Semaglutides have been in demand for those who have struggled with weight loss. As of now, the US Food and Drug Administration (FDA) has approved for the long-term usage of seven medications in individuals with a body mass index of 30 or higher: orlistat, phentermine-topiramate, setmelanotide, tirsepatide, bupropion-naltrexone, liraglutide, and semaglutide.
Wegovy is classified as a semaglutide that acts like a hormone that our body produces called glucagon-like peptide-1 (GLP-1). One of the key functions of GLP-1 is to stimulate insulin secretion from pancreatic beta cells in response to elevated blood glucose levels. It also inhibits glucagon secretion, slows gastric emptying, and promotes feelings of fullness or satiety, which can help regulate food intake and body weight.
If you’re on Wegovy and you haven’t lost any weight, we will explore the reasons such as stress, metabolic differences and diet tweaks. Plus, you’ll learn about a registered dietitians (me!) 5 ways to increase weight loss while on Wegovy so that you can optimize your journey.
Keep in mind, that more research is being conducted to answer the question of how long will it take to lose weight on a GLP-1. One research article published by the Journal of the American Medical Association showed that after 3 months, participants experienced an average weight loss of 14.76 pounds (5.9% of initial body weight), which increased to 27.06 kg (10.9% of initial body weight) after 6 months.
Topics We Cover
- How Does Wegovy Work in Weight Loss?
- Why Am I Not Losing Weight on Wegovy
- 5 Ways to Increase Weight Loss While on Wegovy
- Clinical Observations on Wegovy from a Registered Dietitian
How Does Wegovy Work in Weight Loss?
Wegovy, or semaglutide, operates as a glucagon-like peptide-1 receptor agonist (GLP-1 RA) which essentially reduces appetite and cravings, increases feelings of fullness, and slows gastric emptying, resulting in decreased food intake and gradual weight loss over time.
One of the main mechanisms of action is it slows down how food leaves your stomach through the reduction of motility. This delay reduces the way carbohydrates are absorbed and how it can help type 2 diabetic patients gain better glycemic control. More research is still needed to see what long-term use will have on gut function.
Why Am I Not Losing Weight on Wegovy
In clinical trials, Wegovy after 68 weeks with 2.5 mg injections provided an average weight loss of 33.66 pounds (14.9%) versus the placebo group at 5.7 pounds (2.4%). However, what if you are the one person who is not seeing the results you’d like to on the medication? Below are some considerations to take as part of your weight loss plan.
Setting Realistic Expectations for Weight Loss with Wegovy
It’s important to manage our expectations that it’s not a one-size-fits-all approach to weight loss. This is why working with a registered dietitian and medical team ensures your journey is comprehensive to include lifestyle adjustments. Wegovy should be used as a tool that can help get a part of the work done. Other tools such as protein-rich foods, strength training exercises, and stress management will make your weight loss goals more achievable in the long run. Based on research, it’s safe to say that you should see an average of 5-15% of your current body weight lost in little over a year.
If you’re a 250-pound individual the maximum weight loss you would see is a 37.5-pound. This also would be about a 1/2 pound of weight loss per week over 68 weeks.
Metabolic Differences in Weight Loss on Wegovy
Your metabolism is defined as the reactions that take place to provide the cells in your body with the energy needed to function.
The reason you might not be losing weight while on Wegovy is due to metabolic inflexibility. This means that your body is having a hard time switching between energy sources, specifically fat. In my practice, I see a handful of individuals who have been prescribed Wegovy, but can’t seem to lose weight after 6-months of being on it.
Improving intake and physical activity have been two major tools we’ve used to help combat these difficulties.
Not Eating Enough
This was one you probably weren’t expecting! However, if you have a history of dieting where you tend to restrict your calorie intake your metabolic rate goes down. This means it may be harder for you to lose weight.
When your body is not getting the fuel it needs, it begins to store fuel as fat. Then, when you exercise it will protect the fat that is stored. This is why weight loss may be difficult for those who are overweight or obese.
Imagine having a history of eating like 500 calories, you work out hard for a period of time and then going on a medication that makes you eat less.
This is why it’s very important to work with a registered dietitian, so that you can establish a plan before, during, and potentially after taking the medication. This way your weight loss becomes sustainable for the rest of your life.
Inconsistent Medication Adherence
What some doctors do, is bring the dose up to the full 2.4 mg over a couple of months based on the schedule above. Of course, the above is a general recommendation and is between you and your doctor.
When you skip a dose of Wegovy you may not see the results as fast as you would like, but that does not mean all is lost! At the very least, if you continue to make adjustments to your daily routine such as reducing stress and improving your movement routine, you can still lose weight.
Too Much Stress
Stress influences weight gain through hormonal fluctuations, such as increased cortisol levels, which promote fat storage and trigger cravings for high-calorie foods. I always say to my patients, you want cortisol to kick in when running away from a bear, but not every day!
This never ending presence of stress releases chemicals like cortisol, norepinephrine, and CRH, which can cause problems in different parts of the body. They can slow down growth, affect thyroid function, and cause hormonal irregularities in eating patterns. All which can lead to muscle loss, bone loss, and accumulation of fat in the belly.
Managing stress through techniques like exercise, mindfulness, and seeking support, can help mitigate its impact on weight gain, fostering healthier habits and coping mechanisms.
Improving a sedentary lifestyle involves gradually increasing physical activity and reducing prolonged sitting. Begin by setting achievable goals and incorporating movement throughout the day, like taking regular breaks to stand up or stretch. While on weight loss medication such as Wegovy, it’s essential to maintain a strength training exercise routine.
Research shows that fat loss does take place on these medications but, so does muscle loss.
Find enjoyable activities such as walking, cycling, or dancing, and schedule regular exercise sessions while starting slowly and progressing gradually to prevent injury. Incorporate strength training at least twice a week, and be active in daily routines by opting for stairs over elevators and walking for short errands.
Monitor progress, make exercise social, and prioritize rest and recovery to maintain motivation and prevent burnout. These steps help cultivate healthier habits but, also may be the reason why you’re not seeing weight loss while on Wegovy.
Medical Conditions Affecting Weight Loss
There are differences in medications such as those prescribed for weight loss and another for type 2 diabetes, most commonly known as Ozempic which has different strengths. If you have hormonal difficulties such as thyroid disorders, this can be an underlying reason you’re not losing the weight you want.
5 Ways to Increase Weight Loss While on Wegovy
Starting a weight loss journey can feel like a big task but, with options like Wegovy now available, it’s easier to feel hopeful about reaching your goals. As more people focus on getting healthier, it’s important to know how to make the most of Wegovy.
Whether it’s changing what you eat or making small lifestyle changes, finding the right strategies can help you lose weight while using this new treatment. Let’s explore some simple tips and ideas that I provide to my patients to help make your weight loss journey with Wegovy a success.
Seeking professional guidance for personalized advice
There is a reason I stuck this one first! Food and exercise are more than just eating vegetables 5 times a week and doing high-intensity interval training. If you’re someone who has emotional eating tendencies, consider working with a therapist and dietitian together to help you uncover the main cause of why they originated.
It also helps to have a plan to maintain lifestyle behaviors.
These are the steps I take with my patients before they start weight loss medications like Wegovy
- Biometrics: Gain a baseline of your body fat %, height, weight, waist circumference
- Current intake: Get clear on how much you’re eating now
- Emotional Food Tendencies: Do you stress eat? Do certian foods evoke emotion triggers?
- Current Digestion: Do you have bloating? Bowel irregularities?
Adopting a Balanced and Nutritious Diet
Protein here is going to be key. Protein helps with cravings, period. In my practice, when I encourage my patients to start with something as simple as two boiled eggs at breakfast, they see:
- Reduction in cravings from every day to maybe one time a week
- Improvements in energy levels, to the point they are asking themselves “Why do I have all this energy?!”
- Feel more in control of their choices because they don’t feel like they are “snacking” all the time
One study showed that with an increase of protein to 25% of their daily calories, cravings and late-night snacking were reduced by 60%. It also can help to burn more calories, temporarily boosting metabolism.
Incorporating Regular Physical Activity
I’m sure you’ve already heard about the 150-minutes of exercise we need to have in a week. Well, I’m not about to beat that point over the head here! Instead, I want to give you an action plan to start with.
If this is your first venture into incoporating exercise into your plan, take these steps:
- Assess: In your week, where do you have 2-15 minute windows to add purposeful movement?
- Explore: Now that you established the time, I want you to figure out what you like to do. Is it walking, playing with your children in the backyard, stretching, or a dance routine?
- Remind: How will you remember to do this? Will it be post-it notes around your desktop?
- Implement: Now, get ready to do it and feel great!
- Reflect: Once you’re done with your 15 minutes, what did you notice afterward? Less tension? Muscle release? More energy? Better sleep at night?
Monitoring and Managing Stress Levels
One of the key questions I ask, is on a scale of 1 to 10 how stressful would you describe your day? If you’re chronically a 6 or higher, there is something that is on your plate that is too much. Identify what your triggers are and see if there is something that can help to reduce it.
Some great ways to help your body handle stress a little better can be the following:
- Consider an adaptogen supplement which can come in the form of tea or capsules. Common names are Ashwagnhda or Reishi Mushroom which have been studied to have therapeutic effects on stress-related conditions.
- Add stretch breaks to your day. This can be a 5-minute stretch that opens up your hips and shoulders allowing for more movement and tension release.
Establish a Good Sleep Hygiene Schedule
Sleep should be at the core of every wellness routine because it’s when our bodies have a chance to repair and refresh us. Some of the common things I hear, is that just before bed one is scrolling on their phone for an hour and then trying to get to sleep, or having a choppy sleep. Blue light from devices has an impact on sleep quality and duration which can affect your daily performance from day to do.
It’s important to establish a night time ritual and some ideas can look like the following:
- Consider leaving your phone in the next room about 30-minutes before you go to bed
- Add some night time tea to your evening ritual to calm and soothe you
- Listen to your favorite relaxation music or turn on the Calm app so that you can start entering into your sleep
Clinical Observations on Wegovy from a Registered Dietitian
I’ve often been asked the question, “What do you think about me going on a weight loss medication like Wegovy?” My answer will always be if you and your doctor are willing to try a weight loss medication and you have no medical condition prohibiting it, give it a shot.
I do see patients with weight loss anywhere from 5-20 pounds on average while on the Wegovy. It is also observed that patients who are inconsistent with working out and eating consistently do not see rapid weight loss. They also plateau at 5 pounds. For patients who have a history of chronic dieting with severe calorie restrictions (we’re talking like 500 calories a day), this medication does not work because it forces them to continue eating less.
What I do see, is there is a reduction in cravings. This gives my patietns the chance to make choices that will benefit them.
If there is no urgency to going on the medication establish a baseline of healthy food habits and an exercise routine that you can maintain. Then, if you need additional help consider weight loss medication to give you the boost.
This can be a variety of factors such as not exercising enough or incorporating enought protein in your diet. This is why it’s important to work with a registered dietitian to improve these lifestyle factors to enhance weight loss outcomes while on this weight loss medication.
In clinical trials, Wegovy after 68 weeks with 2.5 mg injections provided an average weight loss of 33.66 pounds (14.9%) versus the placebo group at 5.7 pounds (2.4%).
This can be because you’ve skipped a few doses or you have underlying medical conditions prohibiting your weight loss.
You should stick to a wellness routine that will improve your quality of life. Seek medical help, improve the food choices you make, promote good sleeping patterns, and add strength training movement to your weekly routine.
Disclaimer: This article is not intended to provide medical advice, diagnosis, opinion, treatment or services. This article and the links contained in it provide general information for educational purposes only. The information provided in this article is not a substitute for medical care, and should not be used in place of the advice of your physician or registered dietitian.
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Christa is a media dietitian and nutrition consultant in the New York City area. She works with various brands and has been featured in dozens of outlets such as Women’s Health, EatingWell, and Peoples Magazine as a nutrition expert. Being a fact checker for EatingWell Magazine and a Medical Reviewer for Nourish, she brings her extensive experience within the field to provide compassionate, inclusive care using science for intimate and personalized messaging.
Christa brings warm laughter, joy, and medical expertise to any conversation allowing for honest science-based discussions with authenticity at their core.
In her private practice, she works with men and women suffering from emotional traumas that cause binge eating disorders exacerbating their type 2 diabetes, PCOS and insulin resistance.