GLP-1 medications, such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound), have gained recognition as significant tools in weight loss. However, some individuals find that these drugs don't produce the desired results. If you're taking one of these medications and not seeing the scale budge, several factors could be at play. It's important to remember that patience is key, as it can take several weeks to notice any changes, and weight loss plateaus are common.
It is important to note that Ozempic is approved as a type 2 diabetes medication, but doctors also prescribe it off-label for obesity when you have a body mass index (BMI) of 30 or higher. Other GLP-1s for diabetes that are sometimes prescribed for weight loss include Bydureon, Byetta, Mounjaro, Rybelsus, and Victoza. GLP-1 medications that are approved for weight loss include Saxenda, Wegovy, and Zepbound.
The Necessity of Lifestyle Changes
You shouldn't rely solely on Ozempic to reach your weight loss goals. According to Samantha Flanagan, DO, an obesity medicine specialist with Temple Health in Philadelphia, GLP-1 medications should be combined with dietary and lifestyle interventions to achieve the results seen in studies. To maximize success, it’s crucial to avoid common missteps that sideline key lifestyle changes.
Paunel Vukasinov, MD, an internist and obesity medicine specialist in New York City, emphasizes that while Ozempic can significantly improve insulin resistance, reduce appetite, and increase satiety, it works best when combined with healthy eating, physical activity, and behavior changes. Ozempic is an effective tool for obesity and diabetes, but it isn’t a cure without the lifestyle component.
Factors Affecting Ozempic's Effectiveness
GLP-1 weight loss drugs don’t work for everyone. Individuals with diabetes may experience slightly less weight loss, and some people without diabetes may need to adjust their dose or switch to a different weight loss medication to see results. Several factors can affect your response to any GLP-1 medication, including your genes, metabolic rate, and current health. Mir Ali, MD, medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California, notes that some people feel the effects immediately and start seeing weight loss, whereas others need to be at higher doses to see results.
Read also: Transformations with Ozempic
Common Reasons for Ozempic Not Working
1. Insufficient Exercise
Many people assume that exercise is unnecessary when taking Ozempic, but regular physical activity can lead to more significant fat loss, improvements in insulin sensitivity, and better heart health. Richard Siegel, MD, an endocrinologist and a codirector of the diabetes and lipid center at Tufts Medical Center in Boston, states that an activity prescription is an essential part of all long-term weight loss plans.
Aim for at least 150 minutes of moderate aerobic activity per week, such as brisk walking, bicycling, or swimming, and incorporate at least three weekly strength-training sessions. Strength training can help to limit the loss of muscle and bone tissue, which can be a problem with all weight programs and may be exacerbated with the use of medication, says Dr. Siegal.
2. Inadequate Dietary Changes
While some people struggle to eat enough on GLP-1 medications, not everyone reduces their overall caloric intake, which is key to successful weight loss. Certain dietary habits can lead to higher caloric intake and less-balanced nutrition, says Dr. Flanagan, including grazing (snacking all day but not eating any true meals) and alternating between skipping meals and eating larger, unhealthy meals.
An optimized eating plan that emphasizes lean proteins, whole grains, fruits and vegetables, and healthy fats can help you stay satisfied and preserve lean muscle mass. If you're struggling to find foods that work for you, consult a registered dietitian-nutritionist who can help you find a doable and delicious eating plan.
3. Improper Medication Adherence
GLP-1s work best when you follow your doctor's dosing instructions carefully, says Siegal. Difficulties sticking to the prescribed plan due to side effects may reduce weight loss and lead to weight regain. It's okay to lower your dose or stop taking your GLP-1 altogether, but it's important to do so with the guidance of your healthcare provider. If there are factors that are making it difficult for you to take your medication as prescribed, they may be able to help you troubleshoot and find a regimen that works better for you.
Read also: Ozempic Meal Plan
4. Interference from Other Medications
Certain medications, such as antipsychotic medications, beta-blockers, certain antidepressants, oral steroids, some anti-seizure drugs, and some diabetes medications like insulin and sulfonylureas, may hinder weight loss. These medications deliver important benefits, so you shouldn't just stop taking them for the sake of weight loss, says Flanagan. Instead, discuss your medication plan with your doctor to figure out how to improve your weight loss plan while keeping any other health conditions under control.
5. Insufficient Dosage
You may need a higher dose of a GLP-1 to achieve the desired results, even with recommended lifestyle changes. Some people have a very significant response at the lowest dose of medication, says Siegal, while others need a higher dose to achieve a weight loss of 5 percent or more. If you've plateaued after a month or two at your current dose, talk with your doctor.
6. Impact of Stress and Poor Sleep
Chronic stress and a lack of quality sleep can negatively impact healthy weight management. Flanagan emphasizes the importance of addressing these factors with patients. Both stress and sleep deprivation signal the release of hunger-promoting hormones like cortisol, which can encourage your body to store fat, says Siegal. You're also more likely to make unhealthy dietary choices when you're zapped. Aim to get the recommended 7 to 9 hours of sleep per night to better support the work of your GLP-1.
7. Body Adaptation and Weight Loss Plateaus
Wesley McWhorter, DrPH, a spokesperson for the Academy of Nutrition and Dietetics, explains that a weight loss plateau doesn’t automatically mean the medication isn’t working or that you need a higher dose. It may mean your body is adjusting, and that’s normal. As your body loses weight, it naturally burns fewer calories, which slows progress. This is a built-in survival mechanism, not a failure. Hormones shift, metabolism adapts, and appetite often increases. It’s biology doing its job.
Most people see the most rapid weight loss within three to six months of starting a GLP-1 medication, followed by a slower pace and occasional plateaus, says Vukasinov. Besides the changes that happen with your metabolism, that six-month mark is also when lifestyle and eating habits often return to old patterns, Vukasinov says.
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8. Skipping Doses
Consistent adherence to the prescribed dosage is crucial. Missing doses, especially with once-weekly medications like Ozempic, can significantly impact results.
9. Constipation
Constipation can hinder weight loss by causing the body to hold onto waste longer than it should. Regular bowel movements are essential for a properly functioning digestive system.
10. The Need for Adequate Protein Intake
Adequate protein intake is essential for weight loss, particularly when using a medication like Ozempic. Protein helps to build and maintain muscle mass, which is critical for metabolism and overall health. A diet rich in protein can also help to reduce hunger and increase feelings of fullness, making it easier to stick to a weight loss diet.
Strategies to Overcome Weight Loss Plateaus
To move past a weight loss plateau, experts suggest several strategies:
- Adjust your diet: Cut back on carbohydrates and added sugars while increasing protein intake. Your doctor or a registered dietitian can suggest specific tips and meal plans.
- Increase your exercise: This can help boost your body's metabolism. Strength training is a good place to start, especially since an early study found that some GLP-1s could shrink and weaken your muscles.
- Get enough quality sleep: Aim for eight hours each night, as sleep deprivation can slow down your metabolism.
- Track your food: This can help you find hidden calories or larger portions that may get in the way of your weight loss.
- Switch up your workout: If you do the same activity each time, your body gradually gets used to it. Try changing the type or intensity of exercise, or do your usual activity more often or for a longer time.
Understanding Weight Regain
Weight gain while taking Ozempic or another GLP-1 is not very common, says Vukasinov, but it may occur if the medication is suddenly stopped, or your diet and lifestyle didn’t change to meet your weight loss goals. These medications can cause side effects like nausea, constipation, cramping, and acid reflux. If you’re uncomfortable, you may stop taking your weekly shot like you’re supposed to, which can keep you from losing weight. It can also be a sign that your doctor needs to change your medication to one that you can better tolerate.
For the best results, keep taking it as prescribed until your doctor tells you to stop. McWhorter advises taking a step back and looking at your overall habits instead of focusing only on medication. Sometimes small tweaks can help break through a plateau.
The Importance of Professional Guidance
If you’re not seeing the results you want, don’t hesitate to consult with your healthcare provider. They can assess your situation, adjust your dosage if necessary, and rule out any underlying medical conditions that may be hindering your progress. A registered dietitian can also provide personalized nutrition guidance to help you optimize your diet and achieve your weight loss goals.
Alternatives to Ozempic
If Ozempic isn't working for you, your healthcare provider may consider other GLP-1 medications, such as Wegovy (semaglutide), Saxenda (liraglutide), or Zepbound (tirzepatide). In some cases, bariatric surgery may be an option.
Long-Term Considerations
GLP-1 medications require a lifelong commitment if one hopes to avoid regaining lost weight, which can be expected when one stops taking them. Anyone embarking on a lifetime of semaglutide or similar medications should understand that their level of long-term risk is unknown.
The Broader Perspective on Obesity Treatment
Effective medical treatments for obesity were previously limited, with most medications offering modest weight loss. Ozempic and similar drugs now yield an average weight loss of 15 to 20 percent, significantly higher than previous options. This has opened people's eyes to obesity as a disease now that there's effective medication for it.