8 reasons why you might not be losing weight on semaglutide

If you’ve been using semaglutide (the active ingredient in brand-name drugs Wegovy®, Ozempic®, and Rybelsus®) for weight loss but aren’t experiencing the transformative results you’d hoped for, you’re not alone. 

Despite the hype, these FDA-approved drugs aren’t magic-wand solutions for weight loss. Semaglutide medications work differently for everybody, and some people don’t respond to this medication at all. 

In fact, 14% to 31% of people taking semaglutide for weight management don’t lose a significant amount of body weight, according to clinical trials. 

There are several reasons that some don’t lose weight while taking semaglutide, and understanding these can help you take the next steps on your weight loss journey. 

Why might someone not be losing weight on semaglutide? Individual results vary. But here are some possible reasons: 

The drug needs more time to kick in

Semaglutide needs time to work, so don’t expect instantaneous weight loss. It’s a prescription medication and not a miracle cure. This type of drug reduces appetite, curbs cravings, and helps you feel more full after eating. For some people, short-term weight-loss effects of semaglutide can begin in the first few weeks. However, for others it can take as long as three months to determine whether or not semaglutide is working effectively. 

Other health conditions and other drugs may be a factor

Zoom out for a second and think about what else is happening in your body. You may not see significant weight loss results due to underlying health conditions or other drugs you’re taking, which might interfere with your body’s ability to lose weight while taking semaglutide injections or tablets. Factors like age, environment, hormone changes, genetics, and predisposition to obesity can also play a role.

You may need to make additional lifestyle changes

Factors like healthy eating, regular exercise, poor sleep, and stress can affect weight loss progress. In clinical trials for semaglutide, participants paired the medication with healthy lifestyle choices, including regular exercise, reduced calorie intake, nutritious diets, and support from a nutritionist or dietitian. So, for best results, you’ll need to start or ramp up your routine to include healthy eating and increased physical activity. 

You haven’t been taking the correct dose

Semaglutide comes in two forms: an injectable medication in pen form (Ozempic and Wegovy) taken weekly or a daily tablet (Rybelsus). Compounded versions may also be available as either tablets or injection. For the best results, carefully follow the instructions from the manufacturer and your medical provider. 

Rybelsus is typically prescribed once daily. The manufacturer recommends taking one pill on an empty stomach upon waking each day with up to four ounces of plain water. Swallow the tablet whole—don’t crush, chew, or chop it. After taking the pill, wait 30 minutes before having more water, other beverages, food, or other oral medications (including vitamins or supplements).

Found’s clinicians can also prescribe compounded oral semaglutide dissolving tablets to eligible members. These are typically taken once a day. Patients simply let a tablet dissolve under the tongue or between the cheek and gum with no water. After the tablet dissolves, avoid food or caloric drinks for 30 minutes. 

Wegovy or Ozempic are typically prescribed as weekly injections. The manufacturer recommends injecting the medicine just under the skin of the thigh, abdomen, or upper arm (and not into a vein or muscle) on the same day each week, with or without food, as your provider prescribes.

It’s also possible that you’d benefit from a different or a higher dose. Health care providers typically start patients on a low dose before gradually increasing the dose. So, if you’re not losing weight on semaglutide or your weight loss has stalled, talk to your doctor about your dosage.

You’ve reached a weight-loss plateau

Some people may see initial weight loss and then encounter a weight loss plateau or metabolic adaptation—that’s when the body adapts to regain weight. When weight loss is sluggish or not happening (at all), discuss your response to your weight loss medication with your provider. 

Remember, outcomes can look different for different people. If taking semaglutide, along with exercise and healthy eating habits, has halted a trajectory of weight gain, this could still be a success.

The side effects have become unmanageable

Some people have no side effects when taking semaglutide for weight loss, or, if they do, they go away with time. 

For others, the side effects may be so challenging that they stop taking the medicine, don’t feel well enough to exercise, or can’t consume the right mix of nutrients to power their weight loss. About 16% of participants in a semaglutide study published in 2023 discontinued the medication due to adverse reactions. 

Common side effects of GLP-1 medications like semaglutide include nausea, vomiting, diarrhea, and acid reflux. More serious but less common side effects include pancreatitis, gallbladder disease, worsening of diabetic eye disease, and gastroparesis (stomach paralysis). Those with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasias should not use these drugs. Find detailed side effect and risk information for semaglutide and other medications on the dedicated GLP-1 medications page.

You need a different treatment to address the root cause of your condition

“Virtually every system in the body is affected by obesity,” explains the Obesity Medicine Association. Treating this highly complex, chronic condition, with numerous contributing factors requires a nuanced and tailored approach. So, even if one type of medication doesn’t work for you, another might be a better match—whether that’s a different GLP-1 medication or different type of weight loss drug. Working with one of Found’s obesity medicine specialists can help you uncover why you’re struggling to lose weight and pinpoint a more effective treatment plan.

You need a personalized weight care plan 

With Found’s MetabolicPrint™ tool, our clinicians assess metabolic health to personalize a weight care plan for each member. Found membership includes an in-app behavior change program, health coaching, and consultations with a provider who specializes in obesity medicine. Our clinicians can prescribe a wide range of medications, including GLP-1s, to tailor the best treatment for you.

About Found

Found is among the largest medically-supported telehealth weight care platforms in the country, having served more than 250,000 members to date. To discover your MetabolicPrint™ and start your journey with Found, take our quiz.

Found is not affiliated with Novo Nordisk A/S., the owner of the registered trademarks Wegovy®, Ozempic®, and Rybelsus®. The content provided is for informational purposes only and should not be used as a basis for diagnosing or treating any health condition. Always follow your healthcare provider’s instructions to ensure safe and effective management of your health conditions. Certain medications are only FDA approved to treat conditions other than weight but may be prescribed to help aid in weight loss. Compounded semaglutide is not FDA- approved or evaluated for safety or efficacy. Prescriptions are up to a medical provider’s discretion and not available in all states. Semaglutide has serious contraindications and risks. For key risk information by drug, visit the Found medication page.