Accepted answer
They are distinguishable, mostly through your food choices rather than through introspection about hunger, and your instinct about the consequences is correct: aversion-driven restriction is the less durable of the two because the pathway that produces it becomes tachyphylactic.
The discriminating features
| Observation | Reduced reward drive | Nausea-driven aversion |
|---|
| Response to a favourite food placed in front of you | Mild interest, easy to eat a normal small portion, easy to stop | Actively repellent, or fine for two bites then abruptly not fine |
| Food selection | Broadly unchanged in kind, reduced in quantity. Still choose things you like | Narrows toward bland, cold, dry, low-fat, low-odour. Crackers, toast, plain yoghurt, cold chicken |
| Cooking smells | Neutral or pleasant | A specific trigger, often the strongest one |
| Fat tolerance | Normal | Notably reduced. Fatty and fried food is the classic aversion category |
| Pattern within the dosing week | Fairly flat across the week | Strongly worse on days 1-3 post-dose, easing by days 5-7 |
| Pattern after a dose increase | Modest step change, stable | Marked worsening for 1-3 weeks, then partial recovery |
| Thoughts about food between meals | Quiet. This is the food-noise effect | Often still present. You can want food and be unable to face it, and this combination is miserable |
| Excess salivation, burping, metallic taste, sulphur burps | Absent | Frequently present and frequently unrecognised as nausea |
| Effect of an antiemetic or ginger | None | Noticeable |
Your post already contains three of the aversion markers: cooking smells as a trigger, a drift toward bland cold food that you did not consciously choose, and a specific category becoming repellent. So the honest read is that you have a substantial version B component. Most people have both, in a ratio that shifts over time.
Why the distinction predicts what happens next
The two effects have different substrates and different time courses. Nausea and aversion are largely area-postrema and vagally mediated and are strongly tachyphylactic: the whole reason titration schedules exist is that the emetic response attenuates with continued exposure, which is why week two of a new dose is worse than week eight. Reduced incentive salience appears to be much more persistent, which is consistent with the trials maintaining effect over 68 to 104 weeks at a fixed dose.
So the prediction: your aversion component will diminish over the coming months, your reward-drive component will largely persist, and your intake will rise somewhere in between. If your current intake is 40% aversion-driven, expect a meaningful increase and plan for it rather than experiencing it as failure.
Tests you can actually run
- The day-6 test. Compare your appetite, food choices and intake on day 2 post-dose against day 6, over three consecutive weeks. Aversion is much more cycle-dependent than reduced salience. If day 6 looks like normal eating with smaller portions and day 2 looks like an illness, you have your answer.
- The cue test. Deliberately expose yourself to a strong food cue that used to be irresistible, in a context where you are not obliged to eat: walk past the bakery, watch someone eat the thing. Reduced salience feels like indifference. Aversion feels like recoil. They are genuinely different sensations and most people can tell them apart once they are looking for the distinction.
- The bland-versus-liked test. Offer yourself two options of similar size, one bland and one a genuine favourite. Reduced drive picks the favourite and eats less of it. Aversion picks the bland one.
- The symptom inventory. Score, honestly, for one week: excess salivation, burping, early morning queasiness, sensitivity to smells, reflux, sulphur burps, metallic taste. Low-grade nausea is frequently invisible to the person experiencing it because it arrived slowly, and this inventory surfaces it.
What to do about it
If it is substantially aversion, two things follow. First, this is worth raising with whoever prescribes for you, because continuous low-grade nausea for months is not a target state and there may be room to hold or reduce the dose rather than escalate. A dose that produces reduced salience without aversion is strictly better than one that produces both. Second, do not build your eating architecture on the aversion, because it will go away. Specifically:
- Make sure protein intake is not a casualty of the aversion. Fat and meat aversion plus a drift to crackers and toast is how people end up at 60 g of protein and losing lean mass.
- Build a structured eating pattern now, while intake is low for pharmacological reasons, so that there is something in place when the aversion fades.
- Track intake so that you can see the rise when it comes rather than discovering it four months later at a plateau.
And a point worth making because it gets lost: eating being restricted by aversion is not a superior outcome that you should be grateful for. It is a side effect. The desirable state on this class is reduced drive with a normal, if smaller, relationship to food.
edited 14 Sept 2025 by gradient_slope — updated for the 2026 guidance change
7The day-2 versus day-6 comparison is a genuinely good experiment and costs nothing. – tobias_maartens 5 months ago 8The bland-versus-liked test caught me out. I have been picking crackers over things I love for four months and telling myself it was reduced appetite. – rae_oyelowo 7 months ago Agreed strongly with the last paragraph. Chronic queasiness as a weight-management strategy is not a good trade. – two_two_micron 2 months ago add a comment