Kari Dahlgren

Coach | Author | Advocate

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Why Am I Not Losing Weight on Ozempic? 11 Reasons — Backed by Science

why am I not losing weight on Ozempic? a look into the clinical evidence for and against Ozempic for weight loss

Ozempic is a medication intended to manage diabetes that has garnered enormous attention for its weight loss potential. But what happens when you start taking this medication and find yourself constantly wondering, why am I not losing weight on Ozempic? It can be a frustrating problem, especially if you’re eating well and exercising.

First, it’s important to know that Ozempic is not FDA-approved for weight loss. That important detail aside, weight loss medications often overlook 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. I am an eating psychology coach with almost a decade of experience as a medical writer. My expertise allows me to uncover valuable clinical evidence, offering insight into why you’re not losing weight on Ozempic while providing 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. If you’re in this camp, you could be experiencing the normal and well-documented biological backlash of weight regain that often follows restriction-induced weight loss.[5], [6], [7], [8], [9], [10]

Although there is one long-term study on Ozempic for weight management — where participants were followed for 17 months with clinically significant weight loss[4] — longer follow ups are required. 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 17 month study on Ozempic for weight loss is insufficient at best and misleading at worst.

Why am I Not Losing Weight on Ozempic? Common Reasons

Exploring all possible reasons for not losing weight on Ozempic is crucial for anyone seeking relief from the frustrating pattern of weight cycling (constantly gaining and losing weight). 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:

  • 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. However, it’s far more complex than this because even if you are eating less on Ozempic, there’s still a possibility of not losing weight, as you’ll soon see.
  • 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 be why you are not losing weight on Ozempic.
  • Emotional Eating: Studies show that negative emotions are strongly correlated with overeating and binge eating.[11], [12] If you struggle with emotional eating and have not addressed it before starting Ozempic, you might not lose weight.
  • Insufficient Dosage or Duration: Inadequate dosage or insufficient duration of treatment with Ozempic can cause limited results, if any. 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]
  • Inconsistent Ozempic Injections: Inconsistent Ozempic dosing can weaken the medication’s potential weight loss effects, as continuous drug levels are needed for optimal appetite control and metabolic regulation.
  • 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.[13], [14] This disruption counteracts the desired effect of Ozempic, potentially explaining why you aren’t losing weight with the diabetes medication.
  • Excessive Stress: When stressed, the body releases cortisol, a hormone that can increase appetite and cravings for high-calorie food.[15] 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.[16], [17] This can make weight loss more challenging 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 more dense than body fat,[18] which means that it’s possible to gain muscle and lose fat without seeing any results on the scale.

These are just some of the factors that can cause minimal weight loss while taking the medication. 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. Then we will dive into some tips for overcoming weight loss plateaus without the need for medication.

Set Point Weight Theory: Deeper Reasons 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 and actively maintains 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.

Ironically, something that can cause an increase in your set point weight is reduced caloric intake.[19], [20], [21], [22], [23] 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.[24], [25], [26] 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 causes a significant decrease in resting metabolic rate, the number of calories burned while at rest. Because of this, researchers state that further restrictive dieting might be required to sustain weight loss achieved through a caloric deficit.[27] At the same time, a growing body of clinical research shows that restrictive dieting leads to short-term weight loss but long-term weight gain.[5], [6], [7], [8], [9], [10]

If you find yourself wondering — why am I not losing weight on Ozempic? — it’s worth contemplating the merits of pursuing weight loss through restrictive means. Restriction-based weight loss not only demand ongoing dietary limitations post-treatment but also might prove ineffective in the long term, presenting a compelling dilemma about the sustainability and desirability of Ozempic for 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 physiological aspects of weight loss but also the psychology of weight loss. As an experienced eating psychology coach, 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.[28]
  • 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.[29]
  • Embrace Emotional Awareness: Start identifying patterns around emotional eating to address the root cause of overeating. This is a skill that often goes overlooked during conventional dieting or weight loss medication like Ozempic.
  • Build Emotional Tolerance: Practice the 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 to help manage stress, improve your mood, and maintain a healthy metabolism. Avoid excessive exercise such as marathon running as this increases stress hormones.[30]
  • Prioritize Stress Management: 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.[31]
  • 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 that used to hop on and off diets practically every month, I know how scary it can be to abandon something as hope-inducing as Ozempic and trust that your body can reach a new set point weight all on its own. What finally convinced me to try intuitive eating was the compelling evidence linking dieting with long-term weight gain, not weight loss.

The practice of intuitive eating alone is not guaranteed to get the scale to move, but it fosters better mental health,[28] which can provide the necessary energy for addressing the negative emotions that fuel compulsive eating to begin with. For a holistic approach, be sure to incorporate intuitive eating into a regimen that also addresses the psychological triggers for overeating, such as my Stop, Drop, & Feel technique.

Navigating Your Weight Loss Journey

The evidence behind set point weight theory encourages us to look more closely at the body’s biological reaction to restriction-induced weight loss, such as with Ozempic, and try a different approach — one that abandons restriction altogether. If diets have never worked for you and you’re frustrated with not losing weight on Ozempic, I hope you’ll redirect your focus to the psychology of eating after a thoughtful discussion with your doctor if it’s appropriate for you.

  1. Singh, Gurdeep et al. “Wegovy (semaglutide): a new weight loss drug for chronic weight management.” Journal of investigative medicine : the official publication of the American Federation for Clinical Research 70,1 (2022): 5-13. doi:10.1136/jim-2021-001952
  2. Tan, Hanna Clementine et al. “Efficacy and Safety of Semaglutide for Weight Loss in Obesity Without Diabetes: A Systematic Review and Meta-Analysis.” Journal of the ASEAN Federation of Endocrine Societies 37,2 (2022): 65-72. doi:10.15605/jafes.037.02.14
  3. Ghusn, Wissam et al. “Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity.” JAMA network open 5,9 e2231982. 1 Sep. 2022, doi:10.1001/jamanetworkopen.2022.31982
  4. Wilding, John P H et al. “Once-Weekly Semaglutide in Adults with Overweight or Obesity.” The New England journal of medicine 384,11 (2021): 989-1002. doi:10.1056/NEJMoa2032183
  5. Maclean, Paul S et al. “Biology’s response to dieting: the impetus for weight regain.” American journal of physiology. Regulatory, integrative and comparative physiology 301,3 (2011): R581-600. doi:10.1152/ajpregu.00755.2010
  6. Del Corral, Pedro et al. “Dietary adherence during weight loss predicts weight regain.” Obesity (Silver Spring, Md.) 19,6 (2011): 1177-81. doi:10.1038/oby.2010.298
  7. Lowe, Michael R et al. “Dieting and restrained eating as prospective predictors of weight gain.” Frontiers in psychology 4 577. 2 Sep. 2013, doi:10.3389/fpsyg.2013.00577
  8. Sumithran, Priya, and Joseph Proietto. “The defence of body weight: a physiological basis for weight regain after weight loss.” Clinical science (London, England : 1979) 124,4 (2013): 231-41. doi:10.1042/CS20120223
  9. Dulloo, A G et al. “How dieting makes the lean fatter: from a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery.” Obesity reviews : an official journal of the International Association for the Study of Obesity 16 Suppl 1 (2015): 25-35. doi:10.1111/obr.12253
  10. Dulloo, A G, and J-P Montani. “Pathways from dieting to weight regain, to obesity and to the metabolic syndrome: an overview.” Obesity reviews : an official journal of the International Association for the Study of Obesity 16 Suppl 1 (2015): 1-6. doi:10.1111/obr.12250
  11. Wonderlich, Joseph A et al. “Negative affect and binge eating: Assessing the unique trajectories of negative affect before and after binge-eating episodes across eating disorder diagnostic classifications.” The International journal of eating disorders 55,2 (2022): 223-230. doi:10.1002/eat.23648
  12. Sultson, Hedvig et al. “Exploring the role of momentary positive and negative affect in overeating and binge eating: Evidence for different associations among men and women.” Appetite 168 (2022): 105758. doi:10.1016/j.appet.2021.105758
  13. Mosavat, Maryam et al. “The Role of Sleep Curtailment on Leptin Levels in Obesity and Diabetes Mellitus.” Obesity facts 14,2 (2021): 214-221. doi:10.1159/000514095
  14. Prinz, Patricia. “Sleep, appetite, and obesity–what is the link?.” PLoS medicine 1,3 (2004): e61. doi:10.1371/journal.pmed.0010061
  15. Yau, Y H C, and M N Potenza. “Stress and eating behaviors.” Minerva endocrinologica 38,3 (2013): 255-67.
  16. Sanchez-Garrido, Miguel A, and Manuel Tena-Sempere. “Metabolic dysfunction in polycystic ovary syndrome: Pathogenic role of androgen excess and potential therapeutic strategies.” Molecular metabolism 35 (2020): 100937. doi:10.1016/j.molmet.2020.01.001
  17. Sanyal, Debmalya, and Moutusi Raychaudhuri. “Hypothyroidism and obesity: An intriguing link.” Indian journal of endocrinology and metabolism 20,4 (2016): 554-7. doi:10.4103/2230-8210.183454
  18. Etchison, William C et al. “Body mass index and percentage of body fat as indicators for obesity in an adolescent athletic population.” Sports health 3,3 (2011): 249-52. doi:10.1177/1941738111404655
  19. Korkeila, M et al. “Weight-loss attempts and risk of major weight gain: a prospective study in Finnish adults.” The American journal of clinical nutrition 70,6 (1999): 965-75. doi:10.1093/ajcn/70.6.965
  20. Stice, E et al. “Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents.” Journal of consulting and clinical psychology 67,6 (1999): 967-74. doi:10.1037//0022-006x.67.6.967
  21. French, S A et al. “Predictors of weight change over two years among a population of working adults: the Healthy Worker Project.” International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity 18,3 (1994): 145-54.
  22. Bild, D E et al. “Correlates and predictors of weight loss in young adults: the CARDIA study.” International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity 20,1 (1996): 47-55.
  23. Coakley, E H et al. “Predictors of weight change in men: results from the Health Professionals Follow-up Study.” International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity 22,2 (1998): 89-96. doi:10.1038/sj.ijo.0800549
  24. Cameron, Jameason D et al. “Energy depletion by diet or aerobic exercise alone: impact of energy deficit modality on appetite parameters.” The American journal of clinical nutrition 103,4 (2016): 1008-16. doi:10.3945/ajcn.115.115584
  25. Thomas, Elizabeth A et al. “Eating-related behaviors and appetite during energy imbalance in obese-prone and obese-resistant individuals.” Appetite 65 (2013): 96-102. doi:10.1016/j.appet.2013.01.015
  26. Redman, Leanne M, and Eric Ravussin. “Endocrine alterations in response to calorie restriction in humans.” Molecular and cellular endocrinology 299,1 (2009): 129-36. doi:10.1016/j.mce.2008.10.014
  27. Johannsen, Darcy L et al. “Metabolic slowing with massive weight loss despite preservation of fat-free mass.” The Journal of clinical endocrinology and metabolism 97,7 (2012): 2489-96. doi:10.1210/jc.2012-1444
  28. Schaefer, Julie T, and Amy B Magnuson. “A review of interventions that promote eating by internal cues.” Journal of the Academy of Nutrition and Dietetics 114,5 (2014): 734-60. doi:10.1016/j.jand.2013.12.024
  29. Van Dyke, Nina, and Eric J Drinkwater. “Relationships between intuitive eating and health indicators: literature review.” Public health nutrition 17,8 (2014): 1757-66. doi:10.1017/S1368980013002139
  30. Karkoulias, K et al. “Hormonal responses to marathon running in non-elite athletes.” European journal of internal medicine 19,8 (2008): 598-601. doi:10.1016/j.ejim.2007.06.032
  31. Pawlow, L A et al. “Night eating syndrome: effects of brief relaxation training on stress, mood, hunger, and eating patterns.” International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity 27,8 (2003): 970-8. doi:10.1038/sj.ijo.0802320

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