9 reasons you’re not losing weight on GLP-1 medication (and what you can do about it)

GLP-1 medication for weight loss is relatively new, but is seen worldwide as a breakthrough for people with obesity or overweight. The success stories are everywhere, and scientific research also confirms its effectiveness [1,2]:

• With 1 mg Ozempic, people can lose an average of 7% of their body weight within a year (for example 7 kg for someone weighing 100 kg).

• Studies show that weight loss can continue after two years of use.

• More than 86% of users lose at least 5% of their body weight.

But what if you’re not one of them? Then you’re not alone. If 86% of people lose weight, that automatically means 14% don’t. That’s normal. No medicine works exactly the same for everyone, and losing weight remains a complex process in which several factors play a role.

So it may be that you fall within that 14%, but it’s also possible that other factors are at play. You can read more about that below.

It can be frustrating when you’re using GLP-1 medication such as Ozempic, Saxenda or Mounjaro but aren’t losing as much weight as you’d hoped. Good news: in many cases there’s something you can do about it.

We’ll tell you the 9 most common reasons you’re not losing weight and give practical solutions to give your weight loss a boost.

Cause 1: You’re still in the titration phase

Have you just started Ozempic and not seen any weight loss yet? Don’t worry, that’s completely normal!

To minimise side effects and give your body time to get used to the medication, there is a titration phase. What that build-up looks like and how long it takes varies per medicine and person. With Ozempic it generally takes three months. You start with 0.25 mg per week and build up to 1 mg per week.

Losing weight is a marathon, not a sprint. Be patient, focus on healthy habits and talk to your doctor if you don’t notice any difference after 16 weeks.

Cause 2: You need a higher dose

With weight-loss medication it often holds true: the higher the dose, the stronger the effect. Depending on your situation, you could increase as follows, for example:

• From 1 mg Ozempic to 1.7 mg Wegovy

• Switching to Mounjaro (tirzepatide), which activates GIP as well as GLP-1 and is often more effective

Talk to your doctor about whether you’re eligible for a higher dose or whether a different medicine might have more effect for you.

Cause 3: You haven’t adjusted your diet

How well medicines such as Ozempic, Wegovy and Mounjaro work depends on your eating habits. If you keep up an unhealthy diet, with lots of sugary or ultra-processed foods for example, that will hinder the effect of your medication and slow down your progress.

Avoid:

• Alcohol

• Fast carbohydrates

• Ultra-processed foods

Do eat:

• Protein-rich food

• Fibre-rich products

• Healthy fats

Maintain a calorie deficit

Besides healthy food being important, you need a calorie deficit to lose body fat. That means taking in fewer calories than you burn. Your body then gets the energy it needs from stored fat reserves.

In the following 3 steps you can calculate how many calories you need to take in to lose weight.

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Step 1: Calculate your BMR (Basal Metabolic Rate)

This is the number of calories your body uses at rest, purely to function, such as for breathing, heartbeat and maintaining your body temperature.

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Men: (10 × weight in kg) + (6.25 × height in cm) - (5 × age) + 5.

Women: (10 × weight in kg) + (6.25 × height in cm) - (5 × age) - 161.

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Step 2: Multiply your BMR by your activity level

Depending on how active you are, you adjust your BMR:

• Little to no exercise (BMR × 1.2)

• Lightly active (exercise 1-3 days per week) (BMR × 1.375)

• Moderately active (exercise 3-5 days per week) (BMR × 1.55)

• Very active (exercise 6-7 days per week) (BMR × 1.725)

• Extremely active (intensive training/elite sport) (BMR × 1.9)

This gives you your total daily energy expenditure (TDEE): the number of calories you need per day to maintain your weight.

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Step 3: Adjust your calorie needs to your goal

• Losing weight: eat 10-25% less than your TDEE

• Gaining weight: eat 10-20% more than your TDEE

• Maintaining weight: eat the same as your TDEE

Cause 4: You’re not moving enough

Physical activity is important if you want to lose weight, especially in combination with GLP-1 medication such as Ozempic, Wegovy and Mounjaro. But how much do you actually need to move to see real results?

The basic guideline is to do at least 150 minutes of moderate-intensity aerobic exercise per week, such as brisk walking, swimming, dancing, cycling, strength training and jogging.

Although 150 minutes is the minimum standard, research shows that weight loss only really gets going at 300 minutes per week (for example an hour of brisk walking 5 times a week) [3]. This is because fat burning only really kicks in after about 30 minutes of moderate-intensity exercise.

Also important: avoid sitting still for long periods. Try to move for 5 minutes every hour. A quick vacuum, hanging up the washing or stretching already helps. This stimulates your blood circulation, raises your metabolism and burns extra calories, which contributes to weight loss.

Tip: The best way to keep up exercise is to do something you really enjoy. Try different sports or activities and build up gradually to avoid injuries and loss of motivation.

Cause 5: You’re not taking your medication consistently

Your medication is less effective if you don’t use it as prescribed, for example if you sometimes forget a dose or don’t keep to the right timing or dosage.

Pick a fixed day of the week (for example Saturday) to inject your medication and do this consistently.

Cause 6: You’ve hit a weight-loss plateau

Did the kilos fly off at first, but has your weight loss suddenly stalled? This is called a ‘weight-loss plateau’ and is completely normal. Even if you use medication such as Ozempic, Wegovy or Mounjaro. Fortunately, there are ways to get your body back into fat-burning mode.

Here’s how to give your weight loss a new boost:

• Make your training more challenging: Add extra strength training or interval training to speed up your metabolism and build muscle mass.

• Check your calorie intake: As you lose weight, your body needs fewer calories. Make sure you’re still in a calorie deficit.

• Eat enough protein: Protein helps prevent muscle loss, speeds up your metabolism and keeps you feeling full for longer.

• Stay consistent: Your body needs time to adapt. Stick to your healthy habits and break through the plateau in the long run.

Cause 7: You’re suffering from stress

Many people underestimate the influence of stress on weight loss. Chronic stress can slow down your weight loss and even contribute to weight gain. That’s because it affects your metabolism and eating behaviour.

If you experience prolonged stress, it can lead to:

• Fat storage, especially around the belly

• More cravings for sugary and fatty food

• Slower metabolism

• Less energy and motivation to exercise

• Sleep deprivation and weight gain

Proven methods to manage stress better:

• Mindfulness and meditation

• Regular physical activity (especially walking, yoga and strength training)

• Enough sleep (7-9 hours of quality sleep per night)

• Breathing exercises

• Healthy food (such as foods rich in omega-3 fatty acids, magnesium and antioxidants)

Want to lose weight? Then pay attention not only to food and exercise, but also to your mental and emotional wellbeing. A relaxed body cooperates better!

Cause 8: Your sleep pattern could be better

If you don’t sleep well, it disrupts the hormones ghrelin (hunger) and leptin (satiety). As a result, you crave calorie-rich food more. Sleep deprivation also raises your cortisol level. And as we just mentioned, that can stimulate fat storage. So try to sleep 7-8 hours a night.

Tips for a better night’s sleep:

• Go to bed at the same time every day and get up at a fixed time.

• Avoid screens (phone, laptop, tablet) from an hour before bedtime.

• Create a calming evening routine (such as reading or meditation).

Cause 9: You have a medical condition or take medication

Certain medical conditions can hinder weight loss, such as:

• Hypothyroidism (underactive thyroid)

• Sleep apnoea and chronic insomnia

• Insulin resistance or type 2 diabetes

Medicines that can affect weight loss include:

• Antidepressants

• Beta blockers

• Antipsychotics and certain hormone therapies

Discuss your situation and medication use with your doctor to get appropriate treatment.

It’s realistic to lose 0.5 to 1 kilo per week until you reach your target weight. There are a few things you should bear in mind here, though.

First of all, losing weight is different for everyone and is never a linear process. For instance, you might lose 2 kilos in the first weeks and then 0.5 kilo per week, or the other way round.

Furthermore, not everyone responds the same way to a particular approach, whether that’s medication or a specific eating plan or training regime. Some people lose weight faster than expected, while others lose less weight than the studies indicate.

In addition, the figures you hear about the results of weight-loss medication, for example that you can lose 15-20% of your body weight, are averages. And in those studies on semaglutide, lifestyle interventions are also applied, for both the medication group and the placebo group.

To achieve the best results with a GLP-1 medicine, patients should follow the six pillars of lifestyle medicine:

1. Eating a largely plant-based diet

2. Exercising regularly

3. Managing stress

4. Avoiding substance use (such as alcohol and nicotine)

5. Getting quality sleep

6. Maintaining strong social relationships

So lifestyle changes are essential for successful lasting weight loss, even if you use medication.

Tip:Evaluate your lifestyle. Ask yourself:

• Do I stop eating when I’m full?

• Do I mainly eat unprocessed foods?

• Do I cook myself or do I often eat takeaways or ready meals?

• Do I drink enough water?

• Do I sleep at least 7 hours a night?

• Do I exercise regularly?

If you answer ‘no’ to some questions, small adjustments can already make a big difference. By improving your eating and exercise habits step by step, you increase your chances of lasting weight loss and better health.

For around 15% of users, medication such as Ozempic, Wegovy and Mounjaro doesn’t work. But if you’re using the medication and not losing weight, something else may also be going on.

You may not be taking your medication consistently enough, or you may not be in a calorie deficit.

Not experiencing any weight loss? Then talk to your doctor. Adjustments to your dose, lifestyle or medication may be needed to achieve better results.

Curious whether you’re eligible for weight-loss medication?Fill in our short questionnaire.

Why am I not losing weight on Ozempic, Wegovy or Mounjaro?

Not everyone loses weight on GLP-1 medication such as Ozempic, Wegovy or Mounjaro. Factors such as diet, physical activity, sleep, stress and genetic predisposition can influence your weight loss. It may also be that you need a higher dose or that a different approach suits your body better.

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How long does it take before I see results with GLP-1 medication?

Most people start losing weight within three to four weeks after starting GLP-1 medication, but it can take up to 16 weeks before you notice an effect.

What can I do to speed up weight loss with Ozempic, Wegovy or Mounjaro?

You can improve the effect of GLP-1 medication by:

• Eating healthily and with plenty of protein.

• Exercising regularly, with a combination of strength training and cardio.

• Getting enough sleep and limiting stress.

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Can I stop Ozempic, Wegovy or Mounjaro without regaining weight?

If you stop GLP-1 medication abruptly, there’s a good chance you’ll regain some of the weight you lost within a few months. This is because the medication suppresses appetite, and without this support it can be harder to maintain a calorie deficit. Slowly tapering off your medication or using a maintenance dose can help prevent weight gain.

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What is the best dose of GLP-1 medication for weight loss?

The right dose varies from person to person. Clinical studies found that higher doses such as 15 mg tirzepatide (Mounjaro) or 2.4 mg semaglutide (Wegovy) were more effective for weight loss. Discuss with your doctor which dose is best for you.

What should I eat when using GLP-1 medication?

Focus on a wholesome, natural diet with enough protein, vegetables and healthy fats. Avoid calorie-rich, ultra-processed foods that can slow down your weight loss and get in the way of your health.

What side effects can I get from GLP-1 medication?

Common side effects are nausea, diarrhoea, constipation and bloating. These side effects usually decrease over time, as your body gets used to the medication. If the symptoms persist, talk to your doctor.

Does GLP-1 medication work for everyone?

No, studies show that around 14% of people don’t respond to GLP-1 medication. Factors such as underlying health problems, genetics and metabolism can play a role here.

What if my weight loss stalls on Ozempic, Wegovy or Mounjaro?

A weight-loss plateau is normal. Possible solutions are:

• Increasing the dose in consultation with your doctor.

• Adding more strength training to stimulate your metabolism.

• Adjusting your calorie intake.

Is GLP-1 medication covered by health insurance?

In most cases GLP-1 medication is only reimbursed for diabetes patients, and not for weight loss without medical necessity. Check with your health insurer whether you’re eligible for reimbursement.