- Interest in semaglutide, the generic name for Ozempic and Wegovy, spiked in 2023.
- Clinical trials indicated that, with these drugs, people can lose an average of 15% of their body weight.
- However, not everyone will lose that weight; others may plateau after months of significant loss.
- Doctors share that various factors play a role in what’s being called the “Ozempic plateau,” including genetics, dosing, and lifestyle habits.
Semaglutide, sold under the brand names Ozempic and Wegovy, reached new heights of popularity in 2023.
Clinical trials have indicated that people can lose an average of 15% of their body weight while taking weekly injections of these medications.
However, not everyone who takes these drugs experiences this weight loss — or significant weight loss at all.
Some may notice a reduction quickly, only to see the loss taper off before hitting the average amount. It’s known as the Ozempic Plateau.
What gives?
The idea that “every body” and “everybody” is different may sound cliche, but doctors say it rings true for how a person responds to medication prescribed for weight loss.
“Many people often forget that this is just the average amount,” says Dr. Michael L. Glickman, MD, a triple-board-certified family and obesity medicine physician who founded Revolution Medicine. “Some patients may lose more than average, some patients may lose less than average, and some patients may not lose any weight at all.”
There’s no hard and fast answer to this question because, again, every person is different.
What we do know is that semaglutide is designed to imitate GLP-1, a hormone that naturally occurs in the body, to lower blood sugar levels. It affects the stomach and brain, slowing down digestion and helping people feel satisfied for longer after eating, thereby eating less (and losing weight).
However, various factors influence the way our bodies behave. A person may react differently to weight loss drugs compared to another, just as one person may experience different side effects of hormonal birth control and another may not.
“This is due to many factors, such as genetics, medical history, environment, diet, exercise, sleep, stress, and even new areas of study such as the microbiome,” says Dr. Todd Worley, MD, FACS, FASMBS, FICS, a bariatric surgeon and the medical director of digestive health services with Houston Methodist Willowbrook Hospital. “Since almost every patient has a different combination of these factors, we may see different responses to weight loss medication from patient to patient.”
Genetics and wiring aren’t in a patient’s control.
However, a few factors that physicians and patients can change might be the culprit of the “Ozempic plateau.”
Size of the medication dose
A person may need to be on a higher dose before they see results. However, guidelines require patients to start on the lowest dose of medication (0.25 mg in Ozempic’s case) and increase it every four weeks as needed.
“This also allows patients to adapt to potential side effects, such as nausea,” says Dr. Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center. “Some patients may not see the desired weight loss results until they reach higher doses.”
Ali recommends practicing patience during the ramp-up process and keeping regular appointments.
“If a patient is not seeing the prescribing provider regularly, they might not be at the correct dose,” Ali says.
But what about a plateau after months of significant weight loss that seemed on pace with the average?
“Weight plateaus are a common phenomenon in the weight loss journey,” says Dr. Steven Batash, MD, FACG, a board certified gastroenterologist and physician with Batash Endoscopic Weight Loss Center. “Initially, when people start taking Ozempic, they often experience significant weight loss. This is the same with a new diet or exercise routine.”
The same can be said for what might happen next.
“As the body adapts to the changes, weight loss may slow down or even come to a temporary halt,” Batash says. “These plateaus may last for several weeks or even months, varying from person to person.”
Other lifestyle factors
The clinical trials for Wegovy mentioned that the medication worked when taken in conjunction with other lifestyle changes.
“Dosage can be a factor in the general effectiveness of medications like Ozempic, but it’s important to know that it is not the only factor,” Batash says. “Ozempic and similar drugs are meant to work hand-in-hand with lifestyle modifications like adapting to healthier eating habits. Ozempic is not a quick fix.”
A medication may have done all it can without these tweaks, including stress management and exercise. Consider it a piece of the puzzle.
“The thing I tell patients is that all these interventions, medications, or surger[ies] are tools to help the patient change to a healthier lifestyle,” Ali says.
Medication cessation
Worley says the medication comes with side effects, notably GI discomforts like nausea, stomach pain, and constipation. While expected, these side effects aren’t necessarily pleasant, and Worley says some patients may stop taking the medication.
Notably, the medications aren’t always covered by insurance and can cost more than $1,000 a month. Price and access may also be a barrier to continuing (or regular administration of) the medication.
Clinical trials indicate that medications like Wegovy and Ozempic are meant for long-term use, so patients may notice a plateau (or even regain weight) after cessation.
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Experts share it’s crucial to discuss weight loss plateaus and challenges while taking semaglutide or a similar weight loss drug. A physician can help with a personalized plan — keyword: Personalized.
“Treating each patient as an individual, with a personalized treatment plan, means that all patients are wired individually and may need a different treatment regimen,” Worley says.
Make lifestyle modifications
Experts stress that it’s important not to overlook lifestyle modifications, like increased diet and exercise.
However, some people may have tried those modifications, including before going on Ozempic of Wegovy, and either found it challenging or did not see results despite following meal and physical activity plans.
A food and activity log might help, especially now with the new tool: Medications.
“Many people underestimate their calories and overestimate their energy expenditure,” Glickman says.
Increase the dosage
Dosing is personal to each person, and some may do better on a higher dose.
“In our practice, if a patient has reached a plateau on a certain dose, we would increase their dose by one dosing interval and monitor their progress for at least one to two months before making a further decision,” Glickman says. “If we are noticing that weight loss has resumed and continues steadily, we tend to be conservative and keep them on the dose that is working at that time until we see another plateau.”
Some patients may see steady — but not rapid — weight loss for as long as two years before reaching their final plateau, and Glickman says that’s healthy.
Try a different medication
Patients cannot exceed 2.4mg doses of Wegovy, so what happens when they hit a prolonged plateau at that dose?
In November, the
Manufactured by Eli Lilly, Zepbound is the same drug as Mounjaro, which is only approved for people with type 2 diabetes. Per the approval, doses begin at 2.5mg weekly and can max out at 15mg.
Moreover, a trial published in 2022 indicated patients lost an average of 15% of their body weight and up to nearly 23%.
Another
“With this thinking, it is a reasonable alternative for someone who has reached a plateau in their weight loss,” Worley says.
The manufacturers and clinical trial data are not the only differences between Zebpound and Wegovy.
“Zepbound takes a unique approach by focusing on appetite regulation, specifically targeting brain receptors to induce a feeling of fullness,” Batash explains. “This sets it apart from Ozempic, which primarily addresses glycemic control in individuals with type 2 diabetes.”
“Zepbound is like the tool that helps with feeling full, while Ozempic is more about keeping blood sugar levels in check. They each cater to different physiological aspects, providing healthcare professionals with targeted options based on the specific health needs of their patients,” Batash added.
So, yes, a person may respond better to Zepbound. However, Ali says it’s important to note that your healthcare professional will likely start on the minimum dose for that drug as well before increasing it to as high as 15mg weekly.
Clinical trials indicate patients can lose up to 15% of their body weight by taking 2.4mg doses of Wegovy once per week.
However, not everyone will experience this weight loss, and experts share that some patients will plateau.
Various factors could be behind this plateau, including genetics and how a person is wired.
Semaglutide mimics the naturally occurring hormone GLP-1, and people respond differently.
A need to increase the dose may also be at play.
Some patients may experience more significant weight loss on a different medication, like Zepbound.
Speaking with a healthcare professional is essential, as it’s highly personalized. They can help you determine next steps.
