Why am I not losing weight on semaglutide?

Semaglutide, the active ingredient in the popular weight loss and diabetes medications Ozempic, Wegovy, and Rybelsus, has been shown to produce significant weight loss in many people. In a 68-week clinical trial of Wegovy, participants lost an average of nearly 15% of their initial body weight, making it one of the most effective medications available for weight management.

Of course, weight loss results on semaglutide can vary from person to person. While some people experience steady and noticeable progress, others may find their weight loss slowing down or stalling altogether. If you’ve been wondering, “Why am I not losing weight on semaglutide?”, you’re not alone. There are many potential reasons why you may not see the results you want—such as your diet and exercise habits, your dosage, metabolism, or underlying health conditions.

Understanding why semaglutide may not be working as expected is the first step to making necessary adjustments and improving results. In this article, we’ll explore 12 common reasons why semaglutide might not be leading to the weight loss you anticipated and what you can do to break through a plateau.

There are a number of reasons that can affect weight loss on semaglutide. 

1. You haven’t yet hit a calorie deficit

The main way that semaglutide causes weight loss is to reduce one’s appetite.

 Studies show that semaglutide increases fullness, so people eat less naturally and can reduce calorie intake by almost 40%. It is important not to force yourself to eat more if you’re no longer hungry or because you’re used to eating more. 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.

2. Your eating habits could use an upgrade

One of the best ways to see a change in your weight is to change what you’re eating.

In other words, even if you’ve started eating less, but you haven’t made any other changes to adopt a more balanced diet, it could explain why you’re not losing weight on semaglutide. Food choices and habits associated with weight gain include:

• Eating to relieve stress and negative emotions

• Eating late at night 

• Following a diet rich in processed foods, which tend to be high in calories and low on nutrition

3. You need to be more physically active

Like other GLP-1 receptor agonists, semaglutide works best when combined with a reduced-calorie diet  and exercise. People who adopt more active lifestyles, with consistent physical activity tend to lose more weight. And, exercise plays a key factor in ensuring that the weight that you lose on semaglutide stays off—by boosting your metabolism and increasing satiety (fullness).

Simply increasing your physical activity through small changes, like walking more and sitting less day-to-day, can help support weight loss. If you’re not losing weight on semaglutide, consider if you can increase your physical activity. In the STEP 1 clinical trial of semaglutide 2.4 mg, participants were instructed to aim for at least 150 minutes per week of physical activity.

4. You may need a different dosage

Semaglutide dosing typically follows a gradual titration schedule, meaning your dose is increased slowly over several weeks to months until you reach a maintenance dosage that balances effectiveness with manageable semaglutide side effects. You and your healthcare provider should check in regularly to monitor your progress and ensure semaglutide is working as expected.

With Wegovy, this titration process can take more than four months, so it may take time before you notice significant weight loss. For some people, the process takes longer, depending on how their body responds to the medication and its side effects.

Healthcare providers typically recommend a gradual approach to dose adjustments to help your body adjust and potentially curb any unpleasant side effects. 

5. You sometimes forget to take your dose

Doing so will not only help ensure the drug maintains a steady state in your bloodstream, but 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. If you need to change the day you inject Ozempic or Wegovy, you can do that, so long as you follow the guidelines provided by your healthcare provider and the medication guide.

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 the reason why. Plateaus are a normal part of the 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, potentially leading to a plateau. Eventually, your body may start conserving energy by burning fewer calories, which often aligns with this plateau phase. A study of 14 adults who were contestants on a reality TV show focusing on lifestyle-induced weight loss found that people’s metabolisms slowed down with weight loss and they became more energy efficient.

There are many ways to push through a weight loss plateau, but it depends on what is holding you back.  For some, it might be work-related stress that is temporary, or it might be the holidays during which weight maintenance, rather than weight loss, is a perfectly acceptable goal. 

It is important to discuss weight loss plateaus with your provider who can help determine if it’s a lifestyle issue that is holding you back or if it’s normal physiology.  If it’s normal physiology, your provider can discuss what next steps might be depending on your overall goals, which could mean a different medication (tirzepatide causes more weight loss than semaglutide) or an additional medication, which is an off-label practice but supported by research. 

7. You need more sleep

One in three adults get fewer than 7 hours of sleep per night, according to research from the Centers for Disease Control and Prevention (CDC). If you’re one of them, it could be slowing down your weight loss on semaglutide.

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

8. You’re stressed out

If this sounds familiar, know that you’re not alone. Living with chronic stress can make weight loss more difficult—and research shows that high stress levels can even contribute to weight gain. 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—may help improve your weight loss outcomes.

9. You have other health conditions that affect weight loss

Some health conditions can contribute to weight gain, including polycystic ovarian syndrome (PCOS), diabetes, heart failure, kidney or liver problems, and metabolic conditions like high blood pressure and cholesterol. 

If you’re managing one of these medical conditions, you may experience less 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. After six months, people with diabetes lost an average of 7.2% of their body weight, while those without diabetes lost 11.8%.

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

Similarly, some medications can cause weight gain as a side effect, such as:

• Antidepressants, including amitriptyline and citalopram

• Diabetes medications, including insulin and sulfonylureas

• Antipsychotic medications, including lithium and clozapine

• 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.

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 6 pounds in 12 weeks. Those taking a placebo lost less than half a pound in the same time period. More dramatic results take time, as shown in one study where people taking Wegovy lost about 15% of their initial body weight after 68 weeks—that’s over 15 months.

12. You may need a different drug than semaglutide

Sometimes, a medication just isn’t the right fit. You may experience significant side effects that make it difficult to continue, or you might not see the weight loss results you expected.

While semaglutide is effective for most people, it doesn’t work for everyone. In one clinical trial, 86% of participants 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 medications out there, and some are even more effective at weight loss on semaglutide. We’ll cover these in the next section. 

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, see if you want to adopt any of these 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—while still meeting 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 shoot to keep a diet 200-300 calories below your TDEE. 

2. Try more nutritious foods

Semaglutide works for weight loss by slowing down stomach emptying and bowel function, so we stay full after eating. “This is the blessing and the curse; if we have the right things in our stomachs we will be satiated.”

Taking advantage of the way semaglutide decreases your appetite can help you change how you relate to food, so you can make better choices for your goals. Try to increase protein and healthy fats, eat plenty of fruits and vegetables, and reduce carbohydrate intake. Combined with regular physical activity and stress management—though that’s easier said than done—this forms the foundation for success. The medication can support the process, but lasting change requires commitment.

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). 

When it comes to exercise, finding a workout you like—and can stick to—is more important than finding the “best” workout. That said, resistance training exercises can be particularly helpful at preventing the loss of muscle mass that can happen with weight loss.

Expert guidelines from the American Academy of Clinical Endocrinologists suggest that people with obesity should aim for at least 150 minutes of moderate-intensity aerobic exercise each week. Examples of “moderate” intensity exercise are activities like brisk walking, swimming, or cycling. Consult a healthcare or fitness professional for guidance and to determine the best plan for you. 

4. Sleep more and stress less

Stress and decreased sleep [can] increase cortisol, the stress hormone, and lead to increased fat deposition so it’s important to try to regulate your stress levels and, if you can, sleep 7-8 hours a day.

So, consider this your permission to get a better night’s sleep. Studies show that people who enjoy better sleep tend to lose more weight 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 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 light later in the day

• Practicing meditation

Meditation is also a good way to manage stress. In one study of obese people, those who underwent a stress management program experienced a significantly larger reduction in their body mass index (BMI) than those in the control group. Some of the stress management techniques they learned included progressive muscle relaxation, guided visualization, and 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 to succeed in your new diet and exercise routine can actually influence how much you lose weight, according to research. If you have friends or family who tease or criticize you for your new healthy choices, consider how you can set up boundaries or spend less time with them. Research shows that feeling undermined by others, especially family members, while trying to lose weight can result in weight gain over the course of two years.

Other research has found that having a weight loss “buddy” can also lead to better results than going it alone. If this sounds like it would be motivating for you, seek out someone to be your buddy, whether it’s someone you already know or someone you connect with online or through your doctor’s office.

6. Consider alternatives to semaglutide

If you’ve been taking semaglutide for a while and have made healthy lifestyle changes but aren’t seeing significant weight loss, 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. Zepbound is FDA-approved for weight loss and the treatment of sleep apnea in people with obesity,  while Mounjaro is approved for type 2 diabetes but may be prescribed off-label for weight loss—similar to Ozempic. In a 72-week clinical trial, people taking Zepbound lost up to 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).

Learn more about making the switch from semaglutide to tirzepatide.

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

• In a small study of Rybelsus, people lost just under 6 pounds in 12 weeks, and were eating nearly 40% fewer calories daily.

• In a study of Ozempic, people lost 11 pounds in 12 weeks, mostly from fat mass.

• In a study of Wegovy, people lost 5.9% of their body weight in three months. 

If you’re wondering about the variability between these results, it’s worth noting that Wegovy is the highest-dosage formulation of Ozempic and is the only version of semaglutide officially FDA-approved for weight loss. Rybelsus and Ozempic, on the other hand, are FDA-approved for type 2 diabetes but may be prescribed off-label for weight loss.

Hear from Ro patients

Ro members taking branded GLP-1 medications were paid for their testimonials.

Sonia

Ro member

James

Ro member

Chaleeta

Ro member

If you’re reading this, you may not be losing weight as quickly as you’d hoped on semaglutide—but that frustration can fuel your motivation for change. Keep these key takeaways in mind:

• Achieving a calorie deficit is key to weight loss on semaglutide. Semaglutide helps with appetite suppression, but weight loss depends on maintaining a calorie deficit as well. 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 the effects of semaglutide and support long-term, sustainable weight loss.

• Exercise can help you keep the weight off and break through plateaus. Regular physical activity not only boosts calorie burning but also helps preserve muscle mass, which can keep your metabolism active. Even small increases in movement, like walking more, can make a difference.

• It is important to take the right dosage of semaglutide and take it consistently. Semaglutide follows a titration schedule, and it may take time to reach an effective dose. 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. Taking care of your overall wellness can help enhance semaglutide’s effectiveness.

---

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.

Editorial Guidelines | Medical Review Process

Current version

February 28, 2025

Written by

Amelia Willson

Fact checked by

Beverly Tchang, MD, DABOM and Patricia Weiser, PharmD

---

About the medical reviewers

Beverly Tchang, MD, DABOM

Beverly Tchang, MD, DABOM, is an Obesity Medicine Advisor for Ro. She is also an assistant professor of Clinical Medicine at Weill Cornell Medicine in New York and triple board-certified in Internal Medicine, Endocrinology, and Obesity Medicine.

Patricia Weiser, PharmD

Patricia Weiser, PharmD, is a licensed pharmacist, health content writer, and medical reviewer with more than a decade of clinical experience in community and hospital pharmacy.