Why am I not losing weight on Ozempic?

Medically reviewed by Carmen Pope, BPharm. Last updated on Jan 30, 2025.

Official Answer by Drugs.com

Although Ozempic is not FDA-approved for weight loss, over 86% of people lose at least 5% of their body weight in trials that have studied semaglutide, the active ingredient of Ozempic. But the same clinical trials also show that just under 14% don’t lose weight, and some may even gain weight.

Reasons why you may not be losing weight with Ozempic may be:

You are not following a strict enough diet and exercise regimen – such as avoiding fatty or fried food and foods high in sugar, eating smaller meals, drinking plenty of water, and exercising daily. Lifestyle changes are necessary to lose weight with Ozempic
You have not given it enough time. Some trials of Ozempic have lasted 68 weeks (that’s 1 year, 4 months). Most people started losing weight within the first 4 weeks, but some took longer
The dose of Ozempic is not high enough yet. To reduce the risk of side effects, Ozempic is usually started at a dose of 0.25mg for the first 4 weeks, then gradually increased to 0.5mg, for 4 weeks, then 1mg for 4 weeks, then 2mg. This means that it may take over 3 months for the dose to reach one that is adequate for not only blood sugar control but also weight loss. Trials that investigated semaglutide for weight loss used dosages of 2.4mg once weekly subcutaneously. Research has shown that while the dose of semaglutide is low, 25% of people are likely to gain weight
Side effects may also prevent you from increasing your dosage of Ozempic to one that is effective for blood sugar control and weight loss. Common side effects include stomach pain, bloating, diarrhea, nausea, vomiting, and constipation. In clinical trials, almost 5% of people discontinued semaglutide because of side effects
You’re skipping doses – while once weekly dosing is convenient, it does mean that a missed dose will have a bigger impact on your results. Choose the same day each week (i.e., a Saturday) to take your Ozempic and stick to it
You have other existing health conditions that may be preventing you from losing weight. Trials of semaglutide have shown that people without diabetes are likely to lose more weight than those with diabetes and that non-responders tend to be sicker with more complicated metabolic abnormalities and often psychosocial issues that are going on in their life
You’re constipated – if your body is holding onto waste longer than it should be because you are constipated, this may cause you not to lose weight. Your digestive system needs to be moving and this means regular bowel movements. Try to improve regularity by eating plenty of fiber in the form of whole grains, fruits, vegetables, nuts, seeds, and legumes (at least 25 grams per day), drinking plenty of water, and being physically active.

There is no known biological marker that can predict who will respond and who won’t. It may be that people who have been prescribed a GLP-1 agonist before will have less of a response. Research has also shown that an early response to the injections is a good indicator of your response a few months later.

If you are not experiencing the expected amount of weight loss with Ozempic, talk with your healthcare provider. Keep a food diary before you go that records how many calories you are eating, and it may be beneficial to talk with a dietitian or nutritionist.

Tirzepatide vs semaglutide: How do they compare?

Both tirzepatide and semaglutide are prescription medicines used with diet and exercise to treat people with type 2 diabetes or to help people lose and maintain weight loss. Tirzepatide is also approved by the FDA to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity, while semaglutide is approved to reduce the risk of serious heart problems and to help reduce the risk of worsening kidney disease.

Can you get tirzepatide from a compounding pharmacy?

Tirzepatide cannot be legally compounded in a U.S. pharmacy at this time. It has been removed from the FDA drug shortage list as of October 2, 2024. When drugs are in short supply, the FDA may allow temporary compounding of some medicines to allow patients to continue to access their treatments. Tirzepatide is now widely available as a prescription medicine made by Eli Lilly under the brands names Mounjaro (for type 2 diabetes) and Zepbound (for weight loss and sleep apnea).

Does Ozempic cause muscle loss and how to prevent it?

Clinical trials have shown GLP-1 agonist drugs like semaglutide (Ozempic) can lead to a 13.9% loss of lean muscle mass (equal to a 6.9 kg or 15 lb) during treatment. Strategies to help prevent muscle loss include regular strength (resistance) training, aerobic exercise and adequate dietary protein, fluid and nutrient intake.

Why am I not losing weight on Ozempic?

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Tirzepatide vs semaglutide: How do they compare?

Can you get tirzepatide from a compounding pharmacy?

Does Ozempic cause muscle loss and how to prevent it?

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