Why Isn’t Ozempic Working For Me?
Over the past year, I've been guiding patients through weight loss journeys with medications like semaglutide (Ozempic) and tirzapetide (Mounjaro, Zapbound). It's been rewarding to witness many succeed with a combo of meds, dietary tweaks, and lifestyle changes. But every now and then, there are patients who hit roadblocks or don't see the results they expected. Let's dive into some common reasons why Ozempic might not be doing its thing as expected.
High sugar intake: The first question I always ask is, "What's in your cup?" If it's soda, sweet tea, alcohol, or milk brimming with sugar, that could be the culprit. Ozempic (semaglutide) works by regulating blood sugar levels but if you are chugging high-sugar drinks, it’s like trying to swim upstream. I recommend keeping sugar intake under 30 grams/day for best results.
High carb intake: Carbohydrates essentially turn into sugar, especially simple carbs like bread, fruits, and sweets. Again, this causes an elevation in blood sugar and handcuffs Ozempic effectiveness.
Low protein intake: Protein is key for keeping those hunger pangs at bay and revving up metabolism. I steer away from the 1gm per lb of body weight rule and instead suggest a science-backed approach that recommends 0.5 gm of protein per day of ideal body weight. You can check it out HERE. If you're not hitting your protein goals, those cravings and snack attacks might be holding you back.
Supplementation use: Oftentimes, weight gain isn't just about calories. Hormonal imbalances, like low vitamin D levels, can throw a wrench into your weight loss plans. I often recommend supplements like MTV, vitamin D, and Berberine to my patients, especially in regions like Kentucky and Tennessee where vitamin D deficiency is common. Vitamin D is a pre-hormone and if it is low then it can impact all hormone levels and ultimately weight gain and weight loss. Low Vitamin D levels are linked with obesity. Patients who live in Kentucky and Tennessee where I practice almost always have a Vitamin D level that is deficient, low, or at minimal not optimal ( I recommend levels around 60 or more).
Not eating enough: Rapid weight loss might seem appealing, but it can lead to issues like gallbladder stones and stalled metabolism. Slow and steady wins the race, with a target of no more than 2 lbs per week on average weight loss. For patients who aren’t eating enough, I recommend they decrease their dose of Ozempic and increase their daily intake.
Activity levels: Although exercise only plays a small part in actual weight loss (much more is due to what we eat) if you’ve had a change in your activity level it can impact your weight loss. For example, if you are a nurse who goes from working on the floor of a hospital and routinely getting over 10,000 steps per day and you change to a desk job and struggle to get 3,000 steps per day that is going to take some adjusting. Consider either increasing activity outside of work or adjusting the amount you eat per day.
Expectations: When I start new patients on medication I have them start at a very small dose and very slowly increase it until their appetite is suppressed. Weight loss won’t happen until the dose is sufficient to curb the appetite but I often get patients that say, “I took my first two doses and I haven’t lost any weight yet”. You have to give it TIME! Gaining weight didn’t happen overnight and losing it certainly won’t either.
Hormone imbalances: If nothing else seems to be the cause then it’s always a good idea to have some lab tests run to see if hormonal imbalances might be playing a part. A variety of hormones can impact weight gain and loss such as cortisol, thyroid, and our sex hormones.
If none of these seems to be the issue then I typically recommend my patients try another weight loss medication. For example, if they have been on semaglutide and aren’t responding well then we might try tirzapetide and see if that works better for them or vice versa.
And unfortunately, studies show that about 10% of people simply do not respond to Ozempic. I haven’t seen that high of a number in my own personal practice. I've found that creating a tailored program for each patient, where medication is just one piece of the puzzle, can significantly improve outcomes. So if Ozempic isn't cutting it, don't lose hope— keep tweaking things until you find what works best for you!