Wait—Why Am I Not Losing Weight on Ozempic?
Ozempic boxes
Ozempic is technically for the management of type 2 diabetes. However, its side effects, like "Ozempic face," "Ozempic butt" and GI discomfort, have been discussed often on social media and even a primetime Oprah special. The most significant "side effect" of the diabetes drug, weight loss, has made it sought after for off-label use.
Another drug, Wegovy, uses the same active ingredient, semaglutide, and can be prescribed for weight loss and management for people who are obese or overweight with specific conditions.
Indeed, the transformations are incredible, and people deserve to celebrate them. If you're not shedding pounds on Ozempic (or Wegovy), you may feel alone in your quest to figure out, "Why am I not losing weight on Ozempic?" You may also find yourself constantly hungry still—which isn't the way the drug is supposed to work. What happens if you notice Ozempic is not suppressing appetite like it's designed to do?
Let's start with an important fact: You're not alone.
"Patients may not be losing weight on Ozempic for several reasons," explains Dr. Maria Teresa Anton, MD, an endocrinologist and educator at the Pritikin Longevity Center.
Your circumstances will determine why it's not working for you. Dr. Anton and other specialists answered the question, "Why is Ozempic not working for me?"
Related: Thinking About Trying Ozempic? Here's What You Can Expect Week by Week
What Is Ozempic, and How Does It Work?
While it's hard to go long without hearing about Ozempic these days, knowing how it works can help determine whether something is off. "Ozempic is the brand name for the drug semaglutide," says Dr. Mir Ali, MD, a board-certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center. "It works by stimulating the GLP-1 receptor in the brain and the gastrointestinal tract. This induces satiety and slows the emptying of the stomach, making the person feel full for longer."
As a result, a person eats less and loses weight. In clinical trials, individuals taking 2.4 mg of semaglutide (the maximum dose for Wegovy—meanwhile, Ozempic's is 2.0 mg) lost an average of about 15% of their body weight in 68 weeks. Here's what Ozempic isn't: a standalone miracle drug.
"When used in conjunction with healthy habits and daily movement, Ozempic or other forms of semaglutide can be powerful tools to kickstart your weight loss journey," Dr. Spencer Nadolsky, DO, an obesity and lipid specialist and the medical director of WeightWatchers, says.
Why Am I Not Losing Weight on Ozempic?
1. Your dosing is off
The maximum dose of Ozempic is 2 mg, but a doctor won't start you on it. "These medications are prescribed initially at a low dose, and then the dose is adjusted periodically to reach the desired effect," Dr. Ali says.
You'll begin on a .25 mg dose and work up until you reach the needed amount to get your blood sugar in check or lose weight. Dr. Ali says that is also the most common reason that Ozempic is not suppressing appetite, a key cog in weight loss efforts. Dr. Anton echoes these sentiments.
"Over time, the body can develop tolerance to the medication, and the individual may experience less nausea related to the medication and, in turn, less appetite suppression," Dr. Anton says.
2. You're missing doses
Ozempic is considered a long-term solution to weight management. In one trial extension, people who stopped taking semaglutide regained two-thirds of the weight loss within a year. However, even periodically missed doses can hinder weight loss efforts.
"Medication compliance is also essential to achieving the desired weight loss while on the medication," Dr. Anton says. "Missed doses of the medication or taking it off schedule will reduce the effects."
People may miss doses for several reasons, including GI discomfort or issues accessing the drug due to cost or shortages.
3. You're consuming too much of certain foods
Doctors can't stress it enough: "This medication isn't a quick fix," says Dr. Dina Peralta-Reich, MD, of New York Weight Wellness Medicine.
While there is no such thing as an "Ozempic diet," Dr. Peralta-Reich says it's best to limit certain foods, especially when taking GLP-1.
"It's really important to watch what and how much you eat while on this medication because overeating can make you feel uncomfortable and unwell and ultimately won't help you lose weight," she says. "Dense, heavy, fried foods or those rich in sauce and high in fat take longer to digest due to the slowed gastric emptying caused by Ozempic. If you're taking Ozempic for diabetes or Wegovy for weight loss, remember that these types of foods will take more time to process in your digestive system."
Also, if you are taking Ozempic for blood glucose control, Dr. Peralta-Reich notes that you'll want to monitor your sugar intake to better your chances of the drug lowering your A1C as it's designed to.
4. You're engaging in restrictive dieting
On the other hand, eating too little can also hinder weight loss goals.
"You don't want to completely restrict yourself," Dr. Peralta-Reich says. "Moderation is key, and you should enjoy the foods you love without overindulging. If you restrict too much, you might end up binge eating later, which can lead to weight gain."
Dr. Peralta-Reich adds that the restriction-binge cycle can play a role in Ozempic not suppressing appetite.
"Patients with binge eating disorder who are not on combined medications and psychotherapy might also struggle," she says.
5. You need to make other lifestyle tweaks
Dr. Nadolsky says that in addition to diet, sleep, mental health management and fitness are important for maximizing the benefits of Ozempic.
One study published in Obesity in 2023 highlighted the importance of physical activity in helping patients on anti-obesity medications improve quality and muscle function, which can be reduced along with weight. Researchers suggested two days of resistance training and 150 minutes of moderate-intensity exercise weekly.
6. You hit a plateau
Maybe you did lose weight on Ozempic but no longer are, despite not hitting the target you and your doctor set. Believe it or not, this plateau is part of the process. Dr. Nadolsky empathizes, saying it can be frustrating, but recommends waiting until the plateau reaches four to six weeks.
If it's been that long, Dr. Nadolsky suggests speaking to your doctor about adjustments to dosing and lifestyle.
7. Your body doesn't respond to Ozempic
While many people see dramatic results on Ozempic, some won't. If that's the case, there's nothing wrong with you. "Some people are just hypo or nonresponders to the medicine altogether," Dr. Nadolsky says. "This is likely due to genetics."
If this is you, you can always talk about other options with your providers.
Related: Is the Popular Red Mountain Weight Loss Program Right for You?
How to Lose Weight on Ozempic
1. Check your eating habits
Dr. Peralta-Reich says eating habits start in the kitchen. She recommends:
Cutting back on takeout
Focusing on protein sources like chicken, turkey, fish and yogurt
Prioritizing fiber-rich fruits and veggies like avocados and apples
Opting for whole wheat carbs
Mindful eating can also help. "Eat slowly and allow your brain to communicate with your stomach," Dr. Peralta-Reich says. "This way, you can recognize when you're satisfied and stop eating, even if your plate isn't empty."
2. Get a move on
Dr. Nadolsky says any physical activity can benefit overall health but recommends prioritizing strength and resistance training to preserve lean muscle.
"This could include weight lifting, pilates, yoga, resistance band exercises, or bodyweight exercises like push-ups, squats and lunges," Dr. Nadolsky explains.
New to working out or returning after a lag?
"If you haven’t incorporated exercise into your plan, it may seem overwhelming to know where to start," he says. "Set goals based on where you are currently on your journey and try to ditch the all-or-nothing approach. It could be as simple as incorporating a 10-minute walk on your lunch break and slowly building from there."
3. Review medications and dosing
You may need to increase the dose of Ozempic, or medications may interfere with your success.
"A comprehensive medication review and medical evaluation may also be necessary to understand if there is an impact from other underlying health conditions or medications that are interfering with the function of Ozempic," Dr. Anton says.
TL;DR: Communication with your healthcare provider is vital throughout your journey, so don't be afraid to ask them questions if you have any concerns.
Next up: What's the Difference Between Ozempic and Metformin, and Which One Is Right for You?
Sources
Dr. Maria Teresa Anton, MD, an endocrinologist and educator at the Pritikin Longevity Center
Dr. Mir Ali, MD, a board-certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center
Dr. Spencer Nadolsky, DO, an obesity and lipid specialist and the medical director of WeightWatchers.
Once-Weekly Semaglutide in Adults with Overweight or Obesity. NEJM.
Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism.
Dr. Dina Peralta-Reich, MD, of New York Weight Wellness Medicine
Physical activity in the new era of antiobesity medications. Obesity.
