12 reasons you’re not losing weight on semaglutide

If you’re not losing weight on semaglutide, you’re not alone. This could happen for a number of reasons, from lifestyle factors to medication issues. Here are the most common ones and what you can do about them.

When you’re watching so many people around you shedding pounds on semaglutide, it can feel incredibly frustrating not to be seeing the same results. But all is not lost. Here are 12 reasons you might not be seeing those dramatic changes on the scale you’d hoped for. 

1. You haven’t yet hit a calorie deficit

If you’re not losing weight on semaglutide, it’s possible you need to reduce your calorie intake. To hit a caloric deficit and lose weight, you need to eat fewer calories than you burn. 

Studies show that semaglutide increases feelings of fullness, so people eat less naturally and can reduce calorie intake by up to 30%, but everyone is different. Sometimes, we eat not out of hunger but out of habit or for emotional reasons. Recognizing the difference can help you achieve the calorie deficit necessary for weight loss. Don’t force yourself to eat more if you’re no longer hungry or just because you’re used to eating more. 

Not sure you’ve hit a calorie deficit? Use a calorie calculator or speak to a dietitian to determine how many fewer calories you need to eat daily to achieve your weight loss goals.

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2. Your eating habits could use an upgrade

If you’re eating a lot of processed, fried, or fatty foods, that could explain why you’re not losing weight on semaglutide. These foods tend to be high in calories (and low in nutrition), which can make it difficult to feel satisfied and lose weight. 

Other food choices and habits associated with weight gain include eating to relieve stress and negative emotions, and eating late at night.

One of the best ways to see a change in your weight is to change what you’re eating. Adopt a more balanced diet that focuses on fruits, vegetables, lean proteins, and whole grains.

3. You need to be more physically active

If you haven’t stepped up your workout routine, that could be slowing your weight loss on semaglutide. Like other GLP-1s (glucagon-like peptide-1 receptor agonists), semaglutide works best when combined with lifestyle interventions including a reduced-calorie diet  and exercise. People who follow a consistent exercise routine tend to lose more weight. And, exercise plays a key factor in helping ensure the weight you lose on semaglutide stays off.

Beyond scheduled exercise, simply increasing your physical activity through small changes, like walking more and sitting less day-to-day, can help support weight loss. 

How much exercise do you need to lose weight on semaglutide? In one clinical trial, participants were instructed to aim for at least 150 minutes per week of physical activity.

If you have underlying health conditions like issues with your heart health, speak with your healthcare provider before making any major changes to your physical activity. When in doubt, it’s better to start low and go slow. 

4. You may need a different dosage

You may need a higher dosage of semaglutide if you’re not losing weight as expected. Semaglutide dosing typically follows a gradual titration schedule. That means your dose is increased slowly over several weeks to months until you reach a maintenance dosage. Healthcare providers typically recommend a gradual approach to dosing changes to help your body adjust and potentially curb any unpleasant side effects. 

You and your healthcare provider should check in regularly to monitor your progress and ensure semaglutide is helping you lose weight at a pace that feels right.

5. You sometimes forget to take your dose

If you don’t take semaglutide consistently, that could explain why you’re not losing weight. Taking semaglutide on the same day each week maintains a steady state in your bloodstream. It can also help you minimize some of the uncomfortable side effects that can happen when you don’t take semaglutide on schedule. 

Avoid skipping doses of semaglutide unless specifically instructed to skip the medication by your healthcare provider. If you need to change the day you inject Ozempic or Wegovy because of lifestyle circumstances, you can do that, so long as you follow the guidelines provided by your healthcare provider and the medication guide. In general, it’s best to keep changes to your medication routine to a minimum.

6. You’ve reached a weight loss plateau

If you’ve been taking semaglutide for a while and have been losing weight, but now your weight loss seems to have slowed or stopped, a plateau may be to blame. Plateaus are a normal part of any weight loss journey, even if that journey includes semaglutide.

Weight loss occurs when you burn more calories than you consume. However, over time, your metabolism adjusts to your new caloric intake, and your weight loss slows. Eventually, your body may start conserving energy by burning fewer calories, contributing to the plateau. 

There are many ways to push through a weight loss plateau, but it depends on what is holding you back. Your healthcare provider can offer guidance regarding whether you need to:

• Reduce your portion sizes.

• Cut back on snacking or emotional eating.

• Adjust your diet.

• Increase total time spent doing physical activity.

• Adopt a more intense workout routine.

• Improve your sleep to get 7–9 hours nightly.

• Reduce chronic stress.

7. You need more sleep

One in three adults in the United States gets fewer than 7 hours of sleep per night. If you’re one of them, this could be slowing down your weight loss on semaglutide.

Research shows that people who are chronically sleep-deprived are more likely to gain weight. Lack of sleep disrupts hormone levels, including the hormones that regulate your appetite — causing your cravings to soar, particularly for high-carb, high-calorie foods. 

Make time to sleep for at least 7 hours per night. And, follow these tips to make the sleep you get even more restful:

• Follow a calming bedtime routine that relaxes you into sleep.

• Avoid watching TV or scrolling on social media in the hour before bed.

• Limit alcohol, caffeine, and heavy meals in the evening.

• Get exercise during the day so you feel tired and ready to rest at night.

• Keep your bedroom quiet, dark, and cool.

8. You’re stressed out

Living with chronic stress can make weight loss more difficult, even on semaglutide. Whether your stress comes from a traumatic event, relationship challenges, or a demanding work environment, it could be affecting your progress on semaglutide.

Obesity itself can be a source of stress, especially if you experience weight stigma from family, friends, or even strangers. Research suggests that the more stressors you experience, the greater the likelihood you will gain weight. 

Managing stress in healthy ways — such as exercise, mindfulness, or seeking support from trusted individuals — may help support your weight loss on semaglutide.

9. You have other health conditions that affect weight loss

If you’re managing certain medical conditions, you may experience less dramatic weight loss on semaglutide. For example, in a study of semaglutide’s effects on obesity, people with type 2 diabetes lost less weight than those without type 2 diabetes. Some additional health conditions that can contribute to weight gain and cause difficulty losing weight include:

• Polycystic ovary syndrome (PCOS)

• Type 2 diabetes

• Heart failure

• Kidney or liver problems

• Metabolic conditions like high blood pressure and cholesterol

• Thyroid disease (especially hypothyroidism)

If you have other health conditions, talk to your healthcare provider about whether they could be affecting your weight loss on semaglutide. 

10. You’re taking other medications that can cause weight gain

If you take medications that cause weight gain as a side effect, that could be disrupting your weight loss on semaglutide. Some of these medications include:

• Antidepressants, including amitriptyline and citalopram

• Certain diabetes medications, including insulin and sulfonylureas

• Antipsychotic medications, including clozapine and olanzapine

• Some drugs that treat high blood pressure, including clonidine and atenolol

These medications can contribute to weight gain in different ways. Some increase your appetite, some cause your body to retain more fluid and fat, and some may slow down your metabolism. 

If you’re concerned another medication is affecting your weight loss goals on semaglutide, talk to your healthcare provider. Never stop a medication without the guidance of a qualified healthcare professional.

11. You may need to give it more time

This one’s frustrating to hear, but it’s possible that you just need to be a bit more patient — especially if you’ve recently started taking semaglutide. It takes 4–5 weeks for semaglutide to reach a steady state in your body, but it may take longer for you to start seeing noticeable results. 

In a study of adults with type 2 diabetes, those taking oral semaglutide lost about 6 pounds in 12 weeks. 

More dramatic results are seen in studies of those without type 2 diabetes and tend to take more time. In one study, adults with obesity or overweight and a weight-related coexisting condition taking Wegovy lost about 15% of their initial body weight after 68 weeks — that’s over 15 months. (Of note, this study excluded individuals with diabetes from the study population).

If you’ve only been taking semaglutide for a few weeks, see if your weight loss improves over the next month. If it’s been a few months, talk to your healthcare provider. They may recommend a dosage increase, additional lifestyle changes, or another weight loss medication altogether. And if you have type 2 diabetes, hang in there. Sometimes that can make it more difficult to lose weight on GLP-1 medications.

12. You may need a different drug other than semaglutide

If you’re not losing weight on semaglutide, it’s possible the drug simply isn’t the right fit for you. 

While semaglutide is effective for most people, it doesn’t work for everyone. In one clinical trial, 86% of participants without type 2 diabetes lost at least 5% of their body weight after 68 weeks — but that also means nearly 14% of people lost less than that. 

If this ends up being you, don’t lose hope. There are several GLP-1 and related medications out there, and some are even more effective at weight loss than semaglutide. Talk to your healthcare provider if another medication could be a better fit for you, such as: 

• Zepbound (tirzepatide)

• Mounjaro (tirzepatide)

• Saxenda (liraglutide)

Usually, people start to notice weight loss within the first three months of taking semaglutide (though results can vary for individuals). Here’s a look at the average weight loss results for each type of semaglutide, according to clinical trials:

• In a small study of Rybelsus (oral semaglutide), people with type 2 diabetes taking the medication lost just under 6 pounds in 12 weeks, and were eating nearly 40% fewer calories daily.

• In a study of Ozempic, people without a medical history of type 1 or type 2 diabetes lost 11 pounds in 12 weeks, mostly from fat mass.

• In a study of Wegovy, people with and without diabetes lost an average of 5.9% of their body weight in three months. Of note, people with type 2 diabetes had a lower mean percentage weight loss at the 3-month mark compared with those without type 2 diabetes: 3.9% in those with type 2 diabetes vs 6.3% in those without type 2 diabetes.

If you’re wondering about the variability between these results, it’s worth noting that the study populations differ. In general, people with type 2 diabetes have a more difficult time losing weight on these medications. Wegovy is the highest-dosage formulation of Ozempic and is the only version of semaglutide officially approved by the United States Food and Drug Administration (FDA) for weight loss in certain populations. Rybelsus and Ozempic, on the other hand, are FDA-approved for type 2 diabetes but may be prescribed off-label for weight loss.

Hopefully, you now have a few ideas about why you may not be losing weight on semaglutide. Even so, it’s a good idea to make an appointment with your healthcare provider and get their opinion on how your weight loss is going on semaglutide. In the meantime, you can try these six strategies for maximizing weight loss on semaglutide.

1. Eat fewer calories

Calorie counting may not be everyone’s idea of a good time. But, it can be a helpful way to measure how much you typically eat, and find ways to cut down where you can — making sure to still meet your daily nutrition needs.

It’s a good idea to  calculate  your total daily energy expenditure (TDEE), which describes how many calories your body burns for energy in a day. Most guidance suggests you aim to consume 200–300 calories below your TDEE for weight loss. (It’s still important to maintain healthy nutrition, so don’t decrease your calories by too much! For individualized nutrition advice, speak with your healthcare provider or a registered dietitian).   

2. Prioritize more nutritious foods

Semaglutide works for weight loss by slowing down stomach emptying and bowel function, so we stay full after eating. 

Taking advantage of the way semaglutide decreases your appetite can help you change how you relate to food. Try to increase protein and healthy fats, eat plenty of fruits and vegetables, and reduce carbohydrate intake. More nutritious foods — especially those high in fiber and protein — help you feel full longer.

3. Ramp up your exercise routine

If you’ve already taken steps to increase your physical activity, pat yourself on the back! Take a moment to think about whether it might be fun to add a bit more to your routine, such as an extra workout session each week or maybe just an extra 10 minutes to the ones you already have scheduled. 

If you’re just getting started with exercise, try walking for 2,000 steps per day (about 1 mile). 

Expert guidelines suggest that people should aim for at least 150 minutes of moderate-intensity aerobic exercise each week. Examples of “moderate” intensity exercise include:

• Brisk walking

• Swimming

• Cycling

• Dancing

Consult a healthcare or fitness professional for guidance and to determine the best plan for you. If you have major health conditions including issues with your heart health, be sure to clear any plans for increased physical activity with your healthcare provider before starting.

4. Sleep more and stress less

Stress and decreased sleep can increase cortisol, the stress hormone, and cause your body to hold on to belly fat.

So, consider this your permission (and encouragement!) to get a better night’s sleep. Studies show that people who enjoy better sleep tend to lose more weight (and fat) in a year than those with poor sleep. Being well-rested can make it easier to stick to a balanced diet and workout routine, and you may feel less stressed.

To help you sleep better, adopt healthy sleep hygiene habits like:

• Going to bed and waking up at the same time each day

• Following a regular bedtime routine

• Exercising regularly

• Avoiding caffeine, alcohol, heavy meals, and bright light later in the day

• Practicing meditation

Meditation has a dual benefit because it’s also a good way to manage stress. In one study, those who underwent a stress management program lost significantly more weight. Some of the stress management techniques participants learned included:

• Progressive muscle relaxation

• Guided visualization

• Deep breathing exercises

5. Set up your support system

By now you know that your diet, physical activity, health situation, and general sense of wellbeing can all contribute to — or derail — your weight loss efforts. But who you spend your time with can also play a role.

Having a strong support system of family, friends, romantic partners, or coworkers who are rooting for you can actually influence how much weight you lose, according to research. Other studies have found that having a weight loss “buddy” can also lead to better results than going it alone.

If you have friends or family who tease or criticize you for your new healthy choices, consider how you can set up boundaries or, if all else fails, spend less time with them. What’s most important is you are well set up to make healthy choices and lifestyle changes that work best for you.

6. Consider alternatives to semaglutide

If you’ve been taking semaglutide for a while and you’ve made healthy lifestyle changes, but you still aren’t losing weight, it may be time to talk to your healthcare provider about other options. Semaglutide is one of several GLP-1 medications, and another option, tirzepatide, has been shown to be even more effective for weight loss in clinical trials.

Tirzepatide is the active ingredient in the brand-name medications Zepbound and Mounjaro, and it’s a combination of a GLP-1 and a GIP (glucose-dependent insulinotropic polypeptide). In a 72-week clinical trial, people taking the highest dose of Zepbound lost an average of  20.9% of their body weight. By comparison, those taking Wegovy — the highest-dose semaglutide formulation approved for weight loss — lost up to 17.4% in a similar time period (68 weeks). (Of course, your individual results may vary depending on numerous factors like your activity level, how your body responds to the medication, and whether or not you have type 2 diabetes). 

Learn more about making the switch from semaglutide to tirzepatide (but don’t make any medication changes without speaking with your healthcare provider).

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If you’re reading this, you may not be losing weight as quickly as you’d hoped on semaglutide. The good news is there may be some simple solutions available. Keep these key takeaways in mind:

• A calorie deficit is key to weight loss on semaglutide. If you’re not losing weight, you may still be consuming more calories than you burn.

• The quality of your diet matters. Swapping processed foods for protein-rich, nutrient-dense options can maximize weight loss on semaglutide.

• Exercise can help you keep the weight off and break through plateaus. Even small increases in movement, like walking more and taking the stairs instead of the elevator, can make a difference over time.

• It’s important to take the right dosage of semaglutide and take it consistently. Skipping doses can impact weight loss results and lead to side effects, so stay consistent and follow your healthcare provider’s guidance.

• Other factors can also influence weight loss. Your sleep quality, stress levels, and other health conditions and medications can all affect your progress.