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

Evan Walker
Evan Walker TheMediTary.Com |
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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
  • Drugs such as Ozempic and Wegovy eventually reach a weight loss plateau, beyond which further weight loss slows or stops.
  • Like any other healthy weight loss method, the body eventually settles at an appropriate weight, which may or may not correspond with that person’s weight loss goals.
  • GLP-1 medications require a lifelong commitment if one hopes to avoid regaining lost weight, which can be expected when one stops taking them.

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.

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.

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.

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