5 reasons why you can't lose weight with GLP-1 drugs

Dr. Michael L. GlickmanDoctor of Medicine defines “success” as GLP-1 Drug therapy is considered a weight loss of 5% or more after 3 months of treatment.

“But ideally we would like to achieve at least 10-15% in clinical practice. [bodyweight loss]That can lead to more meaningful metabolic health,” says Dr. M., a triple board certified physician in family medicine, lifestyle medicine, and obesity medicine. revolutionary medicine. “How someone will respond to a weight loss drug can be a little unpredictable. Research shows that for every drug there is a subgroup of 'non-responders.' ”

why? The five reasons health experts see most often are:

Lifestyle changes

A footnote that is sometimes overlooked is that the semaglutide trial ( This one A study of more than 1,900 adults published in 2021 included a lifestyle intervention in both the placebo and medication groups.

“To see the best response to GLP-1 drugs, patients typically need to follow the six pillars of lifestyle medicine,” Glickman says. Those pillars are:

• Eat a plant-forward diet
• regular exercise
• managing stress
• avoid substance use
• maintain strong social relationships with family and friends

Are these novel? No, but Glickman says they are essential to people, whether they are healthy or not. trying to lose weight or not, which may interfere with the effectiveness of anti-obesity drugs.

2023 study He pointed out another reason why exercise is essential for people taking weight loss drugs: When a person loses weight, lose muscle mass.

Exercise helps reduce that loss and associated risks such as injury.

Not taking medicine as prescribed

Taking the correct dosage regularly is important for success.

“If a medication is not taken as prescribed, such as by forgetting a dose or not following the timing or dosage instructions, it may not be as effective.” Dr. Joshua Quinones, MDa board-certified internal medicine physician at the Manhattan Medical Board; lab finder.

The causes of this problem range from a lack of education on how to take medications to forgetfulness. Additionally, research shows that you are more likely to lose weight if you take this drug for a long time.

a 2022 trial They showed that people regained two-thirds of their weight within a year of stopping 2.4 mg of weekly semaglutide. Similarly, Quinones says you may not see any weight loss.

“GLP-1 agonists often require a period of treatment to reach their full effect,” he says. “Premature discontinuation or failure to adhere to the prescribed regimen may result in failure to achieve treatment goals.”

Recall that this trial followed patients for over a year (68 weeks).

a 2021 Trial A response by week 20 predicted 15% weight loss success, with more than 96% of participants demonstrating that they could maintain weight loss.

in Reuters report Only 32% of people said they were still taking Ozempic and Wigovy a year later, according to an analysis by pharmacy benefits manager Prime Therapeutics.

Not everyone can afford to continue using drugs for long periods of time.of Monthly cost Drugs like Wegovy cost about $1,000.

A report says insurance programs, including Medicare, don't always cover weight-loss drugs, and a bill to expand Medicare coverage to anti-obesity drugs has stalled. Scientific American Report. Even if people can afford the drugs, shortages are plaguing patients.

Beyond access – important elements — Patients may experience side effects such as gastrointestinal discomfort. For some people, these side effects are enough to stop taking the drug altogether.

“Drug side effects often go away over time, but if the side effects are severe enough, some patients may decide it's not worth seeing what happens,” Garcia-Webb says. . “The ultimate goal of these medicines is to improve people's health and quality of life, and it doesn't mean they need to use up all their sick leave.”

Other medical problems

A person may have other medical problems that are undiagnosed or untreated or undertreated.

“Some medical problems – hypothyroidismsleep apnea, chronic insomniaJust to name a few, weight loss should be treated before you begin treatment, as it can hinder your weight loss efforts,” says Garcia-Webb.

Additionally, some may suffer from eating disorders.

“For patients suffering from obesity” Bulimia“Bulimia can sometimes be corrected with GLP-1 agonists, but this is not always the case,” says Garcia-Webb.

a Looking back on 2024 A small pilot study suggests that GLP-1 can alleviate some eating disorders, but researchers said more rigorously collected data are needed.

insulin resistance

Ozempic is designed to treat diabetics and help lower A1C. However, research 2022 Story Reviewindicating that weight loss with GLP-1 drugs may be reduced.

“If you already have an established metabolic disease, especially if it's been established for a long time, it's an even harder battle to reverse that abnormality,” Glickman says.

The reaction is physiological.

“In patients with type 2 diabetes, the body's ability to stimulate insulin secretion in response to GLP-1 is reduced,” Quinones explains. “Normally, GLP-1 helps control blood sugar levels by stimulating the pancreas to release insulin after meals. However, this response may not be as strong as it is in people without diabetes. The response to GLP-1 is weakened. This can make it difficult for people with diabetes to manage their blood sugar levels and may require alternative treatments or dosage adjustments.

drug interference

People who take GLP-1 drugs with other drugs may have less weight loss.

“If patients are taking certain medications at the same time, it can be difficult to lose weight. promote weight gainsuch as certain antidepressants beta blocker'' Glickman said.

Garcia-Webb agrees, recommending talking to your health care provider about other medications you're taking before starting GLP-1 treatment and if you're not seeing weight loss.

Importantly, patience is key when taking medications such as Ozempic and Wegovy.

“Ideally, you would take the medication for at least 12 weeks before it takes effect,” Garcia-Webb says.

But if the needle hasn't moved by that point or you have concerns, experts say there are options.

please consult your doctor

Experts stressed the importance of having an open dialogue with your doctor, whether you're losing weight or not.

“It is essential to seek guidance from your health care provider,” Quinones says. “They can evaluate individual factors that influence efficacy and suggest any necessary adjustments, such as changing the dose or considering alternative treatments.”

Garcia-Webb meets with patients at least once a month if the dose is increased, and more often if the patient has serious side effects. She encourages people to find a health care provider with a regular follow-up plan.

Fine-tuning your lifestyle

Collect data about yourself.

“Are you optimizing your lifestyle changes, such as stopping when you’re full, eating mostly unprocessed, whole foods, and making your own meals instead of eating takeout or delivery?” drink enough water, do you sleep seven to several hours each night and exercise consistently? ” Garcia-Webb suggests asking yourself the following questions:

If not, here's how to adjust your habits, says Quinones. Portion control, can help. Additionally, stress can affect your habits, from eating to sleeping.

“addressing emotional and psychological Different aspects are important,” he says. “Seeking help from a therapist, counselor, or support group can help address issues such as emotional eating and emotional eating. stress managementIt promotes progress in overall health and weight management. ”

Manage side effects

Side effects may disappear over time. But Garcia-Webb says people can take several steps to reduce and manage them, including:

• Eat small meals frequently.
• Avoid fatty foods as they can stay in your stomach for longer and worsen digestive problems such as nausea and reflux.
• Ask your doctor about over-the-counter and prescription medications that may help manage side effects only in the short term.

switch to another drug

Ozempic and Wegovy aren't your only options. Zepbound was approved in 2023 for the treatment of obesity and overweight, as well as certain underlying medical conditions.

a 2023 trial They showed that people living with overweight who were not obese or diabetic experienced an average weight loss of 21% by 36 weeks.

Munjarouses the same ingredient (tirzepatide), is manufactured by the same company (Eli Lilly), and is intended for diabetics.

Mr. Quinones, from Wegovy. zep bound It might be worth a try. There are differences between the two drugs.

“Wygoby, derived from semaglutide, acts as a GLP-1 receptor agonist, suppressing appetite by mimicking the GLP-1 hormone, increasing insulin secretion and signaling satiety to the brain,” he says. “In contrast, Zepbound, a tirzepatide, acts as a dual agonist for both glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptors, promoting insulin secretion and satiety. GIP and GLP-1 agonists are both hormones that are naturally produced in our gastrointestinal system.”

Quinones says some people may experience lose more weight Zepbound also includes people who don't respond to Wegovy.

Many people respond to Wigovy and Ozempic for weight loss, but up to about 15% of people do not respond to this drug.

The reasons vary, from the need to make lifestyle adjustments such as diet and exercise to metabolic issues and side effects of other medications.

GLP-1 drugs are best taken long-term, but scarcity, price, and side effects such as gastrointestinal discomfort are potential barriers for some people.

Additionally, other medical issues may interfere with weight loss. It is important to discuss your concerns with your doctor and for your health care provider to develop a follow-up plan. Your doctor may help you manage side effects.

They may also refer you to specialists who treat other conditions or work with you to find medications for conditions such as depression, where weight gain is not usually listed as a side effect.

Other drugs, such as Zepbound, may be more effective for some patients.