11 reasons you’re not losing weight on Ozempic

Ozempic (semaglutide) is an injectable medication that is FDA-approved to treat type 2 diabetes and may be prescribed off-label for weight management. Ozempic has become famous for its weight loss potential, with people losing as much as 7% of their body weight on 1 mg of Ozempic within a year or so of taking the medication. And, follow-up studies show they continue losing weight two years after starting the medication.

While Ozempic has proven to be very effective at weight loss, some people don’t lose as much weight as they expect on Ozempic. So what’s the deal? 

There could be several reasons why you’re not losing weight on Ozempic — from being too stressed out to not exercising or sleeping enough. You may need to change up your diet or have your healthcare provider adjust your dosage. Or, it could be as simple as not giving the drug enough time to work. Below we review 11 common explanations behind a slower-than-expected weight loss on Ozempic and what you can do about them.

If you’ve been taking Ozempic and you’re wondering why you’re not losing more weight, several factors could be playing a role. Read on as we explain ten possible reasons why you’re not losing weight on Ozempic.

1. You may need to be a bit more patient

If you’ve recently started taking Ozempic, that may be one reason you haven’t noticed much weight loss yet. Patience is key when starting any new treatment plan, including Ozempic. 

To minimize side effects, health providers start Ozempic at a low dose of 0.25 mg weekly. You’ll stay at that dosage for four weeks before increasing the dose to 0.5 mg weekly. Depending on your body’s response to Ozempic, your health provider may continue increasing your dosage every four weeks until you reach the maximum dosage of 1-2 mg weekly (this is the typical maintenance dose health care providers prescribe off-label for weight loss). This ramp-up process could take three months.

Be patient and rest assured that the medication is working, even if you’re not at your final dosage just yet. In that same time frame of 12 weeks, people taking 1 mg of Ozempic began eating less, feeling less hungry, and having fewer cravings, particularly for high-fat foods. As a result, many of the participants did lose weight.

2. You may need a higher dosage of Ozempic

The intensity of certain gastrointestinal side effects — including nausea and diarrhea — is dose-dependent with Ozempic. That means that with higher doses of Ozempic, these side effects are more common, especially when you start taking the drug. (With time, these side effects typically lessen or go away entirely as your body gets used to Ozempic.)

The same holds true for weight loss on Ozempic. People taking higher doses of Ozempic tend to lose more weight.

In the landmark study we cited above, people lost 7% of their body weight, on average, within a year and a half of taking 1 mg of semaglutide. However, that’s an average, and different people lost different amounts of weight. 

Everybody reacts differently to medication, and the weight loss you experience on Ozempic may differ from someone else’s. It can also be due to other factors that help or hinder weight loss progress, such as your diet, activity levels, and other reasons we’ll get into below. Another thing to remember is that Ozempic is actually an off-label treatment for weight management, and the same active ingredient, semaglutide, is available under the brand name Wegovy specifically for weight loss. While the ingredients in these two medications are the same, Wegovy reaches a higher maximum dose of 2.4 mg (versus 2.0 mg with Ozempic) and this difference can be significant when it comes to effectiveness at promoting weight loss. 

3. You may need to make more changes to your diet

For the treatment of type 2 diabetes, Ozempic is designed to be taken in combination with lifestyle changes like a reduced-calorie diet and increased physical activity. In clinical studies investigating Ozempic, people taking a placebo are given professional guidance on implementing these lifestyle changes. That’s why the people taking a placebo also tend to lose some weight during the study, although they lose much less weight than those taking the active medication.

In addition to reducing your overall caloric intake, other dietary habits may be hindering your weight loss efforts. For example, starches, refined carbohydrates, sugar-sweetened beverages, and red meat are all associated with weight gain. If you drink alcohol, that could also be impeding your weight loss efforts.

Changing how you eat can also make a difference. Research shows that eating more mindfully — in essence, eating without distractions and taking time to savor your food — leads to weight loss. For more ideas on how to adjust your diet to improve weight loss on Ozempic, talk to a nutritionist or registered dietitian.

4. You may need to eat more protein and fiber

Speaking of what you eat, certain foods may help accelerate weight loss while taking Ozempic. In particular, protein and fiber both increase feelings of fullness. So, eating foods high in these macronutrients can help you feel full sooner, so you eat less and lose more weight as a result. 

The average adult should get about 10% – 35% of their total daily calories from protein. When you’re trying to lose weight, it’s best to aim toward the higher end of that scale. Good sources of protein include:

• Meat

• Fish

• Poultry

• Milk

• Eggs

• Soy

• Tofu and tempeh 

• Beans

• Lentils

• Legumes

• Nuts and nut butters

• Quinoa

Experts recommend 25 grams of fiber daily for women and 38 grams for men. After age 50, those numbers come down slightly — to 21 grams daily for women and 30 grams for men. Fiber-rich foods include:

• Fruits (with the peel; that’s where the fiber is)

• Vegetables

• Beans

• Legumes

• Nuts

• Seeds 

• Whole grains, like oat and barley 

5. You may need to increase your physical activity

As mentioned above, Ozempic should be used in combination with a reduced-calorie diet and increased exercise. For those starting with Ozempic, health professionals may recommend beginning with 150 minutes per week of physical activity, such as walking.

While exercise on its own is limited in its ability to promote significant weight loss, it does lead to some weight loss, and it is essential for keeping the weight off. People who exercise more tend to lose more weight, especially when they adopt a lower-calorie diet. 

Also, exercise can speed up your metabolism. This is especially true for certain types of exercise, like combining aerobic with resistance training. Together, these workouts can help you build muscle mass while you lose fat.

6. You’re not taking Ozempic as prescribed

Do you sometimes forget to take Ozempic or skip doses altogether? If you’re not losing weight on Ozempic as quickly as you’d hoped to, you may want to stop doing that. Like any prescription drug, it’s in your best interest to take Ozempic as prescribed. This ensures the medication works at its best and reduces your chances of experiencing uncomfortable side effects. 

The half-life of Ozempic (how long it takes for the amount of a drug in your body to reduce by half) lasts about one week — just in time for you to take your next dose. Drug makers create dosing schedules based on a drug’s half-life in order to optimize a drug’s efficacy. So, if you regularly skip doses of Ozempic or get casual with your dosing regimen, the medication may not work as well as it’s supposed to.

It’s also important to follow any lifestyle changes your health provider recommends while taking Ozempic, which may include eating less, adjusting your diet, or getting more exercise. 

7. You’ve reached a plateau

Those who have dieted before may be familiar with the most unwelcome phenomenon of any weight loss journey: the dreaded weight loss plateau. If you’ve been taking Ozempic for a while and feel like your weight loss has slowed down, a plateau may be the culprit. 

When people start dieting and exercising, it’s common to lose a lot of weight quickly in the beginning. But, there may come a point when the weight loss slows down significantly. This is known as the plateau, and it can happen when you lose too much muscle and fat simultaneously. As a result, your metabolism starts to slow — and so does your weight loss. 

Hormonal changes can also occur during this period, so you might feel hungrier for high-calorie foods. Ozempic can help with these cravings, but in the meantime, don’t blame yourself. This is a normal part of losing weight for many people. It’s also why it is essential to keep up with physical exercise — especially activities that build lean muscle mass, like resistance training. As you build muscle, your metabolism will catch up. 

8. You may be too stressed out

If you’re losing as much weight as you expected on Ozempic, it could be due to stress. Stress can lead to weight gain. Regular chronic stress from work or personal issues can lead to weight gain, as can a specific stressful event, like losing a loved one. In addition to that, obesity itself can be a stressor due to the social stigma. And, the more these stressors you’re dealing with, the more weight you may gain. 

Stress can contribute to weight gain in several ways. You may simply not have time to make healthy meals. People who are stressed out may be less likely to exercise and more likely to crave sugary, calorie-dense foods that slow down weight loss efforts. So, you may be working out less often and eating more calories than you burn. Stress can even affect your hormone levels, and parts of your brain and gut that impact how hungry you feel and what foods you crave. 

Stress can also disrupt your sleep, which brings us to our next point.

9. You may not be sleeping well

Even your sleep habits may explain why you’re not losing weight on Ozempic. That’s because poor sleep habits — whether you’re sleeping too much or too little — are also linked to weight gain. 

People who get fewer than six hours or more than eight hours of sleep are more likely to gain weight in the long run. People who sleep too little experience hormonal changes that impact their perception of how hungry they are and crank up their cravings for foods high in calories and refined carbohydrates. 

On the other hand, sleeping “too much” (more than 10 hours daily) is linked to obesity, as well as other health conditions that are connected to weight, such as diabetes and hypertension (high blood pressure).

10. You may have other conditions like type 2 diabetes

Finally, other health conditions you’re managing can affect how quickly you lose weight on Ozempic. For example, you may be taking certain medications that cause weight gain and slow your weight loss. 

If you have type 2 diabetes, which Ozempic treats, you may also lose weight slower than those who are taking Ozempic solely to treat their obesity and who do not have type 2 diabetes. In one study, after three months of taking semaglutide, people without type 2 diabetes lost 6.3% of their body weight, on average, compared with 3.9% for those with type 2 diabetes. At six months, those without type 2 diabetes had lost 11.8%, while those with type 2 diabetes lost 7.2%. 

These are still significant changes in body weight, but it’s helpful to remember that other conditions may make your weight loss a bit slower with Ozempic.

11. You may need a different treatment

Ozempic may be the drug making all the headlines, but it’s not the only medication that can be prescribed for weight loss. It’s also not necessarily the most effective. 

For example, Zepbound (tirzepatide) is a weekly injectable medication that is FDA-approved for weight loss in people with obesity or those with overweight and a weight-related health condition like high blood pressure or heart disease. In clinical trials, people taking Zepbound lost between 15%–21% of their body weight within a year and a half — an average of 35–52 pounds. That’s significantly more weight loss than people typically see on Ozempic.

In studies comparing Zepbound and Ozempic directly, the amount of weight loss achieved on the lowest 5 mg dose of Zepbound was similar to that achieved on the highest 2 mg dose of Ozempic. However, people taking higher doses of Zepbound — 10 mg and 15 mg — lost significantly more weight. In less than a year, people lost an average of about 12 lbs more on the highest dose of Zepbound vs. the highest dose of Ozempic. 

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Taking Ozempic is one of many positive changes you can make toward a healthier lifestyle. Follow these healthy habits to make Ozempic more effective.

Change what you eat and how you eat

The key to losing weight, whether or not you’re taking Ozempic, is eating fewer calories than you burn. Start by reducing your caloric intake by 500 calories per day, aiming for fewer than 1,500 calories total per day if possible (or whatever your health provider recommends).

Consider adopting a Mediterranean or vegetarian diet, both of which have been proven to help with weight loss, as well as better blood sugar control — a plus for those taking Ozempic to manage their type 2 diabetes. One study found that following a Mediterranean diet for one year led to a weight loss of nearly 9%. 

Limit or avoid salty, sugary, and fatty foods, as well as red meat and processed food. Instead, eat more vegetables, fruit, nuts, and whole grains. Even small changes, such as choosing healthier snacks or cutting out one type of food or alcohol, can help with weight loss.

Speaking of snacks, try to limit late-night snacking and eating too late at night, both of which can lead to weight gain and negatively impact your sleep cycle. Eat smaller portions and try to slow down while eating, really focusing on savoring your food.

Move more

People taking Ozempic may start with 150 minutes of exercise per week, but exercising for longer can lead to more weight loss and maintenance. If you can, health experts recommend at least 200 minutes of physical activity per week to prevent weight gain and maintain weight loss while on Ozempic. 

Ultimately though, start with whatever amount of exercise you can stick with. Even smaller amounts of exercise can help prevent additional weight gain while making it easier for you to develop a habit that grows into more exercise and more significant weight loss. You might try walking for 2,000 steps per day (about 1 mile or 30 minutes). 

Following a routine will make it easier to sustain the habit and make regular exercise a part of your lifestyle. Schedule it on your calendar, and listen to music or a podcast to make it more fun. Living a sedentary lifestyle is associated with obesity. So try to move more during the day, in general. You might get up every hour and walk around your house or office for a few minutes, for example.

Most importantly, find a workout routine that you enjoy. Resistance training is important for building muscle mass and keeping your metabolism working, but aerobic, resistance, and flexibility exercises can all offer benefits.

Choose healthy habits

In addition to diet and exercise, explore other healthy habits you can develop to support your weight loss journey on Ozempic. Don’t drink or smoke. Find a stress management technique that gives you relief, whether it’s yoga, deep breathing exercises, meditation, or a mix of the above. Do what you can to get around 7 to 8 hours of sleep per night. 

Make sure to stay hydrated, too. Not only can drinking water help relieve some of the less desirable effects of Ozempic — like nausea, vomiting, or diarrhea — but it can also help with weight loss.

Another healthy habit is to seek support from family and friends. Research shows that finding support from friends, family, and even coworkers who support your new diet and exercise goals can make you more likely to lose weight on Ozempic. On the other hand, spending time with family members who don’t practice healthy eating or exercise (or worse, criticize you for doing so) can undermine your progress and lead to weight gain. 

Does having an accountability partner help you reach your goals in other aspects of your life? Apply that same approach to your weight loss goals. In one 15-week study, people who chose a weight loss “buddy” lost more weight than those who didn’t. And those who found buddies who really cheered each other on experienced the greatest reductions in their body mass index (BMI) and waist size.

Talk to your healthcare provider

Finally, talk to your healthcare provider and ask them why you’re not losing weight on Ozempic. There may be other weight loss strategies that are more tailored to your body and your health situation. They may also want to try switching you to an alternative medication like Wegovy or Mounjaro, which are both known to help with weight loss. 

Don’t despair if you’re not losing as much weight as you expected on Ozempic. Try out a few of the strategies above, and see if they make a difference. In the meantime, try to enjoy the process, be patient, and talk to a health professional about what else they recommend you do.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

March 05, 2024

Written by

Amelia Willson

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.