Semaglutide has emerged as a popular medication for weight loss, celebrated for its ability to suppress appetite and slow down digestion. This innovative medication has become famous for weight loss due to its appetite-suppressing and digestion-slowing properties. However, some individuals using semaglutide may not experience the desired weight loss, leading to frustration and questions. This article explores the various reasons why semaglutide might not be working as expected and provides guidance on how to optimize its effectiveness for a successful wellness journey.
What is Semaglutide?
Semaglutide is an injectable medication designed to treat type 2 diabetes and obesity; it has gained popularity as a weight-loss medication. Semaglutide helps reduce blood sugar levels to normal. It also slows down food digestion and decreases hunger, leading to weight loss.
Semaglutide belongs to a class of drugs known as glucagon-like peptide-1 receptor agonists (GLP-1RA). Semaglutide is the active ingredient in three FDA-approved drugs, which include Wegovy injection, Ozempic injection, and Rybelsus tablets.
- Wegovy: Approved for chronic weight management in adults and children 12 years and older with obesity, or some adults who are overweight and have weight-related medical conditions, to help them lose weight and keep it off.
- Ozempic and Rybelsus: Approved to reduce blood sugar levels in people with type 2 diabetes mellitus. Ozempic is also authorized to lower the risk of stroke, heart attack, or death in people with known heart disease and type 2 diabetes mellitus.
These medications are combined with increased physical activity and diet adjustments and are only available with a prescription. As demands for semaglutide for weight loss keep rising, medical experts are developing strategies to control the market. Many prescribe Rybelsus and Ozempic off-label (using a drug that is FDA-approved for a different purpose).
How Semaglutide Works for Weight Loss
Semaglutide mimics the GLP-1 hormone produced in the gut after eating. GLP-1 stimulates the body to produce more insulin, which lowers blood sugar (glucose). Higher doses of GLP-1 also affect the brain regions that control hunger and make you feel full.
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When combined with diet and exercise, semaglutide can result in significant weight loss, as well as a decreased risk of diabetes, heart disease, and cancer in people with obesity or overweight.
Reasons Why You Might Not Be Losing Weight on Semaglutide
Semaglutide is generally effective, but if it isn’t delivering the weight loss results you hoped for, here are the common reasons that might be holding you back.
Starting the medication: Everyone responds differently to semaglutide. While some people lose weight quickly, others may require a few weeks to notice changes. In an Ozempic trial, which lasted 1 year and 4 months, some people took longer to lose weight, but most people began losing weight within the first four weeks. In another study, people taking 1.0 mg of semaglutide lost 13 pounds on average in 56 weeks. Starting semaglutide requires patience.
Dosage is too low: Health professionals begin semaglutide at a low dosage of 0.25 mg once a week for the first 4 weeks to minimize side effects. After 4 weeks, you will increase the dosage to 0.5 mg per week for 4 weeks. Your doctor may increase your dosage every four weeks until you reach the maximum maintenance dosage of 2.4 mg for Wegovy and 1 mg for Ozempic, depending on how your body responds to semaglutide. The whole process of scaling up might take up to three months. Studies have indicated that with a low dose of semaglutide, 25% of people may gain weight, while people on higher doses of semaglutide see greater weight loss.
Skipping doses: If you skip a weekly Ozempic or Wegovy injection, it may greatly impede your progress. And predicting how your body will react if you take your prescription inconsistently can be challenging. To ensure you don’t forget, try to take your dose on the same day each week. Consistency in medication administration, eating habits, and exercise are essential for the best weight loss results.
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Diet has not changed: While semaglutide can help promote weight loss, it works most effectively with a healthy lifestyle. Maintaining a balanced and calorie-conscious diet is crucial for weight loss. Medications alone may not compensate for an unhealthy diet. Even in clinical trials, semaglutide was effective in weight loss when combined with lifestyle changes. Participants in this trial were encouraged to implement these healthy diet changes. Weight loss fundamentally depends on burning more calories than you consume. If you’re not losing weight, it could be that your caloric intake is still surpassing your energy expenditure. Besides your calorie intake, various dietary practices may hinder your efforts to lose weight. For instance, red meat, refined carbohydrates, starches, and beverages with added sugar are all linked to weight gain. Drinking alcohol can also hamper your weight loss attempts.
Lack of physical activity: Semaglutide effectiveness in promoting weight loss is enhanced when coupled with regular physical activity and diet. Exercise helps burn calories and improves overall metabolic health, complementing the effects of the medication. Aim for 75 minutes of intense aerobic activity like running or at least 150 minutes of moderate aerobic activity, such as walking or swimming, each week. Perform strength training exercises for all major muscle groups at least twice weekly. Exercise can also boost metabolism, helping your body burn calories more efficiently. This can enhance the weight-loss effects of semaglutide.
Weight loss plateau: You’ve followed a healthy, low-calorie diet, improved your exercise habits, and haven’t missed a dose of semaglutide. You have watched your weight reduce and are excited. But, suddenly, the scale has stopped budging-You’ve hit a weight-loss plateau. Plateaus occur when your body adapts to changes in diet, exercise, or medication, and progress slows down. When it happens like this, it’s essential to reevaluate your diet and ensure you are still maintaining a calorie deficit by choosing nutrient-dense foods and controlling portion sizes. Consider also changing your workout routine. If you’ve been doing the same exercises for a while, your body may have adapted. Try adding a variety of routines, like increasing intensity or resistance training.
Pre-existing medical condition: Several underlying medical issues may impede weight loss efforts. For instance, hypothyroidism may cause a slower metabolism. PCOS (Polycystic Ovarian Syndrome), a medical condition that results in hormonal imbalances, frequently leads to weight gain. People with type 2 diabetes, which semaglutide treats, may lose weight more slowly than those without. Semaglutide trials have shown that people without diabetes have higher chances of losing weight than those with diabetes. People without type 2 diabetes lost an average of 6.3% of their body weight after taking semaglutide for three months, whereas those with diabetes lost 3.9%. Those without type 2 diabetes lost 11.8% after six months, while those with diabetes lost 7.2%. Inform your healthcare provider about your pre-existing medical condition and express your concerns about the lack of significant weight loss. They can assess how the condition may affect your response to semaglutide and adjust your treatment plan accordingly.
Stress: Stress can lead to weight gain. Research suggests that there is a connection between obesity and chronic stress. Stress triggers the release of hormones such as cortisol, often called the “stress hormone.” Elevated cortisol levels can stimulate appetite and lead to cravings for high-calorie and sugary foods. Even if you’re not consuming high-fat and sugary foods, cortisol may also slow your metabolism, making it challenging to lose weight. Some people also respond to stress by seeking solace in food, leading to emotional or stress eating. This can result in consuming more calories than the body needs for energy. You may also exercise less, lack the time and motivation to make healthier meals, and tend to eat anything you find, which is not often the healthiest choice. For some people, weight gain can cause more stress.
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Lack of sleep: Sleep deprivation impacts how many calories you burn and consume during the day. Lack of sleep can disrupt the balance of hunger-regulating hormones, increasing ghrelin (the hunger hormone) and reducing leptin ( the satiety hormone). This hormonal imbalance can lead to increased appetite and cravings for calorie-dense foods. Fatigue and lack of motivation from inadequate sleep can also lead to decreased physical activity and exercise, reducing overall calorie expenditure.
Constipation: Constipation is one of the side effects of using semaglutide. And if your body is holding onto waste longer, you may not lose weight as quickly as you had hoped. Regular bowel movements are necessary for the proper functioning of your digestive system. Increase your regularity by drinking lots of water, exercising, and eating a lot of fiber-from whole grains, fruits, vegetables, nuts, seeds, and legumes.
Compounded Semaglutide Issues: Some online providers offer compounded semaglutide as a budget-friendly alternative, but it isn’t FDA approved, and its safety and effectiveness haven’t been tested like other prescription drugs. Compounded semaglutide is a custom-made version of the weight loss drugs approved by the Food and Drug Administration (FDA). Compounding pharmacists are allowed to compound certain medications when there’s a shortage of brand-name drugs or when the need to meet the specific needs of individuals. The process might include altering the strength of a medication, changing it from a solid tablet to a topical cream, or preparing a formulation that avoids allergens or certain inactive ingredients. In the case of semaglutide, some pharmacists might compound the medication using the same ingredients as the brand-name versions. They might do this to help tackle shortages and capitalize on the demand for weight-loss treatments.
- Dosage Problems: The right dosage is key for semaglutide to work well. Compounded versions might have a different strength than FDA-approved drugs, which can lead to taking too little or too much.
- Inconsistent Batches: Compounded semaglutide can vary from batch to batch, meaning the drug may not be the same each time you get it.
- Storage Issues: How the drug is stored also matters for how effective it is for weight loss. Heat, light, and moisture can all affect the stability of semaglutide.
- Injection Technique: How you inject the drug is important. If done wrong, the drug might not work as well. Semaglutide injections typically need to go under the skin, not into muscle or fat.
- Pharmacy Practices: Not all compounding pharmacies are the same. Some might not follow the best practices, leading them to produce drugs that don’t work well or aren’t safe.
Metabolism and Genetics: Metabolism and genetics can influence weight loss on semaglutide. Some people naturally have a slower metabolism, which can make weight loss more challenging, even with weight loss medications. Certain genetic traits may also impact how the body absorbs, processes, and responds to semaglutide, meaning that some people may feel stronger appetite suppression and see faster results, while others only experience mild effects.
Inconsistent Use: For semaglutide to be effective, you have to take the medication consistently. When doses are missed, it disrupts the hormone-like effects that help curb hunger and manage blood sugar, which can lead to fluctuations in appetite and cravings.
Other Health Conditions and Medications: Certain health conditions and medications can influence how well semaglutide works for you. Conditions like hypothyroidism, polycystic ovary syndrome (PCOS), and insulin resistance can slow down weight loss or make it more difficult to achieve. Additionally, some medications, such as antidepressants, corticosteroids, and certain diabetes treatments, can lead to weight gain or make it harder to lose weight.
Maximizing Weight Loss on Semaglutide
Here are some general tips that may help maximize weight loss while using semaglutide:
Adopt a healthy diet: Adopting a new eating pattern that encourages weight loss must include reducing your overall calorie consumption. Reducing roughly 500 calories each day is a good place to start, striving for fewer than 1,500 calories total per day. But don’t do this alone. Follow a doctor’s instructions while on this diet. One way to reduce your calorie intake is by increasing your consumption of plant-based foods. Prioritize eating a well-balanced and nutrient-rich diet, including plenty of fruits, vegetables, whole grains, lean meats, and healthy fats. Aim for variety to help you reach your goals without sacrificing flavor or nutrition. Limit the intake of processed foods, sugary beverages, and high-calorie snacks, and pay attention to portion sizes to avoid overeating.
Exercise regularly: Semaglutide is prescribed in combination with exercise. Reducing calories and engaging in regular physical activity can help you lose weight more effectively. Exercise can help burn the extra calories you can’t cut through medication alone. Exercise also provides many health benefits, including improving your mood, strengthening your heart, and lowering blood pressure. Exercise can also help you maintain weight. Long-term weight loss maintenance is linked to regular physical activity. Still trying to figure out where to begin? Start with a walk. Set reasonable goals, such as 15 minutes daily, and gradually increase it to 30 minutes. Don’t strive to walk 10,000 steps a day if you’re walking 2,000. Increase to 4,000 daily and increase every week. Next, add strength training and aerobic activities such as biking, swimming, or running. Strength training builds muscles, which helps you burn calories even when sleeping. A healthy balance is walking every day, strength training twice or thrice a week, and cardio or high-intensity interval training (HIIT) once or three times a week.
Make lifestyle changes: Making positive lifestyle changes is crucial for overall well-being and weight management. Ensure you stay hydrated by drinking enough water daily. Studies suggest that drinking a lot of water can prevent you from overeating, leading to weight loss. Prioritize adequate sleep, aiming for 7-8 hours each night, as it impacts metabolism and prevents hormonal changes that can impede weight loss. Manage stress through stress-reducing activities, like walking, reading, journaling, meditation, or deep breathing, to promote a healthier mind-body balance. These lifestyle changes, combined with a balanced diet and regular exercise, contribute to a holistic approach to better health and sustainable weight management.
Monitor your progress: Self-monitoring is a simple and efficient technique to track your progress, especially if you’re using weight loss medications like semaglutide. It can be as easy as writing down what you eat daily or using a calorie calculator to calculate your calories or as extensive as using a smartphone or web app to track your daily caloric intake, weight, exercise levels, and other variables. Weekly check-ins with your doctor can also be helpful to monitor any changes in your weight loss journey and if you’re experiencing any side effects with the medication.
Cut out alcohol: For many people, cutting back on alcohol is a simple method to reduce their calorie intake. Since alcohol has no nutritional value, drinking it will result in empty calories-up to 500 for mixed cocktails that contain fruit juices, ice cream, or heavy cream, as well as syrupy sweeteners. If you order drinks, choose a 5-ounce (145 mL) glass of wine, which has 120 calories, or a 12-ounce (355 mL) light beer with 103 calories.
Be patient: Losing weight with semaglutide may take weeks to start seeing results. Sticking to a healthier diet is not a one-day thing either. It could take weeks to start noticing benefits while using semaglutide for weight loss. Sticking to a healthier diet also takes time. Your body may also take weeks to adjust to the medication, and it takes trial and error to learn the best diet for yourself. Try not to get discouraged if it takes longer than you’d like for your new habits to stick because some days will be easier than others. If you set reasonable goals for yourself, stay committed, and continually monitor your progress, you’re likely to achieve your goals.
How Long Does It Take to Lose Weight on Semaglutide?
You may start losing weight on semaglutide in the first four weeks of treatment, but it might take several months to get the full effects. While this may vary from person to person, other factors, such as food and activity, might influence the rate of weight loss. According to clinical trials, people on a weekly semaglutide dosage can expect to lose an average of 5-10% of their body weight. Patients who were overweight lost 5.9% of their body weight after three months of weekly semaglutide injections. The average weight loss was 10.9% after 6 months of weekly injections.
Weight Loss Plateaus on Semaglutide
Drugs such as Ozempic and Wegovy eventually reach a weight loss plateau, beyond which further weight loss slows or stops. Like any other healthy weight loss method, the body eventually settles at an appropriate weight, which may or may not correspond with that person’s weight loss goals.
Weight-loss plateaus are extremely common, normal, and a necessary part of the weight-loss process. Weight-loss plateaus are a necessary and normal part of the weight-loss process.
"Weight loss plateau happens when your body’s energy burn equals energy being added through food,” said University of Pittsburgh endocrinologist, Dr. Jason Ng.
“The best way to get over a plateau is to again significantly alter the energy balance, which can be done via increased physical activity or further decreasing food intake, for example,” he said.
Maximizing Semaglutide Results
Not everyone responds the same way to semaglutide (Wegovy). Additionally, 86.4% of individuals in this study lost at least 5% of their body weight, an impressive amount. A weight loss intervention is typically considered successful if participants achieve more than 5-10% of weight loss. Wegovy will help you find your off switch by reducing hunger and food-seeking behaviours. The evidence is clear: we must eat within a calorie deficit to lose excess body fat. Additionally, suppose our baseline diet was rich in ultra-processed foods and refined sugars, and we continue to eat this way whilst on semaglutide. Suppose we’ve lost some weight on semaglutide, but then we hit a plateau, and we can’t budge the scales any more. Our brain receives signals from many hormones, letting it know how much energy we’re eating and how much fat we have stored.
Proper injection technique is critical when using semaglutide! Your semaglutide diet plan and physical activity levels are the cornerstone of your weight loss journey, regardless if you’re taking semaglutide or not. While semaglutide helps to reduce hunger levels, what you put into your body and the energy you exert is ultimately the cause of your weight loss. The best way to know what adjustments need to be made is by collecting data on your experience! Therefore, we recommend recording your progress, identifying trends, and adjusting your strategy as needed.
Overcoming Tolerability Issues
Another reason could be tolerability issues. The most common side effects of semaglutide are gastrointestinal, including abdominal discomfort and nausea. Semaglutide works by acting on a receptor called GLP-1, which helps regulate appetite and blood glucose metabolism. Another medication, Tirzepatide, works on both the GLP-1 and GIP receptors. Tirzepatide tends to have fewer gastrointestinal side effects and can be a suitable alternative for those who do not tolerate semaglutide well.
The Importance of Dosage
The effectiveness of semaglutide for weight loss in non-diabetics depends largely on getting the right dosage. If you’re not on the appropriate semaglutide weight loss dosage chart, you may not achieve your desired weight loss goal. A common reason for not losing weight on semaglutide is not being on a high enough dosage. Many patients start on a low dosage and gradually increase it. However, sometimes the dosage increases stop prematurely, even though the patient can tolerate the medication well.
Dr. Ali explained that one’s physician should start at the lowest dose, and then gradually increase it until effective weight loss is achieved.”Once you reach a maximum dose, you can’t go any further than that,” said Dr. Ali.
Alternative Options
If dietary changes, a more powerful medication, or a modified exercise program do not get one off of their semaglutide plateau, they may have reached the limit of such drugs’ effectiveness. There are stronger drugs that a physician may consider in the event of a plateau. As a glucagon-like peptide-1, or GLP-1, agonist, semaglutide targets one hormone. A new double agonist, tirzepatide, marketed as Mounjaro, mimics two, theoretically doubling the strength of the weight-loss effect. It performed successfully in a trial for 85% of participants, achieving sustained weight losses of up to 20% in some people.
If semaglutide hasn’t brought the results you hoped for despite your best efforts, there are other non-surgical weight loss options that may better suit your needs. ESG Stomach Tightening, also called Endoscopic Sleeve Gastroplasty, is a non-surgical, non-invasive weight loss procedure designed to help patients achieve substantial, lasting weight loss without the need for surgery. A study published in JAMA also found that ESG is not only more effective for weight loss than semaglutide, but it’s also more cost effective over a five year period. The Gastric Balloon is a non-surgical weight loss procedure designed to help patients reduce their food intake and build healthier eating habits. The balloon is removed after six months, and most patients experience an average of 10-13% weight loss.
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