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This Is Why You’re Not Losing Weight on Semaglutide + Doctors’ Tips to Speed Results

Not drinking enough water is the #1 sneaky culprit, a top weight loss MD says

Better known by its brand names Ozempic and Wegovy, the medication semaglutide has exploded in popularity over the past few years as a weight loss drug. If you’ve seen friends (or even celebs!) have success on the meds but you’re not getting the same results, you may be wondering, “why am I not losing weight on semaglutide?”

Turns out it’s not uncommon. About 14% of people are non-responders to the drug, according to research in the Journal of the Endocrine Society. “Not everyone responds to GLP-1 drugs, and we are not sure why just yet,” says Mert Erogul, MD, an obesity medicine physician at the Maimonides Medical Center in Brooklyn, NY.

What’s more, many people using the weekly injectable experience slowed or stopped weight loss even if they did lose weight at first. We talked to doctors to answer the question of why you’re not losing weight on semaglutide, plus how to maximize your results.

Why you may not be losing weight on semaglutide

Semaglutide mimics the hormone GLP-1, which helps control your appetite. When you take it, you feel fuller longer and typically eat far fewer calories. It’s often prescribed at a starting dose of 0.25 mg per week. That amount is gradually increased over several weeks to 2.4 mg per week, according to a review in the Journal of Pharmacy Technology. The medication is injected once a week.

While the medication is effective for many people, here’s why you may not be losing weight on semaglutide:

1. You’re not taking the right dose

Like all medicines, you’ll need to take the right dose to start losing weight on semaglutide. And that dosage may be a moving target. “While it is best to start with a low dose to get adjusted to the medications, most people will require bump-ups to higher doses within the first month,” says Kathleen Jordan, MD, chief medical officer at the virtual care clinic Midi.

Two semaglutide injectables, which can used to aid weigh loss, wrapping in a yellow measuring tape against a blue background

Related: Your Guide to Ozempic and the New Weight-Loss Drugs: Top Experts + Real Women Tell All

2. You aren’t drinking enough water

By far, the biggest thing that stops people on semaglutide and similar weight loss drugs from losing weight is a lack of H2O, says Sue Decotiis, MD, a triple board-certified weight loss doctor practicing in New York, NY. Not only does dehydration slow your weight loss down, it can cause you to lose muscle instead of fat, which is the last thing you want.

“A fat cell is mostly water, so for every fat cell you lose, you are losing precious water,” Dr. Decotiis says. “Your body is built to hold onto water. If the body feels you’re losing too much water by losing fat, the body switches to losing muscle — there’s very little water in muscle.” That’s why she urges her patients to drink a gallon of water a day while on weight loss medication. (See how a motivational water bottle can help you up your intake.)

A mature woman drinking water outdoors to start losing weight on semaglutide

3. You didn’t change your eating habits

To lose weight, you must be in a calorie deficit. That means you’re burning more calories than you’re eating. The hitch: Your eating habits don’t automatically change because you’re taking a new drug. And if you struggle with emotional eating, you might not eat less even when your appetite is turned down.

“We always say that the medication gives you some support to make the right choices, but ultimately, what you put in your mouth is up to you,” says Dr. Erogul. And it’s not just food. The calories in your beverages can add up, too. “You can drink your way around the medication by consuming a lot of sugar-sweetened beverages, for example,” adds Dr. Erogul. Alcohol is another way to ingest a lot of calories without even realizing it.

“I advise people to focus on eating healthy food, plenty of protein and vegetables,” Dr. Decotiis explains. “The vegetables also help you go to the bathroom — constipation can be a side effect of semaglutide.”

Related: The Oatzempic Diet Is Going Viral, but Does It Work? Here’s How To Tap Real Weight Loss Benefits

4. You’re struggling to fit enough activity into your day

Physical activity works together with semaglutide to help you start losing weight. The original studies that proved the efficacy of semaglutide for weight loss examined patients who were exercising, says Dr. Jordon.

The good news: Beverly Tchang, MD, an endocrinologist and Ro obesity medicine advisor, says keeping active doesn’t have to mean formal exercise. Even a few 10 to 15 minute “exercise snacks” through the day can benefit your health, found to a study in Exercise and Sport Sciences Reviews.

Walking to the mailbox or toting laundry upstairs during commercial breaks while watching your favorite sitcom are easy ways to get moving. “Just avoiding being sedentary has been shown to have health benefits,” Dr. Tchang says. “Most importantly, whatever activity you do should be something you enjoy. Otherwise, it won’t stick.”

Mature women leaving an outdoor exercise class holding yoga mats
Halfpoint Images/Getty

There are a few fitness caveats, though. “We want people to be active, but no heavy-duty exercise in the beginning,” advises Dr. Decotiis. This goes double for people who aren’t already working out and in good shape when they start the drug. Dr. Decotiis recommends walking, a tried-and-true low-impact way to get active that won’t wear you out when you might already feel fatigued. (Learn how Ozempic can make you tired.)

5. Your other medications are interfering

Have you gone over every other prescription you’re currently taking with your doctor? If not, something else in your medicine cabinet could be throwing a wrench in your weight loss journey. “A number of common medications are associated with weight gain,” says Dr. Erogul. If you’re taking them at the same time, they’re making it harder for the semaglutide or any other weight loss drug to work.

There are actually a whopping 251 known drug interactions with semaglutide, so do a complete medication review with your doctor to get and stay on the right track.  Dr. Erogul notes anti-psychotics, steroid therapy and a particular class of diabetes medicines called sulfonylureas may be the reason you’re not losing weight on semaglutide.

6. You’re new to the med

Semaglutide has been called a miracle drug, but it doesn’t work overnight. Most of the studies that show these drugs work look at patients over a period of years. “People need time to adjust to the medication and ramp up to the effective dose,” says Dr. Jordan. “It’s often not until the second or third month that people start to see weight loss on semaglutide.”

7. A different medicine is better for you

Not everyone responds to semaglutide in the same way. Biochemical individuality means that what works for one person may not work the same way for another, according to Dr. Decotiis. And though semaglutide in the form of Ozempic and Wegovy were the first of these drugs to become household names, other drugs might actually work better when it comes to losing weight.

In fact, Dr. Decotiis’ first choice for weight loss isn’t semaglutide at all. She’d rather start people on tirzepatide (known commercially as Mounjaro). “It works on two appetite regulation centers instead of just one,” she explains. “One study showed that it works longer.” So, if you’ve hit a weight loss wall on semaglutide, it makes sense to ask your doctor about other options.

How to start losing more weight on semaglutide

To maximize your weight loss on semaglutide or other weight loss medications or programs, try this:

1. Pair protein + produce

You don’t need to follow a complicated or restrictive diet to start losing weight on semaglutide. Dr. Decotiis recommends focusing on lean protein, like chicken breast or seafood, plus plenty of nutrient-dense vegetables. Whenever possible, avoid processed snacks and other packaged items. “Stick to a common-sense whole-food diet,” says Dr. Erogul.

A table full of fresh produce (like avocado and tomatoes), lean protein (like chicken) and nuts and seeds, all of which can help you start losing weight on semaglutide

Related: “I Lost 130 lbs at Age 53!” — Here’s the Protein Combo That Builds Muscle + Boosts Weight Loss

2. Check in with your doctor

It can take time to get your dose right, and that means clear and frequent communication with you doctor. Find an MD who specializes in weight loss and has a lot of experience working with people on these drugs if possible, says Dr. Decotiis.

3. Keep a journal

To make losing weight on semaglutide easier, try tracking your food and physical activity in an app or a journal, says Dr. Tchang. This can help you see your progress, maintain motivation and find strategies that work for you. Not sure where to get started? Check out the tutorial below for tracking your health and fitness journey.

4. Set an alarm to move

It’s easy to get caught up in work or binging a favorite sitcom and forget to sneak in those exercise snacks that can speed weight loss. A workaround: “Set an alarm to get up from your desk job every now and then,” says Dr. Tchang. Or try booking a time slot on your calendar for a walk after lunch and schedule a reminder so you actually do it.

For more on the perks and potential pitfalls of semaglutide:

Your Guide to Ozempic and the New Weight-Loss Drugs: Top Experts + Real Women Tell All

Does Ozempic Make You Tired? Docs Share the Surprising Reason + Easy Energy Boosters

Ozempic Can Be a Sneaky Cause of Hair Loss — Dermatologists Reveal How to Restore Volume

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

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