Ozempic and Weight Loss: When the Scale Stalls

4 min read

May 29, 2024 – Weight loss drugs like Ozempic and Wegovy have taken the year by storm, with users hyping extreme weight loss results, sometimes hundreds of pounds. These GLP-1 medications – which are used to treat diabetes and obesity – help suppress your appetite by keeping you fuller for longer. But what happens when taking these drugs doesn’t result in what you’d hoped for? 

It may come as a shock, considering these shots have been touted as “miracle drugs” for weight loss. But “at least 10% to 15% of patients that start these medications are not going to respond,” said Marilyn Galindo, MD, a board-certified internist and obesity medicine specialist. She is also the owner of Leon Springs Primary Care and Obesity Medicine, a medical facility in San Antonio, TX.

After gaining 20 pounds post-menopause, Mariele Hoffman, a 54-year-old real estate agent in Tampa, FL, sought out a quick weight loss intervention. Her OB/GYN prescribed her weekly semaglutide and vitamin B12 shots to help her shed the extra pounds. (Semaglutide is the generic name for Ozempic and Wegovy.) Not seeing weight loss – or any effects at all, she said – her doctor advised her to be patient. After 6 weeks on the shots, Hoffman ended up gaining weight, and ultimately stopped taking the medication altogether. 

“I meticulously reviewed my diet over these 6 weeks to pinpoint the cause of the weight gain,” she said. “Despite eating the same foods in the same quantities, I could not identify any contributing factors besides the medicine I was on.” 

While some people taking these medications may not see results, as Galindo noted, not shedding pounds could be due to a few reasons. First, it’s important to give the medication enough time to do its job. Your doctor usually puts you on a starter dose to allow your body to adjust before going onto a therapeutic dose. Once you are on a proper dose, you should lose at least around 5% of your body weight within the first 3 months of taking the medication, she said. In short, 3 to 6 months is a good time to see if the medication is right for you. 

Genetics can also play a role in your body’s response to semaglutide, Galindo said. 

Obesity is a very complicated disease,” she said. “Maybe they need a different drug to combat their obesity, and a lot of this is genetic.” 

How fast or slow your body metabolizes the drug is a factor, too. “If you don't have a high enough level [of the medication] in your bloodstream, then the medication is not going to work for you,” Galindo said. People with diabetes can also face struggles on the mediation, since insulin resistance can make it harder to lose weight, and certain diabetes medications can also cause weight gain. 

The success of semaglutide can also boil down to lifestyle changes, according to Sarah Palmer, a certified physician assistant and owner of Living Free Weight Loss Clinic, a medically supervised nutrition, weight loss, and mental health counseling service. 

“GLP-1s are an amazing tool. But with any dietary intervention, weight loss plan, or medication, it is vital that the person actively participates and makes the sometimes uncomfortable changes that are necessary to create a permanently healthier lifestyle,” Palmer said. Exercise, like strength training three to four times a week, can make all the difference in who loses weight long-term vs. the initial weight loss before hitting a plateau. The “calories in, calories out” approach – or eating fewer calories than your body burns – is a great marker for the nutrition portion of GLP-1 weight loss, she said. 

Prioritizing lean protein (usually 100 grams per day, but that varies, depending on weight) and drinking enough water (64 to 90 ounces per day) are paramount, the experts said. And highly processed and fried foods eaten in excess can not only negatively impact your weight loss, but it can also result in harmful side effects, such as diarrhea, nausea, and reflux, according to Palmer. But not eating enough calories can also stall your weight gain, as this can slow down your metabolism, she said. 

“Chronic dieters who are used to restricting calories and skipping meals, but have not lost weight doing this, are unlikely to have any significant weight loss on these medications either,” she said. 

Think of semaglutide as a tool, not a solution, Palmer said.

“The solution is repairing your relationship with yourself and with food,” she noted. “The medication is a tool that can help those changes feel easier, but ultimately cannot do all of the work for you.”