the capitalist food industry to continue to put that food out in the world, and we’ll just give you, the individual, a drug to control you.

Olivia: Yes. So then we come back to behavior change, and we come back to the fact that we always place the burden on the individual. Always, always, always. And that’s why the behavior of systems is so important, and this is where change is so enormous. [00:27:00]

Olivia: And I spoke to the founder of a company who reached out to me because of my Substack and just didn’t really — he was an amazing sort of thinker, but I just couldn’t convince him about critical weight science. I couldn’t convince him. And he asked me loads of questions, and it was a very challenging conversation for me but it was really useful. And he just said to me, “I just can’t see a time where this will ever change.” And I thought, “Oh, I can’t take that on board.”

Olivia: Because when I heard about it in your podcast with Angela — you said, “You can do things at an individual level, right? And you can also do them at the systems level.” And I think we have to keep plucking away at both because it’s the systems that are really undermining our ability to make a real change. And what I think GLP-1s are exposing that a little bit — and I wonder if that’s why the questions aren’t being asked. But I do think that this is a really opportune moment for us to have louder conversations about it. [00:28:00]

Stephanie: But I think we need to keep — we, you, me, and the listener — we need to keep asking the question because we cannot rely on the industry system to ask the question. We need to be relentless at asking the question and demanding the science on psychology and neuroscience, research on eating disorder and body image. Like, we need to be relentless while helping the individual cope with the system.

Olivia: Yes, exactly.

Olivia: Well, that’s really well put. And I also think — so the only bit I’m slightly nervous about at the moment is the behavior of healthcare, the healthcare system in itself as a sort of a standalone system, because this is happening at such a fast speed. And also, there are so many experts and people who really understand all the medical side of this, all the neuroscience, all the — really understand it. [00:29:00]

Olivia: But because these drugs have been co-opted, and they are now weight-centric, whether or not they were developed for that — here in England, they’re a weight loss drug. People often don’t even know that they weren’t developed for that in the first place. And people are desperate to be prescribed them, and we’ve got real health inequalities happening.

Olivia: The healthcare system — I’m worried that these conversations, because they’re going so fast and the momentum is building so fast and people are having to adapt and adjust entire service pathways for GLP-1 prescribing — are we going to forget what these were originally for? And is weight going to become even more a proxy for health than it ever has been? And how do we get in there now and sort of question that and just put the brakes on a little bit?

Stephanie: [00:30:00] So here’s another angle for me. We do know that GLP-1 medications were originally intended for type 2 diabetes, and that’s a very small percentage of people who are taking them right now. They were prescribed years ago at small doses. They probably didn’t lose the weight. And then we have this massive group that are taking it for weight loss when we do know that the weight will be regained in the first year, 100% within the next two years, and then we’ll be back to square one. So what are we doing to help these individuals long-term from a health behavior standpoint?

Stephanie: Because what I’m hearing all the time — and I hang out in Reddit threads, that’s where I hear what people really say. They don’t have to put a video. Reddit is anonymous. And I hang out in a thread particularly of anti-diet women who’ve gone through anti-diet work and then decided to take GLP-1. [00:31:00]

Stephanie: And the big argument is, “I’m gonna take GLP-1. It’s gonna quiet the noise. I’m gonna build my health behavior so that when I get off of GLP-1, I’ll be set with health-promoting behavior.” Now, you’re the health behavior scientist. What are your thoughts on that?

Olivia: Well, so how — okay. How is this gonna work? Because what — the way I was trained in behavioral science — I understand the rationale. I do. And I feel there’s so many reasons that that motivation happens. Like, come on, just a kickstart. It’s like, well, I’ll start on Monday. It’s a similar type of psychology. [00:32:00]

Olivia: Um, but if I think about the model that Mickey and Robert West over here developed, COM-B. Do you know about COM-B? Yeah. Um, I’m like, okay, great. So we’ve got capability, we’ve got opportunity, and we’ve got motivation. And threaded throughout COM-B is obviously biology, but it’s not overt. And when it comes to automatic motivation, we really need to think about biological motivation. So it’s not in there overtly, and it really needs to be because for me, if the one thing that is changing people’s behavior is altering their biology, what will be different when they come off that drug? What didn’t work before that now they’ve had six months or a year on the drug is gonna be different when you stop taking the drug? You stop taking the drug. [00:33:00]

Olivia: So you’re… this is biological, this isn’t behavior. It’s like — so, I mean, if we’re being really honest, what needs to change is we need to work out — we need to go right back to psychology and think about what is a rich and meaningful life to us? What will it take for me to be happy in the body that I live in? And am I okay with the fact that my body doesn’t fit the societal ideal? Can I have a rich and meaningful life without it?

Olivia: Um, and if so, then you can start working on your behavior, and you can start — I mean, there are things you can do to slightly adjust your biology from a nutritional point of view. But — and I wonder if you cover this in some of your non-diet work — really teaching people how to learn to eat again. And if they’ve been dieting all their lives, remembering that actually it’s gonna take your body a while to get back to the place it naturally wants to be. [00:34:00]

Olivia: And by the way, that might mean losing weight, it might mean putting on weight. If we could take weight out of the equation for a moment — but getting people to relearn how to eat so that they can understand hunger and fullness cues is not really sexy or fun or faddy, and there’s no really good marketing around that.

Olivia: Um, but that’s what I think. I think it’s not exciting enough for a marketing campaign, but it is — well, I think it’s genuinely useful. If you can say to people, “Okay, so before you started these drugs, all of these things were the case. Now you’re gonna take the drugs, and your biology’s going to change. When you come off those drugs, your biology is going to change back to the way it was before. It’s a temporary fix, unless I’m wrong, and the research will tell us in five, ten years’ time.” So what would you do with that? People need to know what they would need to change without it and accept that, I think.

Stephanie: [00:35:00] So let’s dig into — you said it a few times — your biology will change. Perhaps be more explicit. For a listener who’s not in depth aware of the biology of behavior change, what do you mean by that? Your temporary change with GLP-1. As we know right now from observation.

Olivia: Yeah. Good point. Exactly. And remembering I’m not medical. So, as far as I’m concerned, when you take a GLP-1, what you’re doing is you’re altering your reward system. So whether it’s a GLP-1 receptor and it’s in your gut or whether it’s in your brain, what the GLP-1 is doing is basically stopping you from having these emotional drives or these reward drives.

Olivia: Um, things that go — as far as I can work out — it’s essentially stopping the motivational piece that is a reward drive, which we would normally be pulled towards food or shelter or fight or flight or, you know. It’s dampening those so that you can get rid of this food noise. [00:36:00]

Olivia: Um, but also it has all of the other effects. I’m interested in the reward pull element that we’ve been talking about a lot, but it will also have other effects. So it’s gonna alter your hunger and fullness signals. You’ll be hungry for longer — it’ll slow gut motility, the stomach will empty slower, so you’ll be fuller quicker and fuller for longer.

Olivia: But it’s that brain element of this that interests me. Um, so when you take a GLP-1, it’s the anhedonia we talked about. It just stops you wanting food as much. That’s the receptor that it’s interacting with. Um, so if you have that on GLP-1s and you are biologically changed, and the GLP-1 stops you wanting things too much, and you want things less, what happens when you stop taking that GLP-1 and it no longer stops you wanting things too much? Do you want things too much again or too much in your opinion? [00:37:00]

Olivia: Um, so that’s what I mean. It’s literally altering the neural pathways as far as I can work out. That’s how I would articulate it from a psychological point of view.

Stephanie: [00:37:00] And I wanna bring another angle to this conversation with you — the element that I observe the most in behavior change is dysregulation. Call it nervous system regulation. People have good intention. They’re motivated to go for a walk, to have self-care behavior. They’re motivated, and then something gets in the way. They get dysregulated, and then the inactive behavior — they go into coping behavior. The health behavior that they were intending to do or motivated to do gets hacked by their nervous system being dysregulated. [00:38:00]

Stephanie: Is the circuit of the reward in the brain helping temporarily regulate them to have easier, more consistent behavior? Is that what’s happening?

Olivia: I mean, I’m not entirely sure, but you know what, I think that this is where the research should be. So all of the companies that are able to prescribe it — one of the guidelines is obviously that you have to prescribe behavior change with it. We have to have an element of behavior change alongside it. But I’m not sure that the behavior change speaks to what you’ve just said.

Olivia: So I’m not sure what we’re doing yet is aligning the changes that GLP-1 are causing with adaptive behavior that we need to be supporting people with. And I think that would be really helpful. Not because I think people should be going on GLP-1s necessarily, but because I think that if we could do that piece of research, we would uncover health behaviors that were really founded in psychology and also founded in neuroscience, and we would have a sort of doorway or a window through which we could see what behaviors are really being affected by this, that we need to think about how could we change the menu to support people’s health if that’s what they want. [00:39:00]

Olivia: Um, and I don’t think we’re asking the questions around that yet. We’re just tacking behavior change onto these GLP-1 interventions without — in an old-fashioned way. We’re doing old-fashioned behavior change. You know, what is the future of behavior change? This could give us a window of opportunity to really look at that.

Stephanie: What are your thoughts? What is the future of behavior change in this context?

Olivia: Well, so I think — when I think this through personally — I’ve always been a bit cynical about our ability to change behaviors on our own as an individual. I think we have to be motivated to do it, but I think that the environment’s influence on us is so huge. Our immediate environment, our social environment, our cultural environment, our food environment, our healthcare environment — I think everything is a determinant of our behavior. [00:40:00]

Olivia: And I think really, I think the main changes that would actually support us in the future are those system changes. I think without them — I mean, there’s a caveat to this. I think if we could get rid of diet culture — hang on. Wait a second. I’m not gonna go down this road. I just don’t think — in a way, I don’t think it’s fair to keep asking individuals to take all the burden of behavior change. I think the food industry has to do something, and it’s my real hope that GLP-1s will make the food industry shift enough.

Olivia: Um, you know, if we could just find a profitable way for the food industry to provide food that wasn’t going to dysregulate emotionally and physically, that would be brilliant. But I don’t know. [00:41:00]

Olivia: I think the social influences still override our sort of the boss of our motivation quite often, and I think that’s a real struggle. It’s not very hopeful though, is it?

Stephanie: [00:42:00] Yeah, well, I mean, I agree with you 110%. And it’s probably because of my lived experience, right? Having, wanting a better life for me while holding the systemic issue. I’m always like, “Yeah, and how do I feel better now? How do I improve my own health behavior now in this environment so that I can feel better and lead a better life?” So I think I got really good at holding both.

Stephanie: And perhaps even — and I said that in one of the podcast interviews — it is highly privileged space for a person like me to invest in therapy and invest in specialists to help me so that I can change my behavior and live a better life that is not accessible to many people. Accessible to have the support to resist the system and to personally change while the system is still extremely problematic.

Olivia: Yeah. And I mean, I do wonder if — yeah, the system is extremely problematic. But I do also think that, you know, if I strip this right back — and I have this when I work with individuals — I’m always in a hurry to try and make things a bit better, but it’s never quick. It’s just not a quick fix. [00:43:00]

Olivia: And quite often, I feel that the work we need to do as individuals is to accept that it’s okay not to be happy. Like, it’s okay not to fit the mold. Because not being happy will — unless of course you have severe depression or there are times where that’s not gonna be the case — but it will pass if you’re not feeling happy, like it will pass if you’re feeling happy, unfortunately.

Olivia: But I feel that we’re constantly seeking happiness, success, and with that in our society comes, you know, this body that you should have and this job that you should have and this money that you should have. So we’re constantly chasing these social ideals. Um, so I think the best work that’s going on at the moment out there is work around people being embodied.

Olivia: Um, and for me, the really unsettling thing about GLP-1s — and I wrote a little book about this for mums who’ve got teenage daughters — is that it is terrifying how much the world is shrinking in front of our eyes, and it just reminds me of growing up in the 80s and 90s. [00:44:00] You know, “nothing tastes as good as skinny feels” is the sentence that sticks in my head. I’m like, “Come on, we can’t go back there.” And that’s the only thing I think that is — because I felt, before the rise, the quick introduction and rise of GLP-1s, I felt we were getting somewhere with people starting to be a bit more comfortable in their own skin, regardless of what that was.

Olivia: Um, and now I just see people getting thinner and thinner and thinner and I have to be careful because I also don’t want to judge people if that’s all they’ve ever wanted and want to do it. So it’s a fine line to tread, but I do feel sad about it. Um, it’s a radical act to be comfortable in your own skin these days, really. [00:45:00]

Olivia: Uh, but it is a radical act I would encourage everyone to pursue, and I do think there are behaviors you can feel healthier in your own skin. You can feel healthier by doing all the behaviors you likely promote. You know, gentle nutrition, all that sort of stuff.

Stephanie: If somebody’s listening to this conversation right now and you want to give them from a health behavior change perspective — I hate to say the word tips, but in the context of GLP-1 and health behavior — like one piece of advice or one thing to think about. What would you say? [00:46:00]

Olivia: So from a psychological point of view — I use ACT and EMDR in this space, ACT and compassion-focused therapy — I think the most important thing we can do now is if you are feeling pressure, if it is affecting you, that there’s a real need to take a breath and really start to think about what a rich and meaningful life looks like for you, and also remembering that good enough is good enough.

Olivia: So I quite often say this to people that I’m working with who are trying to change so much: “What would make today a better day for you?” And it sounds really trite, but if you’re sitting at your desk all day because of work, and you can’t get out, but you want to go out — could you go out for five minutes? You don’t have to go out for 20 minutes. So it’s a bit for me about good enough is good enough. But do something that’s gonna make you feel good, and that does quite often involve a walk around the block or something that you enjoy eating without feeling guilty about it. [00:47:00]

Olivia: Small acts of self-compassion.

Stephanie: Yeah. Where can people find you? We’ve referred to an article that you wrote that I read and your work came to me that way — is Substack the best place to follow your work?

Olivia: Yeah, so Substack. I am on Instagram. I’m not very active on Instagram, although I’m sort of tempted to be a bit more again, given the rise of this and the need for louder voices. Um, but also I’m on LinkedIn and I do have a website, oliviapalmer.co.uk if people want to look at that. [00:48:00]

Stephanie: Yeah. Well, highly recommend the Substack because you’ve got some great articles there that I passionately read. So follow Olivia’s work there.

Olivia: Oh, thank you.

Stephanie: And let’s keep in touch as we see more — I’m gonna be posting when I start seeing any research or any intelligence on either behavior change or the psychology of GLP-1, because we’re kind of clueless right now, and we need to keep each other informed.

Olivia: Yeah. No, definitely. And please, you know, keep doing what you’re doing. I think your podcasts are amazing, and the work you do is brilliant. So yeah, I would just keep listening avidly. Maybe not to my one, but to other people’s.

Stephanie: No. Thank you very much for your time today.

Olivia: Thank you.