Ozempic has become one of the most talked-about medications in recent years, not just for diabetes but for its dramatic weight loss potential. Yet many people find themselves asking, why am I not losing weight on Ozempic? If that’s you, you’re not alone—and it can feel discouraging.
First, it’s important to know that Ozempic is FDA-approved to treat diabetes, not weight loss. Furthermore, weight loss medications fail to address the biological backlash of restriction and the psychological reasons for overeating, both of which can make it difficult to lose weight.
Fortunately, you’re in the right place. As a board-certified health and wellness coach with a decade of experience as a medical writer, I know how to parse through the clinical evidence so that you don’t have to. Let’s dig into the potential reasons why someone might not lose weight on Ozempic. Then we’ll cover strategies to overcome the dreaded weight loss plateau.
How Does Ozempic Work for Weight Loss?
Ozempic, generically known as semaglutide, is a medication originally designed to manage blood sugar levels in type 2 diabetes. However, its effects extend beyond just blood sugar control, sometimes causing significant weight loss.
At its core, Ozempic works by imitating a hormone called glucagon-like peptide-1 (GLP-1), which plays a pivotal role in appetite regulation and digestion.[1] When Ozempic binds to GLP-1 receptors, it essentially tricks the brain into thinking it’s fuller sooner and longer, leading to reduced calorie intake and weight loss for some but not all.
Clinical trials have shown that participants using Ozempic experience a noticeable reduction in appetite and food intake, contributing to weight loss over time.[2], [3] One study even followed participants for 17 months and found clinically significant weight loss—where clinical significance is defined as at least a 5% reduction in weight.[4]
This data can make Ozempic look not only promising, but hopeful. This can add an extra layer of frustration if you catch yourself thinking—why am I not losing weight on Ozempic?—despite consistent efforts.
Although there are some long-term studies on Ozempic for weight management—with the longest study spanning four years[11]—even longer follow-ups are required. Why? Because other research shows that over one-third of weight lost through calorie restriction “tends to return within the first year, and the majority is gained back within 3 to 5 years.”[5] Given this, a study that spans beyond five years would be necessary to prove that Ozempic works for weight loss long term.
Why am I Not Losing Weight on Ozempic? Common Reasons
Looking at the many reasons for not losing weight on Ozempic can build not only self-understanding but also self-compassion—both equally important. The obstacles to weight loss can be both biological and psychological in nature, so it’s important to address the full picture.
Here are some potential reasons for not losing weight on Ozempic:
- Not exercising enough: Remember, Ozempic is not FDA-approved for weight loss, and many of Ozempic’s clinical trials also include “lifestyle intervention.”[4] If you’re using this medication without adjusting your diet or exercise regimen, it could explain a resistance to losing weight on Ozempic.
- Eating too much: The primary mechanism that causes weight loss with Ozempic is a decrease in appetite; but if you’re not actually eating less, you won’t lose weight with Ozempic.
- Emotional eating: Studies show that negative emotions are strongly correlated with overeating and binge eating.[12], [13] If you struggle with emotional eating and have not addressed it before starting Ozempic, you might not lose weight.
- Insufficient dosage or duration: If you aren’t taking enough Ozempic, or if you haven’t been taking it for long enough, it can cause limited results.
Recent studies show that 1.7mg or 2.4mg of semaglutide for 3-6 months led to an average of 5.9% reduction in body weight—while 12% of participants saw no significant weight loss.[3]
- Medication side effects: Ozempic slows gastric emptying, the process by which food exits the stomach and enters the small intestine. While this effect can be beneficial for weight loss, it’s also responsible for some potential gastrointestinal side effects. If Ozempic is causing nausea or indigestion, and that interferes with healthy eating or exercise habits, it may hinder weight loss.
- Poor sleep: A lack of sleep has been linked with hormonal changes that increase hunger and decrease feelings of fullness.[14], [15] This disruption can counteract the desired effect of Ozempic, causing a resistance to weight loss.
- Excessive stress: When stressed, the body releases cortisol, a hormone that can increase appetite and cravings for high-calorie, hyperpalatable food.[16] This works against Ozempic’s appetite-suppressing effects. Additionally, stress can lead to emotional eating and disrupted sleep patterns, further complicating weight loss efforts.
- Underlying health conditions: Issues like thyroid disorders, insulin resistance, and hormonal imbalances such as PCOS (Polycystic Ovary Syndrome) can slow metabolism or alter the body’s response to insulin.[17], [18] This can make weight loss more challenging, even with medications like Ozempic.
- Muscle gain: If you find yourself wondering—why am I not losing weight on Ozempic?—ask yourself if your pants fit any looser. Muscle is denser than body fat,[19] which means that it’s possible to gain muscle and lose fat without seeing any results on the scale.
- Inconsistent Ozempic injections: Inconsistent Ozempic dosing can weaken the medication’s potential weight loss effects. Continuous drug levels are needed for optimal appetite control and metabolic regulation.
These are just some of the factors that can cause minimal weight loss while taking Ozempic. If you’re feeling frustrated from not losing weight on Ozempic, recognizing these complexities can inspire more understanding and patience with your body.
Up next, we will explore another powerful potential reason for not losing weight on Ozempic—a topic that deserves to be explored in-depth.
Set Point Weight Theory: The Real Reason for Not Losing Weight on Ozempic
Understanding why you are not losing weight on Ozempic requires delving into set point weight theory, which suggests that your body biologically favors a specific weight range. One reason for not losing weight on Ozempic could be that your body is fighting to defend a specific set point.
This is the same mechanism through which Ozempic facilitates weight loss, which may explain why some people don’t lose weight on Ozempic and why some people regain the weight they initially lost during treatment.
When faced with caloric restriction, your body instinctively initiates adaptations that slow down metabolism while ramping up hunger hormones.[25], [26], [27] This makes you feel hungrier and motivated to eat more food despite the body burning less calories, which is a recipe for weight regain.
Restrictive dieting also causes a significant decrease in resting metabolic rate, the number of calories burned while at rest. Because of this, research shows that further restrictive dieting might be required to sustain weight loss achieved through a caloric deficit.[28]
This is why Ozempic isn’t the magic pill TikTok makes it out to be: once you stop taking it, your appetite hormones surge, yet your metabolism may still be suppressed—creating the perfect storm for weight regain.
If you’ve been asking yourself, why am I not losing weight on Ozempic? it’s worth pausing to think about what weight loss through restriction really means. The truth is, restriction-based weight loss usually requires ongoing limits even after treatment—and often doesn’t last long term. That raises an important question: is Ozempic truly a sustainable path to weight loss?
Ozempic or Not? How to Overcome Weight Loss Plateaus
Overcoming weight loss plateaus, especially while taking medications like Ozempic, requires a holistic approach that addresses not just the biology of weight loss but also the psychology of weight loss. As both an experienced coach and someone living in recovery from compulsive eating, I advocate for a psychology-focused strategy that includes abandoning restrictive diets altogether.
Here are some tips and strategies for your unique weight loss journey:
- Talk to your doctor about weaning off Ozempic: Before making any changes, talk to your healthcare provider about your weight loss journey on Ozempic. Discuss the potential of gradually weaning off the medication, if appropriate.
- Try intuitive eating: Shift your focus from creating a caloric deficit to listening to your body and eating the foods that truly satisfy you. Intuitive eating is associated with not only improved psychological well-being and body satisfaction but also healthier eating habits and lifestyle changes.[29]
- Let go of the food rules: Many people fear weight gain if they abandon diets and adopt intuitive eating. While weight loss isn’t the goal, some studies have shown that intuitive eating can help with weight loss.[30]
- Embrace emotional awareness: Start identifying patterns around emotional eating to address the root cause of overeating. This skill is often overlooked with conventional dieting or weight loss medications like Ozempic.
- Build emotional tolerance: Practice my Stop, Drop, & Feel® method to increase emotional awareness and also cultivate emotional tolerance, your ability to withstand uncomfortable emotions without using food as a coping mechanism.
- Engage in moderate exercise: Incorporate a balanced exercise routine that you enjoy—extra emphasis on the joy factor!—to help manage stress, improve your mood, and maintain a healthy metabolism. Avoid excessive exercise and overtraining as this increases stress hormones.[31] And stress hormones don’t exactly facilitate weight loss, as we discussed earlier.
- Prioritize stress management: Because of the detrimental effects of stress, consider relaxation techniques like meditation, yoga, or progressive muscle relaxation to help reduce stress and stress-related eating. One study found that progressive muscle relaxation helped reduce night eating tendencies after just 8 days, demonstrating the importance of relaxation and mindfulness.[32]
- Address underlying health conditions: Consult healthcare professionals to manage any underlying conditions like thyroid disorders or insulin resistance, which can significantly impact your weight loss efforts.
As someone who used to jump on and off diets almost every month, I know how scary it feels to let go of something as hopeful as Ozempic and trust your body to settle at a new set point weight on its own.
What finally nudged me toward intuitive eating was the research showing that dieting is more often linked with long-term weight gain than weight loss.
Intuitive eating doesn’t guarantee the number on the scale will change, but it does improve mental health[28], which can give you the energy to face the emotions that drive compulsive eating in the first place.
Navigating Your Weight Loss Journey
At the end of the day, Ozempic may change the way your body regulates appetite, but it doesn’t change the psychology of eating. If you’ve found yourself thinking, why am I not losing weight on Ozempic? know that you’re not failing—the medication simply can’t override biology and emotions forever.
Real, lasting peace with food doesn’t come from restriction, whether through diets or injections. It comes from building trust with your body, listening to hunger and fullness cues, and finding new ways to cope with emotions without turning to food. That’s the heart of intuitive eating, and it’s also the foundation of sustainable well-being.
