Why Am I Not Losing Weight on Ozempic? A Dietitian Explains

Ozempic has become a household name in recent years, skyrocketing from a treatment for diabetes and obesity to a trendy weight loss aid used by celebrities, influencers, and everyday people alike.

But despite its nickname as the “magic pill” for weight loss, some people still don’t see the number on the scale budge, wondering what exactly they’re doing wrong. 

From not being in a calorie deficit and alcohol intake to underlying health conditions and lack of movement, there are many reasons why you may not be losing weight on Ozempic—keep reading to learn more, including what you can do to turn things around.

1. You’re Not in a Caloric Deficit

First and foremost, even though Ozempic is known to reduce appetite, you may still be eating more than your body needs. 

Without a calorie deficit, it is not possible to lose weight. 

What to do: If you aren’t sure exactly how many calories your body needs, consider seeing a Registered Dietitian (RD) to get a personalized nutrition plan.

2. You’re Not Exercising

Exercise is essential on a weight loss journey—especially when using Ozempic, as you don’t want to lose muscle mass initially.

If you don’t exercise regularly while taking Ozempic, you may lose weight from muscle and develop a more fat-dominant body composition.

What to do: A combination of aerobic (cardiovascular) exercise and strength or resistance training is ideal for weight loss. 

Aim for daily movement, such as walking, biking, or swimming, and strength training 2 to 3 times per week.

Lose the Guesswork

Get a science-backed calorie & macro plan to lose weight sustainably, built for your life.

Talk to an RD

Lose the Guesswork

Get a science-backed calorie & macro plan to lose weight sustainably, built for your life.

Talk to an RD

3. You Have an Underlying Medical Condition

Certain underlying health conditions can make it much more difficult to lose weight, even if you’re doing everything else right.

Diseases most likely to affect weight include PCOS (polycystic ovarian syndrome), hypothyroidism, insulin resistance, and Cushing’s syndrome.

Similarly, prescription medications like antidepressants, beta blockers, and steroids can also cause weight gain or make it harder to lose weight. 

What to do: Talk to your doctor and see what lab tests or medication reviews they recommend.

4. You’re Not Taking the Full Dosage

Ozempic dosages typically start low, such as 0.25mg, and increase over time. 

Many people don’t reach the therapeutic weight-loss dose (typically 1mg or more per week) for several weeks.

If you’re still titrating up to the therapeutic dose, the full appetite suppression and metabolic effects may not have kicked in.

Plus, it won’t be as effective if you’re not taking the full dosage because you’re skipping doses due to high costs. 

Remember to always consult your healthcare provider before changing your medication dosage or schedule.

What to do: If you’re still in the titration phase, be patient and consistent. 

And if you’re skipping doses due to side effects or cost, talk to your healthcare provider about alternatives or support programs.

5. You’re Not Changing Your Lifestyle

Ozempic is a tool for losing weight, but it’s not a guaranteed result.

If you aren’t making healthy lifestyle choices—like learning about food and eating healthy, exercising, managing stress, and getting enough sleep—it will be challenging to achieve the weight loss you want. 

People who see the most long-term success on Ozempic also pair the medication with fundamental lifestyle changes. 

What to do: Prioritize the basics of health, such as getting 7-9 hours of sleep, exercising regularly, staying hydrated, and managing stress. 

This can help you maintain your weight loss if and when you stop taking Ozempic.

6. You’re Drinking Too Much Alcohol

Similarly, if you’re still drinking a lot, weight loss may not follow. 

Alcohol is calorie-dense, nutrient-poor, and can inhibit fat burning and disrupt blood sugar control. 

It also causes dysregulation of hunger and satiety hormones, leading to overeating unhealthy foods.

What to do: Consider cutting back on your alcohol or taking a break. 

If you want more information about how alcohol impacts your health, check out this article about 11 Good Reasons to Stop Drinking Alcohol.

How Does Ozempic Work?

Before we dive into the reasons you’re not seeing weight loss with Ozempic, let’s take a quick look at how it works so we can better understand its mechanism. 

Ozempic, also known as semaglutide, belongs to a class of drugs called GLP-1 receptor agonists.

These drugs mimic a naturally occurring hormone called glucagon-like peptide-1 (GLP-1), which helps to regulate metabolism and appetite. In addition to Ozempic, other similar GLP-1 agonists include Mounjaro, Rybelsus, and Wegovy. 

GLP-1 reduces calorie intake by lowering appetite and slowing gastric emptying, which means food moves more slowly through the digestive tract. These actions lead to increased feelings of fullness and a decrease in overall food intake. 

Studies have shown that semaglutide can cause significant weight loss. 

A 2021 study found that people who used the medication once a week for over a year experienced a 14.9% reduction in body weight, compared to a 2.4% weight loss in the placebo group. That said, side effects were common, including nausea, vomiting, diarrhea, and other gastrointestinal symptoms.¹

However, although weight loss is common, so is weight regain upon stopping Ozempic. 

Research shows that, one year after stopping semaglutide, people tend to regain two-thirds of the weight they lost.² 

Not only that, but a lot of the initial weight loss comes from lean muscle mass. 

When the weight returns, it tends to come back as fat, not muscle, which can slow metabolism and make it even harder to keep weight off in the future.

How a Registered Dietitian Can Help

If you’re feeling stuck on your weight loss journey and Ozempic hasn’t helped as much as you thought it would, seeing a Registered Dietitian (RD) can be a smart move to troubleshoot and get things moving. 

RDs can help you pinpoint exactly what’s holding you back—whether it’s your calorie intake, food choices, exercise routine, or something more complex. 

Some ways that RDs can help include creating a sustainable meal plan that supports fat loss while preserving muscle, identifying gaps in your diet, and helping to calculate your calorie and protein needs. 

The bottom line is that Ozempic can be a powerful tool for weight loss, but it’s not always that simple—and that’s where experts like RDs can help. 

Ready to take the next step? Schedule an appointment with our virtual RD today!