Zepbound (tirzepatide) has emerged as a promising medication in the realm of weight management, garnering attention for its potential to aid individuals in their weight loss journeys. The active ingredient in Zepbound is tirzepatide, which falls into a group of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. These medications can slow your digestion and make you feel full longer. Clinical trials have consistently found that Zepbound can help with weight loss when combined with healthy habits such as regular exercise and a nutritious diet. In general, higher degrees of weight loss occur in people taking higher doses of the drug.
However, like any medication, its effectiveness can vary from person to person. Social media and news articles cover many success stories about losing weight on Zepbound (tirzepatide), the weight loss drug. Seeing these dramatic transformations can lead to high expectations. But here's the reality: not everyone loses the same amount of weight on Zepbound. Weight loss results vary from person to person, even on medication. It’s natural to question your progress when results seem slow. This doesn’t always signal a problem; Zepbound works best when dosage, timing, and daily habits align.
If you’re not losing weight on Zepbound, it’s natural to be frustrated. However, let’s explore some reasons why Zepbound may not be working for you and a few strategies to jumpstart your weight loss.
How Zepbound Works
Zepbound (tirzepatide) belongs to a class of medications known as GLP-1/GIP receptor agonists. These drugs mimic two natural hormones that help regulate appetite and blood sugar. Zepbound is a weight loss medication that works by lowering your appetite, making you feel full for a longer time after meals, and reducing your cravings. These effects are designed to help you eat fewer calories and burn fat while preserving muscle mass.
Zepbound mimics two hormones in your body: GIP and GLP-1.
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- GIP (Glucose-Dependent Insulinotropic Polypeptide): This hormone helps the body use sugar more effectively and may enhance the effects of GLP-1, leading to better appetite control and weight loss.
- GLP-1 (Glucagon-like Peptide-1): This hormone slows digestion, reduces hunger, and helps the body release insulin to control blood sugar.
The medication works by mimicking the effect of a hormone produced by your intestines called GLP-1. This hormone helps manage diabetes and weight loss by:
- stimulating insulin secretion
- increasing feelings of fullness
- slowing the movement of food through your stomach to your intestines
- assisting with fat loss
Realistic Expectations for Weight Loss on Zepbound
Weight loss results while taking Zepbound depend on factors such as your:
- individual response to the drug
- initial body weight and body fat percentage
- lifestyle habits
- dose of the medication
In a clinical trial, people on Zepbound (Tirzepatide) lost 15-20% of their body weight in a little over a year (72 weeks). However, results varied depending on the dose and individual differences. Clinical trials demonstrate that Zepbound, a prescription medication for weight management, produces the greatest average weight loss at higher doses of 10 mg and 15 mg taken once weekly. Even with this promising research, it’s important to keep expectations realistic. It can be discouraging to see the scale stall, but plateaus and slower progress are part of almost every weight loss journey.
Tirzepatide usually reaches a steady concentration in your blood within 4 weeks. If it’s well-tolerated, your doctor will likely recommend increasing your initial weekly dose from 2.5 milligrams (mg) to 5 mg after this period. Some people taking Zepbound may notice a small amount of weight loss within 4 weeks, but most studies examining weight loss outcomes have reported results after longer periods, such as 52 or 72 weeks. Weight loss results on Zepbound vary between people, but clinical trials have reported weight loss of more than 10% of body weight in people taking tirzepatide for 72 weeks (1.5 years).
In two studies, researchers reported the following at 72 weeks:
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- In study 1, researchers included people with overweight or obesity without diabetes.
- In study 2, researchers included people with overweight or obesity and type 2 diabetes.
Both studies were funded by Eli Lily, the company that produces Zepbound. The average weight loss with Zepbound per month may vary depending on the prescribed dosage. But after 72 weeks, or 18 months, someone using 15 mg of the drug as directed may be able to lose 20.9% of their body weight. This would mean someone who weighs 200 pounds (lb) at the start of their treatment could lose about 41.8 lb. If you have additional questions about the average weight loss on Zepbound, talk with your doctor.
Potential Reasons for Lack of Weight Loss on Zepbound and How to Address Them
If you’ve been on Zepbound for a while and haven’t seen much progress, don’t worry-there might be factors that you can adjust. If weight loss isn’t happening on Zepbound, several common factors may be affecting progress.
1. Inadequate Dietary Habits
Nutrition makes a big difference. It's natural to think that since Zepbound reduces your appetite, you will eat less food and lose a lot of weight. However, the amount and types of food you eat play important roles in your success. Even with a reduced appetite, consuming highly processed foods, added sugars, or eating large meals may affect your progress.
Zepbound is meant to be combined with increased physical activity and a reduced-calorie diet. Not combining it with these lifestyle habits may hinder your weight loss goals. To maximize weight loss while taking Zepbound, it’s best to combine it with regular physical activity and a balanced, nutritious diet. Focus on nutrition - Build meals around protein (chicken, fish, beans), fiber (vegetables, whole grains), and healthy fats (avocado, olive oil). Eating an array of fruits and vegetables and eating plenty of lean protein, such as chicken breast or low fat dairy is also beneficial.
Solution: Consider working with a registered dietitian to create a balanced, sustainable eating plan with lean protein, fiber-rich vegetables, and healthy fats. Clinical guidelines generally suggest 1,200-1,500 calories/day for women and 1,500-1,800 calories/day for men, though individual needs may vary.
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2. Insufficient Physical Activity
Zepbound may help control your appetite, but exercise remains important for optimal results. Exercise improves insulin sensitivity, boosts metabolism, and helps prevent muscle loss during weight loss. Even simple activities like a moderate-intensity walk daily and strength training a few times a week can make a difference.
Solution: The US CDC recommends about 150 minutes of moderate activity each week. This number boils down to just 20 minutes a day. Move regularly - Strength training helps you maintain muscle mass, while cardio supports heart health and endurance.
3. Inconsistent Medication Dosage or Administration
Taking Zepbound as prescribed is essential. Missing doses or using improper injection techniques can slow your progress.
Solution: It’s best to follow your healthcare provider’s recommendation. Zepbound is used once weekly as a simple injection under the skin. When it comes to the best time of day to take Zepbound, there isn’t a medically proven “ideal” time. What matters most is consistency. Some patients prefer mornings because they can monitor side effects throughout the day. Others find evenings easier since they can sleep through any mild nausea.
4. Inadequate Dosage
A clinical trial showed that after 72 weeks, people who took 5 mg of Zepbound (tirzepatide) lost 16% of their body weight, those at 10 mg lost 21%, and those at 15mg experienced a 22.5% weight loss. However, most people start Zepbound at 2.5 mg. This is the starter dose to help your body get used to the medication. It also helps you and your doctor evaluate your response to the drug. While this is a starting point, your dosage may increase over time. So, if you just began taking Zepbound, plan for an adjustment period where you may not see the weight loss results you expect.
Dosage may be too low - Doctors often start you on a smaller dose of Zepbound to minimize side effects, then gradually increase it. Significant weight loss often occurs only after hitting the therapeutic dose, so the early weeks are typically for tolerability rather than rapid results.
Solution: Note: Moving to a higher dose too quickly might cause more side effects. Please do not make any changes to your dose or stop taking your medication without consulting a healthcare provider. Talk with your provider about dosage adjustments or lab testing can also make a big difference. Review your medication dosage.
5. Hormonal Imbalances and Underlying Medical Conditions
Hormones play a crucial role in metabolism. If there is any type of hormonal imbalance in your body, it could affect your weight loss results-even if you’re on Zepbound. For example, people with type 2 diabetes can still lose weight on Zepbound, just not as much as those without diabetes. Dealing with these health issues does not mean you cannot lose weight-it just means you might need extra support and guidance to reach your goals.
Medical conditions like hypothyroidism, polycystic ovary syndrome (PCOS), or use of certain medications (e.g., antidepressants, insulin, beta-blockers) can slow weight loss even when using Zepbound.
Solution: If your weight loss has stalled, consider discussing your concerns with a weight loss dietitian to get a personal evaluation and a custom nutrition plan to help you get back on track.
6. Natural Weight Loss Plateaus
It's common for weight loss to slow down or pause temporarily. This pause is called a weight loss plateau. It happens when your body adapts to changes in diet and exercise, slows your metabolism, and adjusts to its new normal.
Solution: If you've hit a weight loss plateau, try to stay consistent with your medication and make small changes to get back on track. This might mean adding a few more minutes to your daily walk, choosing more nutritious foods, or lowering your alcohol intake. If you would like expert help with figuring out what to do, consider advice from a registered dietitian.
7. Other Lifestyle Factors
You may also benefit from following other healthy lifestyle habits that can support weight loss, such as:
- getting plenty of sleep
- eating adequate fiber
- staying hydrated
- reducing your intake of sugar and highly processed foods
- reducing stress
Solution: Prioritize sleep - Poor sleep disrupts appetite hormones and can make it harder to stay consistent. Manage stress - Chronic stress can affect weight loss.
8. Gastrointestinal Side Effects
Gastrointestinal side effects, such as nausea, vomiting, and diarrhea, are common with Zepbound, especially during the beginning of treatment.
Solution: These side effects are often manageable and may diminish over time, but it’s important to communicate with a healthcare provider and follow individualized recommendations to maintain progress.
9. Cost and Access Issues
Cost and insurance coverage can make it difficult to maintain consistent access to Zepbound.
Solution: Missed doses due to financial or logistical issues can limit therapeutic benefit.
10. Temporary Weight Gain
Although uncommon, some people notice temporary weight gain after starting Zepbound.
Solution: This doesn’t mean the medication isn’t working. Track your meals, water intake, and activity for a couple of weeks, and bring this information to your next appointment with your prescriber. Sometimes, small adjustments - like reducing sugary drinks or increasing protein - can help.
The Importance of a Holistic Approach
Zepbound can be a powerful tool for weight loss, but long-term results depend on more than the medication alone. Think of Zepbound as one piece of a larger puzzle. Successful weight loss with Zepbound comes from combining the medication with healthy lifestyle changes. Making better food choices, staying active, getting enough sleep, managing stress, and addressing any health conditions all play important roles alongside your treatment.
For a more guided approach, working with a registered weight loss dietitian at Health Loft can help you bridge the gap between medication and lifestyle. Through personalized nutrition counseling, you’ll learn how to build sustainable habits, support your metabolism, and navigate challenges as they come up. Finding the right balance of these changes can be challenging, but you don't have to figure it out alone. A registered dietitian can help create a personalized plan that fits your life. They'll work with you to develop strategies for long-term success and adjust your plan when needed.
Cautions and Important Considerations
Note: Zepbound should not be used with other GLP-1 medications or any other tirzepatide products. People may start to experience weight loss at different times while using Zepbound. If you think Zepbound is not working for you, talk with your doctor. They can determine whether Zepbound is the right option for you or if they need to prescribe a different treatment.
Starting Zepbound can feel like a fresh start, but it’s common to question your progress when results seem slow. This doesn’t always signal a problem; Zepbound works best when dosage, timing, and daily habits align. It’s worth reviewing your nutrition, movement, and sleep patterns. Keeping a food and activity journal can provide helpful insights.
Off-Label Use and Potential Risks
The new weight loss medications are approved by the Food and Drug Administration (FDA) only for obesity, which the agency defines as a body mass index of 30 or greater. The FDA makes exceptions for patients who don’t quite meet that threshold but have a related condition, like high blood pressure. Insurers tend to have similar criteria. Of course, that doesn’t stop providers from writing “off-label” prescriptions for people willing to pay out of pocket for them.
Koliwad and Thiara are both concerned that telehealth companies rarely provide meaningful medical supervision for patients prescribed GLP-1s. “We see a lot of them having problems with side effects. They show up in the emergency room or urgent care or come to specialists like me,” Koliwad says.
Potential Side Effects
The potential side effects of GLP-1 drugs are no fun: nausea, vomiting, fatigue, diarrhea, constipation. Most patients nudge up to the recommended dose, slowly adjusting to the drugs to minimize discomfort. Someone I know was put on semaglutide,” says Albert. “They’re older, and they became severely dehydrated and experienced an exacerbation of their atrial fibrillation [irregular heart rhythm]. They went off the drug. It might have helped with their diabetes and weight loss. For others, GLP-1 agonists can slow digestion to a problematic degree. Patients have sued the drugmakers after developing dangerous conditions, such as stomach paralysis and bowel obstructions.
Long-Term Use and Sustainability
Once you start taking GLP-1s, the drugmakers suggest you stay on them. The downsides of GLP-1 medication might not seem so daunting if you only took it temporarily. Unfortunately, the existing studies are clear: People who go off the drugs eventually regain much of their lost weight.