GLP-1 Side Effects Guide: Nausea, Sulfur Burps, Hair Loss, Food Noise - What's Normal and What to Do

Key takeaways

• Most GLP-1 side effects are gastrointestinal and dose-related. On the labels, nausea affected 44% of people on semaglutide 2.4 mg versus 16% on placebo, and 25 to 29% on tirzepatide 5 to 15 mg versus 8%; vomiting, diarrhea, constipation, burping and reflux follow the same pattern.
• They are front-loaded. In the semaglutide trials the median nausea episode lasted 8 days and the share of people with nausea peaked at the end of dose escalation, then fell; constipation lasted longest (median 47 days). The labels' main remedy is time: a slower escalation or a lower maintenance dose.
• Sulfur burps, hair loss and food noise are three different stories. Burping is on both labels (7% and 4 to 5%); hair loss (3% and 4 to 5%) tracks the weight loss and mostly affects women; a quieter 'food noise' fits the trial data on appetite and cravings but has been measured directly only in a survey.
• The serious risks are rare and specific: pancreatitis, gallbladder disease, kidney injury from dehydration, low blood sugar with insulin or sulfonylureas, aspiration under anesthesia, worsening diabetic retinopathy, and a boxed warning on thyroid C-cell tumors from rodent studies. Gastroparesis and NAION are observational associations with small absolute risks.
• Call the same day for severe or persistent abdominal pain, vomiting that stops you keeping fluids down, or sudden vision loss. With a compounded vial, check the units: 5- to 20-fold dosing errors are the best-documented harm specific to compounded products.

Almost everyone who starts semaglutide (Wegovy, Ozempic) or tirzepatide (Zepbound, Mounjaro) feels something, and most of it is predictable. This guide puts the two labels side by side, explains when each side effect starts and stops, and gives the management that the labels and consensus guidance support, symptom by symptom. For drug-specific detail, read is tirzepatide safe and compounded semaglutide side effects; two symptoms have their own pages, how to get rid of sulfur burps and does tirzepatide cause hair loss.

What is normal and what is not

Normal: queasiness, early fullness, burping, loose stools or constipation in the days after a dose increase, easing before the next one; a much smaller appetite; some tiredness while you are eating far less. Not normal: abdominal pain that is severe or will not settle, vomiting that stops you keeping fluids down, fainting, yellowing of the eyes, swelling of the face or throat, a sudden change in vision. The first list is the drug acting on the gut. The second is why the labels carry warnings.

How common each side effect is: semaglutide versus tirzepatide

Sources: Wegovy label Table 3 and text; Zepbound label Table 1 and text (Wegovy label) (Zepbound label). "Not listed" means the reaction did not meet the label's threshold of at least 2% and above placebo. The low-blood-sugar row comes from each label's trial in people with type 2 diabetes, not the pooled tables.

Across all gastrointestinal reactions, 73% of people on semaglutide reported one versus 47% on placebo, and 56% at every tirzepatide dose versus 30%. Severe gastrointestinal reactions occurred in 4.1% versus 0.9% (semaglutide) and 1.7, 2.5 and 3.1% versus 1% (tirzepatide); 4.3% versus 0.7% (semaglutide) and 1.9, 3.3 and 4.3% versus 0.5% (tirzepatide) stopped treatment because of gastrointestinal reactions. Read the columns side by side with care: these are different trials in different populations (a fifth of the Wegovy pool and a quarter of the Zepbound pool had type 2 diabetes), not a head-to-head comparison. Injection-site reactions on tirzepatide were concentrated in people who developed antibodies to the drug (11.3% versus 1%).

When side effects start and how long they last

Both labels describe the same pattern: gastrointestinal reactions with Wegovy "were most frequently reported during dosage escalation," and with Zepbound most nausea, vomiting and diarrhea "occurred during dose escalation and decreased over time." The best timing data come from a pooled analysis of the STEP 1 to 3 trials, 2,117 people on semaglutide 2.4 mg and 1,262 on placebo for 68 weeks (Wharton 2022):

For tirzepatide, a pooled analysis of SURMOUNT-1 to 4 found most gastrointestinal events were non-serious and occurred during dose escalation, and when people needed an anti-nausea or antidiarrheal medicine, they most often started it during escalation (Rubino 2025).

Two practical consequences follow. Each dose increase can restart the cycle, so a rough week after a step is expected rather than a sign that something is wrong. And both drugs are long-acting, with a half-life of about one week for semaglutide and about five days for tirzepatide, so one injection's effects last days, and gaps change tolerance: the Wegovy label says escalation should restart at a lower dose after two or more missed weekly doses.

How to manage each common side effect

The labels' main tool is the schedule. Wegovy allows a dose increase to be delayed by four weeks if a dose is not tolerated; Zepbound tells prescribers to consider a lower maintenance dose. A 2022 multidisciplinary consensus adds options for the prescriber: two to four more weeks at the previous dose, no escalation while symptoms persist, stepping back to the lower dose, a lower maintenance dose, or a temporary pause (Gorgojo-Martinez 2022). A 2025 joint advisory from four US obesity and nutrition societies covers the food side (Mozaffarian 2025). The dietary advice below is expert consensus built on how a slowed stomach behaves; it has not been tested in randomized trials. Dose changes belong to your prescriber, and the legitimate version of going slower is the labels' own flexibility, not the sub-label regimens described in microdosing GLP-1.

Nausea. Eat slowly, eat smaller portions, stop at the first sign of fullness, favor bland, low-fat food, avoid lying down after meals and avoid strong smells (Gorgojo-Martinez 2022). Nausea is often worst in the morning or after long gaps without food, and skipping meals because of it tends to make it worse; the advisory suggests a small breakfast and small meals every three to four hours with fluids, and lists ginger or peppermint tea and acupressure bands as options. A prescriber can add an anti-nausea medicine for the adjustment period; the advisory notes that ondansetron-type drugs can worsen constipation and that agents such as prochlorperazine may be preferable (Mozaffarian 2025). If anti-nausea medicine is still needed a month after reaching the maintenance dose, the consensus suggests a lower dose instead.

Vomiting. It is more likely after large meals. Eat small amounts more often, sip fluids through the day, and if vomiting persists, take drinks 30 to 60 minutes away from meals (Gorgojo-Martinez 2022). The reason to take it seriously is dehydration: most kidney-injury reports on both labels followed nausea, vomiting or diarrhea, and the labels ask prescribers to check kidney function in anyone losing fluids. If you cannot keep fluids down, call that day.

Constipation. The longest-lasting effect. Fluids, fiber increased gradually (prunes and other dried fruit) and physical activity come first; if that is not enough, the advisory lists magnesium citrate, polyethylene glycol 3350, fiber supplements and stool softeners, and notes that high-protein and high-fat foods slow the stomach further and may need to be limited for a while (Mozaffarian 2025). Severe constipation with a swollen abdomen and vomiting is different: both labels list ileus, intestinal obstruction and fecal impaction among post-marketing reports.

Diarrhea. Usually short. Drink generously; avoid dairy, coffee, alcohol, very hot or cold foods and sugar alcohols such as sorbitol, mannitol and xylitol; cut back on high-fiber foods until it settles; loperamide is an option if it persists. Metformin can add to it, so ask whether that dose needs adjusting (Gorgojo-Martinez 2022).

Reflux and indigestion. The consensus approach is smaller, more frequent meals; avoiding coffee, tea, spices, cola, fatty, fried or processed food, tomato, mint, chocolate, alcohol and carbonated drinks; not lying down soon after eating; and, if needed, a short course of a proton pump inhibitor before continuing escalation. Symptoms often improve as weight falls (Gorgojo-Martinez 2022).

Burping and sulfur burps. Burping is on both labels (7% versus under 1%; 4 to 5% versus 1%), and the rotten-egg kind is usually attributed to hydrogen sulfide from food that sits longer in a slowed gut, an explanation that has not been studied directly in GLP-1 users. Smaller meals, fewer carbonated drinks and sulfur-heavy foods, and slower escalation are the practical steps; our sulfur burps guide covers what the over-the-counter remedies can and cannot claim.

Fatigue. Reported by 11% versus 5% on semaglutide and 5 to 7% versus 3% on tirzepatide. Energy intake falls by 16 to 39% on these drugs, and below about 1,200 kcal a day for women or 1,800 for men it becomes hard to cover vitamin and mineral needs; the advisory lists fatigue beyond what is expected among the signs of deficiency (Mozaffarian 2025). Dehydration, low blood pressure (1.3% versus 0.4% on semaglutide, 1.6% versus 0.1% on tirzepatide, more often in people on blood-pressure drugs) and low blood sugar in people on insulin or a sulfonylurea are the other usual causes. Regular small meals with protein, steady fluids, and a review of other medicines are the first steps.

Injection-site reactions. Redness, itching or bruising where you inject: 6 to 8% on tirzepatide versus 2%, and 1.4% versus 1% on semaglutide. Rotate sites with every dose, as the Wegovy label instructs; GLP-1 injection sites shows the map. A hot, spreading, painful area, or hives and swelling elsewhere, is not a local reaction.

Hair loss. Reported by 3% versus 1% on semaglutide (4% of women, 0.9% of men) and 4 to 5% versus 1% on tirzepatide (7.1% of women, 0.5% of men); both labels associate it with weight reduction. The shedding typically starts months after the weight loss begins and regrows; does tirzepatide cause hair loss covers timing, protein, iron and what does not help.

Food noise: what it means and what the evidence shows

"Food noise" is not a medical diagnosis. It is the phrase patients use for constant, intrusive thoughts about food, and the reports that GLP-1 drugs turn it down came from patients and clinicians before any researcher measured it. A 2023 review framed it in terms of food cue reactivity, the strength of the pull that internal and external food cues exert, and proposed a model for studying it (Hayashi 2023).

What is well supported is that these drugs change appetite. In a 20-week randomized trial of 72 adults with obesity, semaglutide 2.4 mg cut energy intake at an all-you-can-eat lunch by 35% versus placebo, reduced hunger, increased fullness, and improved control of eating with fewer and weaker food cravings on the Control of Eating Questionnaire (Friedrichsen 2021). In a six-week randomized trial of 114 adults without diabetes, tirzepatide cut lunch intake by about 525 kcal at week 3 and reduced appetite, food cravings, the tendency to overeat and reactivity to food in the environment; on brain MRI it did not significantly change the response to the full set of palatable-food photos but reduced activation to high-fat, high-sugar photos in frontal, cingulate, orbitofrontal and hippocampal regions (Martin 2025).

What is weakly supported is food noise itself. The most direct study we found used a five-item food-noise questionnaire to survey 550 US adults taking semaglutide, 86% of them women; asked to recall the time before treatment, they reported a median score of 13 out of 20, against 6 afterwards (Arnaut 2026). It was retrospective, relied on memory, had no comparison group and was sponsored by the manufacturer. We found no randomized trial using a validated food-noise measure as its outcome.

What is unknown: whether food noise returns when the drug stops (weight tends to), whether it differs between drugs, and whether quieter is always better. The advisory's clinicians describe patients who lose pleasure in food, develop aversions or go hours without eating, which risks poor nutrition, and note that nausea can trigger cravings for refined carbohydrates (Mozaffarian 2025).

The serious risks, with label numbers

Boxed warning: thyroid C-cell tumors. Both drugs caused thyroid C-cell tumors in rodents at clinically relevant exposures; whether they do so in humans is unknown. Both are contraindicated with a personal or family history of medullary thyroid carcinoma or with MEN 2, and a neck lump, trouble swallowing or persistent hoarseness should be checked.

Pancreatitis. Confirmed in 4 people on semaglutide versus 1 on placebo in the weight-loss trials, and in 0.2% on tirzepatide versus 0.2% on placebo; fatal hemorrhagic and necrotizing cases appear in post-marketing reports. Severe, persistent abdominal pain, sometimes into the back, means stop and seek care.

Gallbladder disease. Gallstones in 1.6% versus 0.7% and cholecystitis in 0.6% versus 0.2% on semaglutide; cholecystitis in 0.7% versus 0.2% on tirzepatide. Rapid weight loss raises the risk, but on semaglutide the excess persisted after accounting for it.

Kidney injury from dehydration. Seven people on semaglutide versus four on placebo, and 0.5% versus 0.2% on tirzepatide, mostly after fluid losses; some post-marketing cases needed dialysis.

Low blood sugar with insulin or sulfonylureas. In people with type 2 diabetes, 6.2% versus 2.5% on semaglutide and 4.2% versus 1.3% on tirzepatide, reaching 10.3% among tirzepatide users also taking a sulfonylurea. Prescribers usually lower those doses at the start.

Aspiration under anesthesia. Rare reports of stomach contents being inhaled during surgery or deep sedation despite normal fasting. Tell the team before any procedure; is tirzepatide safe summarizes the anesthesia societies' guidance.

Diabetic retinopathy. In a two-year trial in type 2 diabetes, retinopathy complications occurred in 3% on semaglutide versus 1.8% on placebo, and 8.2% versus 5.2% in those with existing retinopathy; rapid glucose improvement can worsen it temporarily.

Also on the labels: anaphylaxis and angioedema; a resting heart-rate rise of 1 to 4 beats per minute; and changes to how oral medicines, including the contraceptive pill, are absorbed. The warning about suicidal behavior and ideation was removed from both labels in February 2026 (Wegovy label) (Zepbound label); clinicians still ask about mood.

Signals from observational studies: gastroparesis and NAION

Gastroparesis and bowel obstruction. Both labels say the drugs are not recommended in severe gastroparesis. A claims-database study of 2006 to 2020 compared 613 semaglutide and 4,144 liraglutide users prescribed for weight loss with 654 users of bupropion-naltrexone. The GLP-1 drugs were associated with more gastroparesis (adjusted hazard ratio 3.67), bowel obstruction (4.22) and pancreatitis (9.09), but not biliary disease; the confidence intervals were wide (for pancreatitis, 1.25 to 66.0), body weight was not available, and tirzepatide was not included (Sodhi 2023). On the GLP-1 drugs, gastroparesis was diagnosed at about 7 to 9 cases per 1,000 person-years, against 3 on bupropion-naltrexone. That is an association, not proof of cause.

NAION, a sudden stroke of the optic nerve. In US adults aged 18 to 65 with type 2 diabetes, the 18-month risk of ischemic optic neuropathy was 8.5 per 10,000 on a GLP-1 drug versus 5.5 per 10,000 on an SGLT2 inhibitor, about one extra case for every 3,333 people treated, concentrated in men and people over 50, with residual confounding possible (Reynolds 2026). The North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology describe the evidence as mostly retrospective, with some studies finding no link and an overall risk that remains low, and recommend shared decision-making (DeParis 2026). Europe's drug-safety committee recommended in June 2025 that NAION be listed as a very rare side effect of semaglutide, and advises anyone with sudden loss of vision or rapidly worsening eyesight to contact a doctor without delay (EMA PRAC 2025). The 2026 US labels do not list it.

GLP-1 side effect claims, graded by the evidence behind them

Claim	Grade	What the evidence shows	Sources
GLP-1 drugs commonly cause nausea, vomiting, diarrhea and constipation	A	Pooled placebo-controlled trials: nausea 44% vs 16% on semaglutide 2.4 mg and 25 to 29% vs 8% on tirzepatide 5 to 15 mg; any gastrointestinal reaction 73% vs 47% and 56% vs 30%.	Wegovy label; Zepbound label
Gastrointestinal effects cluster in dose escalation and single episodes are short	B	Post hoc analyses of large trials: on semaglutide, new events plateaued after week 20 and median episodes lasted 8 days (nausea), 3 (diarrhea) and 2 (vomiting), but 47 for constipation; on tirzepatide, most events and first rescue medicines came during escalation.	Wharton 2022; Rubino 2025
Slower escalation and diet changes reduce side effects	C	Both labels use four-week steps to reduce gastrointestinal reactions and allow a delay or lower maintenance dose; the meal advice is expert consensus that has not been tested in randomized trials in GLP-1 users.	Wegovy label; Zepbound label; Gorgojo-Martinez 2022; Mozaffarian 2025
GLP-1 drugs reduce appetite, cravings and food intake	B	Small randomized mechanistic trials: semaglutide cut test-meal intake 35% at 20 weeks with fewer cravings (72 adults); tirzepatide cut it by about 525 kcal at week 3 with less reactivity to food cues (114 adults).	Friedrichsen 2021; Martin 2025
GLP-1 drugs quiet food noise	C	Measured directly only in a retrospective, manufacturer-sponsored survey of 550 semaglutide users (recalled score 13 before, 6 after, out of 20). No randomized trial with food noise as the outcome.	Arnaut 2026; Hayashi 2023
Hair loss is more common on GLP-1 drugs, mainly in women	A	3% vs 1% on semaglutide (4% of women, 0.9% of men) and 4 to 5% vs 1% on tirzepatide (7.1% of women, 0.5% of men); both labels associate it with weight reduction.	Wegovy label; Zepbound label
GLP-1 drugs are linked to gastroparesis and bowel obstruction	C	One claims-database cohort: adjusted hazard ratios 3.67 for gastroparesis and 4.22 for bowel obstruction versus bupropion-naltrexone, with wide confidence intervals and no body-weight data. Severe gastroparesis is a label caution.	Sodhi 2023; Wegovy label; Zepbound label
GLP-1 drugs raise the risk of NAION	C	Observational: 8.5 vs 5.5 per 10,000 over 18 months versus SGLT2 inhibitors in US adults with diabetes; some studies find no link. Specialist societies call the absolute risk low; the EU safety committee recommended listing it as very rare for semaglutide.	Reynolds 2026; DeParis 2026; EMA PRAC 2025

When to call, and when to go to the emergency department

Emergency department, or 911: severe abdominal pain that does not let up, especially spreading to the back; swelling of the face, lips, tongue or throat, or difficulty breathing; a swollen, painful abdomen with vomiting and no bowel movements or gas; confusion or fainting in someone on insulin or a sulfonylurea; sudden loss of vision in one eye.

Call your prescriber the same day: vomiting or diarrhea that stops you keeping fluids down, dizziness on standing or very little urine; pain under the right ribs, with or without fever or yellowing eyes; a resting heart rate that stays fast; new or worsening low mood or thoughts of self-harm; any suspected dosing error (Poison Control, 1-800-222-1222, also takes these calls).

Raise it within days: nausea still there a week or two after a dose step (the median episode in the trials lasted 8 days), constipation that does not respond to fluids, fiber and an over-the-counter laxative, fatigue beyond what you expected, heavy hair shedding, or a neck lump or persistent hoarseness.

These lists follow the labels' warnings and counseling sections and the trial timing data; your prescriber may set different thresholds for you.

Risks that belong to compounded GLP-1s

Every number above comes from brand products in controlled trials. A compounded vial carries the same molecule's risks, assuming it contains what it says, plus one documented hazard of its own: the dose is drawn in insulin-syringe units, and units are volume, not drug. In July 2024 FDA reported patients who had injected 5 to 20 times the intended dose of compounded semaglutide, including one told to draw 5 units who drew 50, and prescribers who converted milligrams to units incorrectly; vomiting, dehydration, fainting, pancreatitis and gallstones followed, and some people were hospitalized (FDA dosing-error alert 2024). The semaglutide dosage chart, the tirzepatide dosage chart and the units converter show the arithmetic; compounded semaglutide side effects covers the rest of the compounded record, and the legal tracker explains when a compounded GLP-1 is lawful in 2026.

Bottom line

Expect your gut to notice the drug: nausea, burping, reflux and bowel changes, mostly in the weeks after each dose increase, mostly gone within days, with constipation the slow one. Expect a quieter appetite, and do not mistake that for permission to eat almost nothing; protein, fluids and regular small meals prevent much of the fatigue and some of the hair loss. Know the short list of symptoms that are not side effects to wait out, and if your vial is compounded, know your concentration and your units.

Frequently asked questions

+−What are the most common GLP-1 side effects?

Nausea, diarrhea, vomiting and constipation, followed by abdominal pain, indigestion, burping, reflux, fatigue and, with tirzepatide, injection-site reactions. On the labels, nausea affected 44 percent of people on semaglutide 2.4 mg (Wegovy) versus 16 percent on placebo, and 25 to 29 percent on tirzepatide (Zepbound) versus 8 percent. Most cases were mild to moderate and clustered in the weeks after each dose increase; between 2 and 4 percent of people stopped the drug because of gastrointestinal effects.

+−How long does GLP-1 nausea last?

Usually days per episode and weeks overall. In the semaglutide weight-loss trials, the median nausea episode lasted 8 days, diarrhea 3 days and vomiting 2 days, and the share of people with nausea peaked around week 20, shortly after the dose reached 2.4 mg, then fell. The tirzepatide label says most nausea, vomiting and diarrhea occurred during dose escalation and decreased over time. Constipation is the exception: its median episode lasted 47 days.

+−Does Wegovy make you tired?

It can. Fatigue, including weakness, was reported by 11 percent of people on Wegovy 2.4 mg against 5 percent on placebo, and by 5 to 7 percent on Zepbound against 3 percent. The usual contributors are eating far less, dehydration from nausea or diarrhea, low blood pressure in people taking blood-pressure medicines, and low blood sugar in people on insulin or a sulfonylurea. Tiredness beyond what you would expect is also a sign of nutrient deficiency that a clinician can check.

+−What is food noise, and do GLP-1 drugs quiet it?

'Food noise' is a colloquial term, not a diagnosis, for persistent, intrusive thoughts about food. Randomized studies show semaglutide and tirzepatide reduce hunger, cravings and how much people eat at a test meal. Food noise itself has been measured mainly in a survey: 550 US semaglutide users recalled a median questionnaire score of 13 out of 20 before treatment and reported 6 after. That survey relied on memory and was sponsored by the manufacturer, and what happens to food noise after the drug stops has not been studied.

+−What are the long-term side effects of GLP-1 drugs?

The longest placebo-controlled data on a label come from semaglutide's cardiovascular trial, in which 8,803 people took it for a median of about three years; the side effects did not change in kind, gastrointestinal effects early and gallbladder disease and rare pancreatitis throughout. Open questions remain: the thyroid C-cell tumors seen in rodents (the boxed warning), and observational signals for gastroparesis and a rare optic nerve stroke (NAION) that have not been shown to be causal. Weight tends to return when the drug is stopped.

+−Do GLP-1 drugs cause muscle loss?

Part of any large weight loss is lean mass, and loss of muscle and bone matters most in older adults and in people who eat little protein or do not exercise. A 2025 joint advisory from four US obesity and nutrition societies notes that protein targets of 1.2 to 1.6 g per kg a day have been proposed during active weight loss, suggests an absolute 80 to 120 g a day may be easier to follow, warns against going below 0.4 to 0.5 g per kg, and stresses that protein alone is unlikely to preserve muscle without resistance training.

+−Why do GLP-1 drugs cause sulfur burps?

Burping (eructation) was reported by 7 percent of people on Wegovy versus under 1 percent on placebo, and 4 to 5 percent on Zepbound versus 1 percent. The usual explanation, which has not been studied directly in GLP-1 users, is that slower stomach emptying keeps food in the gut longer and gives bacteria time to turn sulfur from protein-rich and sulfur-rich foods into hydrogen sulfide, the rotten-egg gas. Smaller meals, fewer sulfur-heavy foods and carbonated drinks, and slower dose escalation are the practical responses.

+−Does tirzepatide cause more side effects than semaglutide?

Not clearly. On their labels, the semaglutide trials show higher rates of nausea (44 versus 25 to 29 percent) and vomiting, but the trials differed in population, length and how events were collected, so the rows cannot be compared directly. A 2022 expert consensus found no definitive tolerability difference between GLP-1 drugs in trials or real-world series, while noting that individuals vary, and switching to another drug at its lowest dose is an option prescribers use.

+−When should I go to the ER while on a GLP-1?

For severe abdominal pain that does not let up, especially if it spreads to the back; vomiting so persistent you cannot keep fluids down, or very little urine; pain under the right ribs with fever or yellowing eyes; swelling of the face, lips, tongue or throat, or trouble breathing; a swollen, painful abdomen with vomiting and no bowel movements; confusion or fainting from low blood sugar; or sudden loss of vision in one eye. These map to pancreatitis, kidney injury, gallbladder disease, anaphylaxis, bowel obstruction, hypoglycemia and NAION.

Sources

1. LabelNovo Nordisk. Wegovy (semaglutide) injection and tablets: prescribing information, revised June 2026 (DailyMed setid ee06186f-2aa3-4990-a760-757579d8f77b). (2026)
2. LabelEli Lilly. Zepbound (tirzepatide) injection, for subcutaneous use: prescribing information, revised August 2026 (DailyMed setid 487cd7e7-434c-4925-99fa-aa80b1cc776b). (2026)
3. StudyWharton S et al. Gastrointestinal tolerability of once-weekly semaglutide 2.4 mg in adults with overweight or obesity, and the relationship between gastrointestinal adverse events and weight loss. Diabetes Obes Metab 2022;24:94-105. (2022)
4. StudyRubino DM et al. Gastrointestinal tolerability and weight reduction associated with tirzepatide in adults with obesity or overweight with and without type 2 diabetes in the SURMOUNT-1 to -4 trials. Diabetes Obes Metab 2025;27:1826-35. (2025)
5. GuidelineGorgojo-Martinez JJ et al. Clinical recommendations to manage gastrointestinal adverse events in patients treated with GLP-1 receptor agonists: a multidisciplinary expert consensus. J Clin Med 2022;12(1):145. (2022)
6. GuidelineMozaffarian D et al. Nutritional priorities to support GLP-1 therapy for obesity: a joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association and The Obesity Society. Am J Clin Nutr 2025;122:344-67. (2025)
7. ReviewHayashi D et al. What is food noise? A conceptual model of food cue reactivity. Nutrients 2023;15:4809. (2023)
8. StudyFriedrichsen M et al. The effect of semaglutide 2.4 mg once weekly on energy intake, appetite, control of eating, and gastric emptying in adults with obesity. Diabetes Obes Metab 2021;23:754-62. (2021)
9. StudyMartin CK et al. Tirzepatide on ingestive behavior in adults with overweight or obesity: a randomized 6-week phase 1 trial. Nat Med 2025;31:3141-50. (2025)
10. StudyArnaut T et al. Retrospective assessment of food noise changes after initiation of injectable semaglutide for weight management in the USA: the INFORM survey. Adv Ther 2026;43:3649-59. (2026)
11. StudySodhi M et al. Risk of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists for weight loss (research letter). JAMA 2023;330:1795-7. (2023)
12. StudyReynolds KR et al. Glucagon-like peptide-1 receptor agonists and risk for ischemic optic neuropathy: a target trial emulation. Ann Intern Med 2026;179:1244-53. (2026)
13. GuidelineDeParis SW et al. Glucagon-like peptide-1 receptor agonists and the risk of non-arteritic anterior ischemic optic neuropathy: a consensus statement by the North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology. Ophthalmology 2026;133:1029-35. (2026)
14. RegulatoryEuropean Medicines Agency. Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC), 2-5 June 2025: PRAC recommends listing NAION as a very rare side effect of semaglutide. (2025)
15. RegulatoryFDA. FDA alerts health care providers, compounders and patients of dosing errors associated with compounded injectable semaglutide products. July 26, 2024 (examples as summarized by Patient Care Online, July 30, 2024). (2024)