Why Am I Not Losing Weight on Ozempic? 5 Reasons to Consider

Ozempic (semaglutide) is an injectable medication that’s FDA approved to treat Type 2 diabetes and lower the risk of serious heart and kidney disease. Ozempic is a glucagon-like peptide-1 (GLP-1) receptor agonist. These medications slow digestion, improve blood sugar, and control appetite. Many people experience weight loss as a side effect while taking Ozempic. 

Unlike Wegovy (another form of semaglutide), Ozempic isn’t FDA approved for weight loss or weight management. So not everyone will lose weight while taking Ozempic. But they can still experience the other health benefits of Ozempic, like better blood glucose control and improved heart and kidney health. 

But if you’re wondering why you’re not experiencing weight loss while taking Ozempic, here are five possible reasons to consider.

1. Your hormones may be making it harder to lose weight

Research suggests that hormone differences may explain why people respond differently to Ozempic. Early studies suggested that factors like sex and baseline glycated haemoglobin (HbA1c) were to blame for semaglutide-response differences. But newer research shows these factors may matter more because of how they affect certain hormones. 

For example, women are often “hyper-resonders” to semaglutide, but lower estrogen levels may make it harder to lose weight. One study found that postmenopausal women who were taking semaglutide but weren’t on menopausal hormone therapy (MHT) had a harder time losing weight compared to those on systemic MHT, also called hormone replacement therapy.

2. You’re taking a low dose

People often lose more weight on higher doses of Ozempic. One study showed that people taking 2 mg of Ozempic lost more weight than those taking 1 mg. This is why Wegovy — another form of semaglutide that’s FDA approved for weight loss — is given at higher doses.

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Also, research shows that in real life, most people are taking lower doses of semaglutide than those used in clinical trials. This can explain why people are experiencing less weight loss than expected based on clinical trial results. 

Studies also show that in the real world, people tend to stop or pause their treatment more often. This means people get lower doses of medication over time, which can impact how well semaglutide works.

If you’re on a lower maintenance dose or have paused your medication, this could explain why you’re not losing weight.

3. You need to adjust your diet

Ozempic is supposed to be taken in addition to changes in your diet that support your blood sugar management and cardiovascular health. If you’re taking Ozempic and not making these changes, this could be why you aren’t losing weight.

To help support blood sugar management and weight loss, it’s important to get the right number of calories from nutrient-dense foods. Focus on foods that are minimally processed and packed with fiber (like whole fruits and vegetables). It’s also important to prioritize lean proteins, complex carbohydrates (like whole grains), healthy fats, and low- or no-sugar drinks.

You may also want to avoid the kinds of foods that can worsen Ozempic’s side effects so that you can tolerate a higher dose. Avoid foods that are high in fat or sugar to help ease side effects so that you can stay on the highest effective dose. It’s also important to avoid ultra-processed carbohydrates, starchy vegetables, and alcohol to avoid Ozempic side effects.

EXPERT PICKS: WHAT TO READ NEXT

• Paying for Ozempic: Ozempic can cost over $1,000 per month, but there are ways to save with or without insurance. 

• Ozempic vs. Wegovy: What’s the difference? Learn how these two semaglutide medications compare for weight loss, dosage, and approval.

• Best foods to eat while taking Ozempic: One reader shares which foods helped her get the best results from her treatment.

4. You have health conditions that make it hard to lose weight

Some health conditions, like  hypothyroidism and polycystic ovary syndrome (PCOS), can make losing weight harder, even if you’re taking Ozempic. Some mental health conditions like anxiety, depression, or binge eating disorder, can all impact weight loss, too. 

Having Type 2 diabetes may make weight loss more difficult. In studies, people with Type 2 diabetes often lose less weight while taking semaglutide compared to people taking semaglutide who didn’t have Type 2 diabetes. 

Your medications may also play a role. For example, steroids and antidepressants may make you less likely to lose weight while taking semaglutide.

5. Your daily habits are keeping you from losing weight

Even while taking Ozempic, daily habits can make weight loss more difficult. Some of these habits include:

• Emotional or habitual eating: You may feel fewer food cravings while taking Ozempic, but that doesn’t always mean your eating habits will change. Emotional eating, frequent snacking, or using too much alcohol can still slow your progress.

• Poor sleeping habits: Not getting enough high-quality sleep has been linked to difficulties with weight loss. One reason for this is that sleep deprivation can increase food cravings, making it harder for you to make nutritious food choices.

• Physical inactivity: Regular physical activity helps support weight loss. So it’s important to stay active while taking Ozempic.

Does Ozempic work for everyone?

Not everyone gets the same benefits from taking Ozempic. 

In clinical trials, Ozempic generally worked much better than other diabetes treatments for lowering blood sugar. Ozempic can lower the risk of heart attacks and stroke, and keep kidney disease from getting worse. 

But not everyone who took Ozempic in these studies got the same benefits:

• While everyone taking Ozempic had improvement in their HbA1c levels, about 30% of people didn’t reach the goal of HbA1c less than 7%. 

• Some people still experienced heart attacks, strokes, or kidney problems while taking Ozempic.

• Some people didn’t lose a meaningful amount of weight (defined as 5% or more of body weight) even while taking higher doses of Ozempic. This was seen more often in people with a higher body mass index (BMI). 

Keep in mind that no medication works equally well for everyone. And your response to Ozempic may change over time depending on your health and other medications. So it’s important to work closely with your healthcare team and give the medication time to work before deciding it’s not right for you.

What should you do if Ozempic is not working?

It’s important to look at more than just changes in your body size to know if Ozempic is working. Improvements in things like your hemoglobin A1C, cholesterol levels, and blood pressure may all be signs that Ozempic is working. 

If you don’t notice any health improvements, talk with your healthcare team about dose adjustments or different medication options. If weight loss is your main goal, there may be better weight-loss medications available, such as:

• Wegovy (also semaglutide) is FDA approved for weight management. 

• Tirzepatide (Zepbound) is also approved for weight management. This is a dual receptor agonist for GLP-1 and glucose-dependent insulinotropic peptide (GIP) hormones.

You can also try these tips to boost the effect of Ozempic:

• Adjust your eating habits to better support your specific health goals. A balanced and nutritious diet should focus on things like whole grains, lean protein, high-fiber fruits and vegetables, healthy fats, and getting plenty of water.

• Try adding more nuts, seeds, avocados, and eggs to your diet. Research shows that these types of foods may help boost your body’s own GLP-1 activity.

• Talk to a nutritionist or your healthcare team. They can help you adjust your eating patterns to help you find a more comfortable weight while taking Ozempic.

• Add more exercise and movement into your weekly routine. Experts recommend focusing on finding activities that feel good for your body and that you enjoy.

• Talk with your healthcare team about your hormone health. If you’re in perimenopause or menopause, or have other conditions that affect important hormones like PCOS, your team can offer treatment options.

• Take Ozempic as prescribed. Talk with your prescriber if the side effects you’re experiencing on Ozempic are keeping you from reaching your target dose. 

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Written by:

Ashley Rawlins, PT, DPT

Ashley Rawlins, PT, DPT, has established herself as a specialist in pelvic health. With over a decade of experience as a physical therapist, her diverse career spans clinical practice, academia, and health content creation.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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