Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for obesity and type 2 diabetes, supporting weight loss and glycaemic control through effects on appetite and ingestive behaviour. The psychobiological mechanisms underlying these effects remain unclear. We reviewed evidence for candidate mechanisms and analysed quantitative and qualitative self-reported changes in appetite-related experiences from 704 people using GLP-1 RAs. Participants reported multiple changes that appeared distinct for food versus alcohol, with reductions in food urges and cravings largely independent of changes in alcohol use. Enhanced awareness and utilisation of hunger and satiety signals were frequently described, suggesting potential changes in interoceptive processes. Changes in enjoyment of eating were largely independent of reductions in food cravings, urges to eat, and gastrointestinal side effects. Improved ability to eat in a goal-directed manner was also frequently reported. Results support the presence of multiple cognitive and behavioural processes contributing to reduced food intake and provide testable hypotheses to explore in experimental work designed to isolate effects of GLP-1 RAs on goal-directed control, interoceptive awareness, attention, memory, and executive function.