Why Am I Not Losing Weight on Ozempic?

Learn about Ozempic and how it works, along with a list of possible reasons you are not losing weight and tips for maximizing weight loss.

A woman using Ozempic
Sarah Bullard, MS, RD, LD
— Signos
Dietitian and Nutrition Writer
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Updated by

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Science-based and reviewed

July 19, 2024
June 18, 2024
— Updated:

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A recent Gallup poll reports that 6% of American adults (or 15.5 million people) have used injectable weight loss drugs like Ozempic, Wegovy, Mounjaro, or Saxenda. About 3% of the population currently use these FDA-approved medications, more commonly women, those with health insurance coverage, and those aged 40 to 64.1

Ozempic, a glucagon-like-peptide-1 receptor agonist (GLP-1 RAs), is a once-weekly injectable medication for people with type 2 diabetes that helps them manage their blood sugar levels and lose weight. The main active ingredient is semaglutide, which can be injected in 0.5mg, 1mg, or 2mg doses.2 

Adults with type 2 diabetes taking Ozempic lost an average of 14 pounds (7% of their body weight) at the 2mg dose and between 8 and 12 pounds at lower doses.2 

You may wonder why you aren’t losing as much weight as expected while taking Ozempic. Keep reading to learn more about Ozempic, common reasons you aren’t losing weight, and tips for maximizing weight loss. 


Common Reasons Ozempic Isn't Helping You Lose Weight

A woman measuring her body

Each person is unique, including their weight loss journey. There are many potential reasons why Ozempic isn’t helping you lose the weight you hoped. It’s essential to look at the whole picture to help pinpoint factors preventing you from healthy weight loss. 

Below are ten possible obstacles preventing expected weight loss.

1. Constipation Issues

Three to five percent of people taking Ozempic experience constipation. One way Ozempic works is to slow down food leaving your stomach and the whole digestive process, which can result in constipation.2 

Most people taking injectable GLP-1 RAs medications, like Ozempic, report their symptoms occur when starting the medication or after increasing their dosage.2, 3

Fortunately, constipation and other GI side effects resolve on their own shortly after acclimating to the weight loss medication.3 

2. Weight Loss Plateau Reached

Most people experience rapid weight loss at the start of a new diet or exercise routine but plateau or maintain a stable weight after the first several weeks. Then, they feel like nothing they do is causing further weight loss.4 

After rapid muscle and fat loss, metabolism slows, and so does weight loss. Many people become frustrated and revert to old lifestyle or eating habits and may regain weight.4 

When your weight loss slows due to rapid weight loss, adding muscle-strengthening activities during this recovery phase can help you increase your metabolism and achieve healthy weight loss again in several weeks.4 

3. Excessive Stress

Every person responds to stress differently–beneficial or detrimental to their health. Many people react to stress with emotional eating, which is a risk factor for weight gain and difficulty losing weight.5  

Learning to use healthy stress management activities, such as exercise, volunteering, listening to music, stretching, and deep breathing, can reduce stress and emotional eating. 

4. Poor Sleep Quality

Increasing evidence indicates that chronic poor or inadequate sleep can increase the risk of obesity and weight gain.6 

Poor sleep quality causes metabolism and endocrine changes that lead to weight gain. Hormones like insulin, cortisol, ghrelin, and leptin are impacted, increasing hunger and appetite.6 

You may inadvertently be sabotaging your weight loss effects with poor sleep. Aim for seven to nine hours each day, but remember improvement is more important than perfection.

5. Inadequate Diet And Exercise Regimen

Ozempic is intended to be used alongside diet changes and increased exercise.2 Expecting Ozempic to work alone to cause weight loss is unrealistic. 

Consider following a balanced diet with healthy fats, lean protein, and fiber-rich carbohydrates to feel your best and lose weight. 

A simple method to get started is the plate method: fill half the plate with non-starchy vegetables, one-quarter with starchy vegetables, and the final one-quarter with lean protein.7 

Additionally, the current Physical Activity Guidelines for Americans encourage 150 minutes of moderate-intensity physical activity a week or 75 minutes of vigorous-intensity, plus two days of weight training.8 Pair Ozempic with diet changes and increased exercise for better results. 

6. Insufficient Time Allowed For Effects

Patience is needed for most things in life, including weight loss. Prescribing information from the Ozempic website recommends starting with 0.25mg weekly for four weeks before increasing to 0.5mg weekly. 

If additional blood sugar control is needed, Ozempic can be increased to 1mg or 2mg weekly for four weeks when treating type 2 diabetes.2 Getting to your recommended dose could take eight to twelve weeks. Remember, Ozempic is intended to control blood sugar levels in people with type 2 diabetes. 

Wegovy, also made by Novo Nordisk, has a higher dosage of semaglutide, at 2.4mg, and is intended for weight loss in individuals who are obese or overweight with related medical problems. Wegovy also has a ramp-up period to achieve the goal dose.9 

7. Ozempic Dosage Too Low

Healthcare professionals start with a lower dose and slowly move up as needed. Side effects like nausea, vomiting, and diarrhea increase with higher doses.2 As mentioned earlier, side effects tend to improve shortly after starting Ozempic.3 

Allowing your body time to adjust to the side effects will help you stay more compliant with the medication. Increased weight loss is seen with higher doses, but monitoring your blood sugar levels is also essential.2 

Keeping them within a target range (not too low or too high) is critical for overall health. Other medications taken with Ozempic may need to be adjusted as well to prevent too low blood sugar levels.2 

Working with your healthcare provider to manage all your medications and health conditions is necessary. 

8. Side Effects Hindering Dosage Increase

Some people have more side effects than others when taking medications. In adults, taking 0.5mg or 1mg of Ozempic:

  • 15 to 20% had nausea
  • 5 to 9% had vomiting
  • 8% reported diarrhea
  • 5 to 7% reported abdominal pain
  • 3 to 5% reported constipation2 

Of those taking Ozempic in the clinical trials, almost 4% discontinued use due to these unpleasant side effects.2 Sometimes, side effects can prevent you from taking a medication or reaching your goal dose. 

Your healthcare provider can help determine if another treatment or medication is best for you. 

<p class="pro-tip"><strong>Also Read: </strong><a href=ozempic-vs-rybelsus>Ozempic vs Rybelsus: Which Is Better for You?</a>.</p>

9. Missing Doses

It is easy to miss a dose of your medications when routines change. 

A survey of 600,000 patients investigated the reasons for not taking prescribed medication. Almost 40% of participants reported they simply forgot to take it, and another 30% forgot to renew the prescription on time or put it off, resulting in missed doses of Ozempic.10 

Ozempic is meant to be taken weekly to keep the proper amount of medication in your bloodstream for effective blood sugar control and weight loss. If a dose is missed, give your prescribed dose within five days or wait until the next dosage.2 

Setting alarms or using notes in visible high-traffic places can help you remember to take Ozempic as prescribed.

10. Existing Health Conditions Affecting Weight Loss

Other medical conditions, like type 2 diabetes, impact how your body loses weight. 

A study from 2022 found that after three and six months of semaglutide use, people with type 2 diabetes lost less weight than those without diabetes.11 

People with diabetes lost 3.9% of their body weight at three months and 7.2% at six months. People without diabetes lost 6.3% of their body weight at three months and 11.8% at six months.11

A 5% to 10% weight loss results in significant health benefits, such as improved cholesterol, blood pressure, diabetes and insulin levels, and reduced inflammation.12 Both groups with and without type 2 diabetes would see overall health improvements, although weight loss was lower in those with diabetes. 

Understanding the Mechanism of Ozempic in Weight Loss

Ozempic and other GLP-1 RAs work in the following ways: 

  • It helps your pancreas secrete more insulin in response to high blood sugar levels and enables you to return to your target range of blood sugar levels.
  • It stops glucagon (sugar) production and secretion in the liver, reducing the body's blood sugar.
  • Slow down food leaving the stomach, preventing high blood sugar levels after meals.
  • Lowers calorie intake by reducing appetite, increasing fullness, and slowing food movement time, leading to weight loss.

High blood sugar and insulin levels make it difficult to lose weight. Ozempic helps address that aspect and helps reduce appetite and increase fullness, leading to less overall food intake and weight loss.2, 3 

Tips for Maximizing Weight Loss With Ozempic

A woman holding a bowl of salad

Ozempic is one tool for helping you lose weight. Combining medications with lifestyle and behavior changes can speed up your progress and provide other health benefits. 

Try some of these tips for maximizing your health and weight loss:

  • Follow a Healthy Diet Like the Plate Method: A balanced diet will keep you full and energized and reduce cravings. Enlist the help of a registered dietitian for personalized nutrition advice and meal plans.
  • Engage in Regular Exercise: Aim for 150 minutes weekly, split it up into five 30-minute sessions.
  • Prioritize Healthy Stress Management and Sleep Routines
  • Track Your Progress on Paper or by Phone: Progress can motivate you to keep working hard.
  • Eliminate Alcohol: Many alcoholic beverages can quickly contribute to extra calorie intake.
  • Practice Patience With Yourself: It takes time to implement diet changes, increased exercise, and sleep routines into your life, and it also takes time for medications to work.

Time Frame For Achieving Weight Loss With Ozempic

Most studies and the data behind the prescribing information for Ozempic are based on six to twelve-month studies.2, 11 It will take up to twelve weeks to reach the goal dose for Ozempic.2 

When implementing lifestyle changes, like diet and exercise, simultaneously, you may start losing weight in the first month of taking Ozempic. At three months, you could lose up to 3 and 6% of your body weight, and then 7 to 11% by six months based on results from other studies.11

Learn How to Improve Your Nutrition and Monitor Your Glycemic Index Levels With Signos’ Expert Advice

A Signos continuous glucose monitor (CGM) can help you track blood sugar levels.  

Tracking your blood sugar response can help you see tangible results from medications like Ozempic. While weight loss can take longer, improvements in blood sugar levels can happen faster. 

This tool (CGM) can help you track your progress as you combine diet, exercise, and medications. A Signos’ CGM can help you improve your health and prevent or manage type 2 diabetes and related health conditions.

Learn more about nutrition and healthy habits on Signos' blog or how Signos works. Take a quick quiz to determine if Signos fits your needs.

<p class="pro-tip"><strong>Learn More: </strong><a href=how-long-can-you-take-ozempic-for-weight-loss>How Long Can You Take Ozempic for Weight Loss?</a>.</p>

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About the author

Sarah Bullard is a registered dietitian and nutrition writer with a master’s degree in nutrition. She has a background in research and clinical nutrition, personalized nutrition counseling, and nutrition education.

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Please note: The Signos team is committed to sharing insightful and actionable health articles that are backed by scientific research, supported by expert reviews, and vetted by experienced health editors. The Signos blog is not intended to diagnose, treat, cure or prevent any disease. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider. Read more about our editorial process and content philosophy here.

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