If you find that you’re not losing weight on Ozempic or other GLP-1 medications, your metabolism, or how quickly your body burns calories, may be the cause. It’s sometimes called the “Ozempic plateau,” but it can happen with any weight loss program.
Ozempic is often used to mean any one of a class of drugs called glucagon-like peptide-1 (GLP-1) agonists. It’s approved as a type 2 diabetes medication, but doctors also prescribe it off-label for obesity when you have a body mass index (BMI) of 30 or higher. Other GLP-1s for diabetes that are sometimes prescribed for weight loss include Bydureon, Byetta, Mounjaro, Rybelsus, and Victoza. GLP-1 medications that are approved for weight loss include Saxenda, Wegovy, and Zepbound.
“A weight loss plateau doesn’t automatically mean the medication isn’t working or that you need a higher dose. It may mean your body is adjusting, and that’s normal,” says Wesley McWhorter, DrPH, a spokesperson for the Academy of Nutrition and Dietetics.
Stalling out on the way to your target weight is frustrating but common. Here’s why weight loss plateaus happen with Ozempic and other GLP-1 medications, and how to move past them.
How Does Ozempic Work for Weight Loss?
This type of drug mimics a hormone (GLP-1) in your body that your gut releases after you eat. These drugs help you feel full and keep your blood sugar steady.
When you inject them once a week into your arm, thigh, or belly, your body is also triggered to make more of its own GLP-1.
But GLP-1 medications – including Ozempic – aren’t magic.
“While Ozempic can significantly improve insulin resistance, reduce appetite, and increase satiety, it works best when combined with healthy eating, physical activity, and behavior changes,” says Paunel Vukasinov, MD, an internist and obesity medicine specialist in New York City. “Ozempic is an effective tool for obesity and diabetes, but it isn’t a cure without the lifestyle component.”
Does Ozempic burn fat or just make you not hungry?
GLP-1 medications like Ozempic affect both your body and your brain.
For starters, it slows down the speed at which food empties out of your stomach. You feel full for a longer period of time (satiety), so you’re likely to eat less.
One study of 30 people showed that GLP-1 medications like Ozempic may also help your body burn fat. We need larger studies to confirm that this is consistently true.
Another way Ozempic and other GLP-1s work is by sending signals to your brain so you think you’re full. Some evidence shows that they could also help reduce “food noise,” or the thoughts that make you eat when you’re not hungry. More studies need to be done to confirm this.
How Long Does It Take to Lose Weight on Ozempic?
A lot of things can affect your response to any GLP-1 medication, including:
- Your genes
- Your metabolic rate (how fast your body naturally turns food into fuel)
- Your current health
“Some people feel the effects immediately and start seeing weight loss, whereas others need to be at higher doses to see results,” says Mir Ali, MD, medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California.
How Much Weight Can You Lose on Ozempic?
If you’re like most people, you can probably expect to lose 15% to 20% of your weight on Ozempic or a similar medication. That’s a better result than older types of medications, which usually result in losing 5% to 10% of your starting weight. But everyone is different. One-third of people who take Ozempic lose 10% of their weight.
In one study, almost 2,000 people with a BMI of 30 or higher were divided into a group that took semaglutide weekly and another that took an inactive treatment (a placebo). After 68 weeks, the semaglutide group lost an average of almost 15% of their body weight, compared to about 2.5% in the placebo group.
An analysis of 47 clinical trials of different GLP-1s found that this class of drug is effective at reducing body weight, BMI, and waist circumference measurement.
Why Am I Not Losing Weight While on Ozempic?
Plateaus are a normal part of any weight loss journey, whether you use Ozempic, another GLP-1 medicine, or another method.
“As your body loses weight, it naturally burns fewer calories, which slows progress. This is a built-in survival mechanism, not a failure,” McWhorter says. “Hormones shift, metabolism adapts, and appetite often increases. It’s biology doing its job.”
Because of that, says McWhorter, “sustainable weight loss is rarely a straight line.”
Most people see the most rapid weight loss within three to six months of starting a GLP-1 medication, “followed by a slower pace and occasional plateaus,” says Vukasinov.
Besides the changes that happen with your metabolism, that six-month mark is also when “lifestyle and eating habits often return to old patterns,” Vukasinov says.
How to Get Past the Ozempic Weight Loss Plateau
To move past a weight loss plateau, experts suggest that you:
Adjust your diet. Try to cut back on carbohydrates and added sugars, while increasing protein. Your doctor or a registered dietitian can suggest specific tips and meal plans.
Increase your exercise. This can help boost your body's metabolism. Strength training is a good place to start, especially since an early study found that some GLP-1s could shrink and weaken your muscles.
Why Am I Gaining Weight on Ozempic?
Weight gain while taking Ozempic or another GLP-1 “is not very common,” says Vukasinov. “But it may occur if the medication is suddenly stopped, or your diet and lifestyle didn’t change to meet your weight loss goals.”
For instance, these medications can cause side effects like nausea, constipation, cramping, and acid reflux. If you’re uncomfortable, you may stop taking your weekly shot like you’re supposed to. That can keep you from losing weight. It can also be a sign that your doctor needs to change your medication to one that you can better tolerate.
You could also regain weight if you stop taking a GLP-1 too soon. For the best results, keep taking it as prescribed until your doctor tells you to stop.
How to Make Ozempic Work Better
This is where the lifestyle part of weight loss becomes important. “Instead of focusing only on medication, it’s important to take a step back and look at your overall habits,” says McWhorter. “Sometimes small tweaks can help break through a plateau.”
It can help to:
Get enough quality sleep. Eight hours is what most people usually need. Being sleep-deprived can slow down your metabolism.
Track your food. This can help you find hidden calories or larger portions that may get in the way of your weight loss.
Switch up your workout. If you do the same activity each time, your body gradually gets used to it. Try changing the type or intensity of exercise. Or do your usual activity more often or for a longer time.
Be kind to yourself. “Weight management is a long game,” McWhorter says. “With the right guidance and consistency, small steps can lead to big, lasting change.”
Does weight loss increase with higher doses of Ozempic?
Ozempic and other GLP-1 medications are usually prescribed at the lowest dose, then increased every month until you see results or reach the highest dose.
If you still don’t see the results you want, “you may need a referral to an endocrinologist or other specialist if you’re truly following the diet, using the medication properly, and are still struggling to lose weight,” says Ali.
In some cases, you may be a good fit for bariatric (weight loss) surgery.
Takeaways
Whether you use a GLP-1 medication such as Ozempic or another weight loss method, it’s common to hit a plateau where your weight loss feels “stuck.” This is often because your metabolism naturally slows when your weight drops, so you burn fewer calories. To rev it up again, try to increase your physical activity while cutting back on calories, especially carbohydrates and added sugars. Talk to your doctor about specific changes you can make to reach your target weight.
