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Why am I not losing weight on semaglutide?

Robbie Puddick
Written by

Robbie Puddick

Medically reviewed by

Fiona Moncrieff

5 min read
Last updated February 2024
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Jump to: How do you maximise the results of semaglutide? | 1 – You’re not in a calorie deficit | 2 – You’re in a weight-loss plateau | 3 – Your current dose isn’t high enough to promote lower hunger | Take home message

The main reasons you’re not losing weight on semaglutide (Wegovy) might be that you’re not eating in a calorie deficit, you’ve hit a weight-loss plateau, or the current dose that you’re on isn’t high enough to lower your hunger to the point where you’re eating less.

Other factors may also contribute to this, such as other medications or health conditions impacting our ability to lose weight.

Not everyone responds the same way to semaglutide (Wegovy). A randomised controlled trial involving over 1,900 people living with obesity showed that 7% of participants discontinued their medication due to adverse events and side effects.

Wegovy is a powerful medication that significantly impacts the gastrointestinal tract and directly communicates with the appetite centre in the brain, the hypothalamus.

Unfortunately, these effects will result in negative responses for some people that aren’t tolerable to enable them to continue leading fulfilling lives.

Additionally, 86.4% of individuals in this study lost at least 5% of their body weight, an impressive amount. Still, that means 13.6% of participants lost less than 5%.

A weight loss intervention is typically considered successful if participants achieve more than 5-10% of weight loss. So, for some people, semaglutide doesn’t lead to clinically meaningful weight loss.

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How do you maximise the results of semaglutide?

To maximise the results of semaglutide, it’s essential to make positive changes to our diet and lifestyle.

Semaglutide (Wegovy) is only approved for weight loss as an adjunct to lifestyle interventions.

So, there’s no evidence that semaglutide can work sustainably in the long term without us also eating a healthy diet, getting active, and improving our emotional health.

At Second Nature, we’ve launched a Wegovy-supported programme that combines our NHS-trusted weight-loss programme to maximise the results of semaglutide.

Wegovy will help you find your off switch by reducing hunger and food-seeking behaviours. Our award-winning programme will provide the practical tools to change your mind about healthy living and keep the weight off for good.

We’d generally recommend trying our weight-loss programme first, as it’s cheaper and research shows it’s the best weight-loss programme in the UK.

Now, keep reading as we dig deeper into the three reasons you’re not losing weight on semaglutide.

1) You’re not in a calorie deficit

The evidence is clear: we must eat within a calorie deficit to lose excess body fat. When we eat below our energy balance, our body has to find the energy required to fuel our body’s primary functions by burning excess fat.

Semaglutide works by interacting with the brain’s appetite control centre, the hypothalamus, to lower hunger and food-seeking behaviours.

Research suggests that semaglutide can reduce our energy intake by around 40% compared to individuals not taking semaglutide.

However, we eat for more reasons than physical hunger, and some people might continue to eat enough food that prevents them from achieving a calorie deficit due to psychological, environmental, or habitual reasons.

Additionally, suppose our baseline diet was rich in ultra-processed foods and refined sugars, and we continue to eat this way whilst on semaglutide. In that case, we may still eat more calories than we need to lose weight.

So, it’s essential we transition to a diet based on whole foods to maximise the results of semaglutide.

Head to our NHS-trusted meal plan for a free diet plan to help kickstart your weight-loss journey.

Key points:

  • We need to eat in a calorie deficit to lose weight
  • If our baseline diet is rich in ultra-processed foods and we continue to eat this way on semaglutide, we may still consume more calories than we need to lose weight
  • It’s essential to eat a diet based on whole foods to support sustainable weight loss

2) You’re in a weight-loss plateau

Suppose we’ve lost some weight on semaglutide, but then we hit a plateau, and we can’t budge the scales any more. In this case, we’re likely in a weight-loss plateau.

Weight-loss plateaus are extremely common, normal, and a necessary part of the weight-loss process. Being on semaglutide doesn’t prevent us from experiencing weight-loss plateaus.

We have a full guide explaining weight-loss plateaus. However, as a quick summary:

  • Our brain receives signals from many hormones, letting it know how much energy we’re eating and how much fat we have stored. We call this the brain’s ‘set point’.
  • Weight-loss plateaus occur when our brain senses that we’re consuming fewer calories than normal and our fat stores are decreasing it ‘slows down’ our metabolism
  • Evolutionarily, we’re wired to protect fat to ensure survival
  • So, weight-loss plateaus are a survival mechanism in the brain to try and protect us from starvation
  • Fortunately, we can gradually lower our brain’s set point by continuing to lead a healthy lifestyle and being consistent in our habits

Key points:

  • Weight-loss plateaus are a necessary and normal part of the weight-loss process. Semaglutide doesn’t prevent weight-loss plateaus from occurring.
  • Weight-loss plateaus occur when our brain senses we’re losing fat and eating less, so it slows down our metabolism to protect our remaining fat stores
  • We can overcome weight-loss plateaus by being consistent with our healthy habits

3) Your current dose isn’t high enough to promote lower hunger

Semaglutide reduces appetite and hunger, helping you eat fewer calories; this effect is almost immediate when you start Wegovy.

However, you might notice the effect of lower hunger wearing off after 4-5 days post-injection in the first month of taking Wegovy.

It can take 4-5 weeks for Ozempic to reach a level in the body we call a steady state. A steady state is when the drug’s levels in the body remain consistent rather than spiking and falling.

Interestingly, this initial weight loss is no different to other weight loss treatments or the impact of diet interventions on weight loss. The real effect of semaglutide is seen beyond three months.

Semaglutide is a long-acting medication that’s started at a lower dose to reduce the number and severity of side effects as it’s built up to a higher maintenance dose.

Additionally, we might find that our body adapts to the lower doses, and hunger can increase. However, we might find this reverses when we move up a dose.

If you’re unsure about the dosing schedules of Wegovy and its impact on the body, read our in-depth guide on Wegovy.

Key points:

  • The lower doses of Mounjaro can wear off after 4-5 days
  • It can take up to 4-5 weeks for the medication to reach a ‘steady state’ where its levels are consistent in the blood
  • Weight loss may be steady at the beginning but become more consistent as you increase your dose

Take home message

As we’ve covered in this article, there are many reasons why you might not be losing weight on semaglutide. For many of us, there’s likely a way of maximising our results on semaglutide to kickstart our weight loss.

However, a small percentage (~10-20%) of individuals are unlikely to respond well to the medication for various reasons.

If you’re currently on semaglutide and are unsure why the medication isn’t having the desired effect, we’d recommend speaking with your GP or local healthcare team.

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Write a response

Veneice Godbolt

21 February, 2024

Ozempic is not working for me, I am doing 2.0 dose, do you have a higher dose or something else that may help with weight loss


Robbie Puddick

21 February, 2024

Hi Veneice, thanks for your comment 🙂

We’re launching a Mounjaro-supported programme this week in the UK.

If you’d like to check your eligibility when we launch, join our waiting list.

All the best,
Robbie


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