Ozempic weight loss plateau: What is it and how to get past it

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After using Ozempic for a while, many people may reach a plateau with their weight loss progress. Jaap Arriens/NurPhoto via Getty Images

For many people who have struggled with losing weight, semaglutide-based diabetes drugs such as Ozempic and Wegovy have offered a different approach to weight loss. The medications can result in a 10% to 15%, or greater, reduction in weight, though the use of Ozempic is not approved for weight loss by the Federal Drug Administration in the U.S.

However, after a certain point, semaglutide medications stop helping one shed pounds. At this plateau, no further weight is lost unless something meaningful changes.

This typically means switching to a stronger medication or making dietary or exercise changes, although these measures do not always resolve the plateau.

Such drugs mimic a naturally occurring hormone that provides the brain with a sensation of feeling full and slows down digestion, causing food to leave the body more slowly.

When a person stops taking semaglutide, lost weight returns. To avoid this, the medication is taken for the rest of one’s life.

Hitting a weight loss plateau after a year

Such plateaus are common, said Dr. Mir Ali, medical director at the MemorialCare Surgical Weight Loss Center.

“The studies I’ve seen say that patients tend to plateau with semaglutide at 60 weeks. So it’s over a year, which is pretty good,” said Dr. Ali.

Indeed, many people find that a weight loss method of any kind may stop working after a while. This is true for conventional diets, exercise regimens, and so on.

“The plateaus tend to happen after the patient loses a significant amount of weight and is getting closer to a healthy weight,” Dr. Ali said. “The body is tending to hold on to calories to preserve itself.”

University of Pittsburgh endocrinologist, Dr. Jason Ng, explained the mechanics: “Weight loss plateau happens when your body’s energy burn equals energy being added through food.”

“Initially, with weight loss, when you significantly decrease energy intake, the body will get energy needs through other sources such as glycogen. This triggers weight loss. Over time, as you lose weight, your metabolism will slow down to compensate,” he explained.

“The point at which your metabolism is equal to how much energy you intake through food is when the plateau hits,” said Dr. Ng.

The best way to get over a plateau is to again significantly alter the energy balance, which can be done via increased physical activity or further decreasing food intake, for example,” he said.

When weight loss expectations do not match reality

A person’s idea of their weight target may be different from what is healthy for their particular body, and this is often the source for those experiencing such plateaus.

“There are patients who are very focused on the scale,” said Dr. Ali. “They weigh themselves every day, and get upset if they go up a pound or down not as much as they want.”

Such weight micromanagement misses the medical point of weight loss, he said.

“My advice to them is to try to focus on doing the right things — eating healthier, exercising — and not weight. You know, the goal is to get you to have better health, not necessarily focus on a number. Maybe the scale isn’t changing as much as they’d hoped, but their body composition is changing, their clothes are fitting better, they’re feeling better, their health is improving,” he told Medical News Today.

Will I need a stronger dose of semaglutide?

Another factor driving a leveling off of effectiveness is that dosing for semaglutide drugs must be precisely tailored to individual patients.

Dr. Ali explained that one’s physician should start at the lowest dose, and then gradually increase it until effective weight loss is achieved.

”Once you reach a maximum dose, you can’t go any further than that,” said Dr. Ali.

There are stronger drugs that a physician may consider in the event of a plateau. As a glucagon-like peptide-1, or GLP-1, agonist, semaglutide targets one hormone. A new double agonist, tirzepatide, marketed as Mounjaro, mimics two, theoretically doubling the strength of the weight-loss effect. It performed successfully in a trial for 85% of participants, achieving sustained weight losses of up to 20% in some people.

The trial study notes, however, that the long-term safety of tirzepatide is unknown. A triple agonist, mincing three hormones, retatrutide, is also under review.

If dietary changes, a more powerful medication, or a modified exercise program do not get one off of their semaglutide plateau, they may have reached the limit of such drugs’ effectiveness.

A lifetime commitment to Ozempic

The cautionary note in the tirzepatide study is worthy of consideration. Semaglutide drugs have been available since 2017, and reported adverse effects are mostly limited to temporary gastrointestinal discomfort as the body accommodates to the drug.

However, a young or middle-aged person committing to semaglutide or the other diet agonists may be taking them for several, or even many, decades. By these standards, such drugs are new, and their very long-term effects on the body are not yet known.

Anyone embarking on a lifetime of semaglutide or similar medications should understand that their level of long-term risk is unknown.

Who might consider semaglutide

As a bariatric surgeon, Dr. Ali explained his criteria for deciding the proper therapeutic approach for someone needing to lose weight for health reasons.

He explained it has to do with body mass index, or BMI. He noted that “it’s not perfect, [but] it does give us a guide to guide patients for weight loss. The [healthy] range for body mass index is 18 to 25.”

“If a patient has a BMI of 40, then they should pursue surgery for weight loss. Between 35 and 40, if they have other conditions like diabetes or high blood pressure, they should still pursue surgery,” Dr. Ali recommended.

“Then between 30 and 35, they don’t meet the criteria for surgery. And that’s where newer medications are effective,” he added.