Find out what could be causing your weight loss plateau on Ozempic and other GLP-1 medications.
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GLP-1 medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) are widely hailed as weight loss game changers. So if you're taking one of these new drugs and the scale doesn't seem to be budging, you may be wondering what's going on.
Sometimes it's a matter of being patient, as it may take a few weeks before you notice results, and plateaus can be a normal part of weight loss. That said, you shouldn't rely solely on Ozempic to reach your goal.
"In order to see the results demonstrated in studies, GLP-1 medications should be combined with dietary and lifestyle interventions," says Samantha Flanagan, DO, an obesity medicine specialist with Temple Health in Philadelphia. For maximum success, you need to steer clear of some common missteps that place key lifestyle changes on the back burner.
Additionally, GLP-1 weight loss drugs don’t work for everyone. Those with diabetes tend to lose slightly less weight, and even some people without diabetes may need to adjust their dose or try switching to a different weight loss medication to see results. If you have questions or concerns about your progress, let your doctor know.
1. You’re Not Exercising
Some may assume you don't need to lift a finger to shed pounds once you're taking Ozempic, but people who use this medication lose more fat when they exercise regularly. Physical activity can lead to bigger improvements in insulin sensitivity and heart health, too.
"An activity prescription is an essential part of all long-term [weight loss] plans,” says Richard Siegel, MD, an endocrinologist and a codirector of the diabetes and lipid center at Tufts Medical Center in Boston.
The clinician who prescribed your weight loss drug should also support your effort to improve your exercise habits. If they don’t, it might be a red flag that you’re not getting the thorough weight loss treatment and expertise that you deserve. Some sources such as online clinics and med spas, perhaps particularly those that provide compounded GLP-1s, may be less likely to offer lifestyle advice and support.
Aim for at least 150 minutes of moderate aerobic activity per week (think brisk walking, bicycling, or swimming). Plan for at least three weekly strength-training sessions, too. "Strength training can help to limit the loss of muscle and bone tissue, which can be a problem with all weight programs and may be exacerbated with the use of medication," says Dr. Siegal.
2. You Didn’t Change Your Diet
While it's more common for people to struggle with eating enough on a GLP-1, not everyone on the medication ends up reducing their overall caloric intake the key to successful weight loss.
"Certain dietary habits can lead to higher caloric intake and less-balanced nutrition,” says Dr. Flanagan. “These include things like grazing (snacking all day but not eating any true meals) and alternating between skipping meals and eating larger, unhealthy meals.”
The quality of the foods you eat matters, too. An optimized eating plan that emphasizes lean proteins, whole grains, fruits and vegetables, and healthy fats can help you stay satisfied (so you're less prone to grazing) and preserve more of that all-important lean muscle mass. If you're struggling to find foods that work for you, your doctor can refer you to a registered dietitian-nutritionist who can help you find an eating plan that's both doable and delicious.
3. You’re Not Taking It as Prescribed
As with any other medication, GLP-1s work best when you follow your doctor's dosing instructions carefully, says Siegal. So if you’re finding it difficult to stick to your prescribed plan, perhaps because of the often-cited unpleasant side effects of Ozempic, you may not lose as much weight as expected. You may even end up regaining some of the weight you already lost.
It's okay to lower your dose or stop taking your GLP-1 altogether, but it's important to do so with the guidance of your healthcare provider. If there are factors that are making it difficult for you to take your medication as prescribed, they may be able to help you troubleshoot and find a regimen that works better for you.
4. Your Other Medications Are Interfering
Certain medications may make it more difficult to lose weight regardless of whether you're taking a GLP-1. Common culprits can include antipsychotic medications, beta-blockers, certain antidepressants, oral steroids, some anti-seizure drugs, and some diabetes medications such as insulin and sulfonylureas.
These medications deliver important benefits, so you shouldn't just stop taking them for the sake of weight loss, says Flanagan. Instead, talk with your doctor about your medication plan as a whole. Together, you can figure out how to improve your weight loss plan while keeping any other health conditions under control.
5. You Need a Higher Dose
You may need a higher dose of a GLP-1 (or any other medication, for that matter) in order to achieve the results you’re seeking, even if you’ve made the recommended lifestyle changes. "Some people have a very significant response at the lowest dose of medication,” says Siegal. “Others need a higher dose to achieve a weight loss of 5 percent (of their body weight) or more."
It's worth giving your body a little bit of time if you're not seeing the number on the scale trend downward. But if you've plateaued after a month or two at your current dose, talk with your doctor, says Siegal. As long as you're meeting your nutritional needs and your side effects are manageable, you may decide together to increase your dosage.
If you’re using a compounded GLP-1 drug, it’s worth noting that these off-brand medications are not inspected by the U.S. Food and Drug Administration (FDA) and in some cases may be less effective than their brand-name equivalents, or even fraudulent. The risk of ineffective medication may be even higher for compounded forms of GLP-1 drugs with non-FDA-approved delivery methods, such as sublingual pills and tinctures.
6. Stress or Bad Sleep Is Sabotaging Your Weight Loss
Regardless of whether you take a GLP-1, chronic stress and a lack of quality sleep aren’t helpful for healthy weight management. "This is something I talk a lot about with my patients," says Flanagan.
Both stress and sleep deprivation signal the release of hunger-promoting hormones like cortisol, which can encourage your body to store fat, says Siegal. You're also more likely to make unhealthy dietary choices when you're zapped.
To better support the work of your GLP-1, aim to get the recommended 7 to 9 hours of sleep per night. And if you're struggling with stress, explore stress management techniques to find a handful that may help you relax on difficult days.
The Takeaway
While GLP-1s often come with the expectation of significant weight loss, a number of factors can influence how your body responds to these medications.
It’s important to combine your GLP-1 with dietary and lifestyle interventions such as regular exercise, a balanced diet, and quality sleep to achieve desired results.
If you’re not seeing the results you want, reach out to your healthcare provider, who can help troubleshoot your current medication dose, connect you with a registered dietitian-nutritionist, and explore other factors that may be hindering your weight loss success.
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Resources
Mozaffarian D et al. Nutritional Priorities to Support GLP-1 Therapy for Obesity: A Joint Advisory From the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society. Obesity. May 30, 2025.
Moorman J. GLP-1 Medications and Weight Loss: Helping Patients Navigate Beyond the Trends. Wolters Kluwer.
Verhaegen AA et al. Drugs That Affect Body Weight, Body Fat Distribution, and Metabolism. Endotext. February 11, 2019.
Neumiller JJ et al. Compounded GLP-1 and Dual GIP/GLP-1 Receptor Agonists: A Statement from the American Diabetes Association. Diabetes Care. December 2, 2024.
Adam Gilden, MD, MSCE, is an associate director of the Obesity Medicine Fellowship at University of Colorado School of Medicine and associate director of the Colorado University Medicine Weight Management and Wellness Clinic in Aurora. Dr. Gilden works in a multidisciplinary academic center with other physicians, nurse practitioners, registered dietitians, and a psychologist, and collaborates closely with bariatric surgeons.
Gilden is very involved in education in obesity medicine, lecturing in one of the obesity medicine board review courses and serving as the lead author on the Annals of Internal Medicine article "In the Clinic" on obesity.
He lives in Denver, where he enjoys spending time with family, and playing tennis.
Marygrace Taylor is a health writer and editor based in Philadelphia. Her work has appeared in publications including Parade, Glamour, Women's Health, Prevention, Redbook, Men's Health, and O, The Oprah Magazine. She's also the coauthor of Eat Clean, Stay Lean: The Diet and Prevention Mediterranean Table.
