Why isn't Wegovy or Zepbound Working for me?
Have you ever wondered why some people seem to lose weight quickly on medications like Wegovy or Zepbound, while others struggle to see much change at all?
The truth is, weight loss isn’t as straightforward as many hope. It’s rarely just about eating less or moving more and even powerful medications don’t guarantee the same results for everyone. A lot depends on how these drugs are used, the lifestyle habits that go along with them, and individual factors like metabolism, other health conditions, and even how the body tolerates the treatment.
That’s why it helps to rethink what “success” actually means. For many, losing just 5% to 10% of body weight can dramatically improve blood sugar, blood pressure, and cholesterol. Sometimes, that’s enough to lower the risk of serious health problems even if the scale doesn’t land where someone originally hoped.
In the sections that follow, you’ll see the most common reasons people fall short of their goals on these medications, how to spot them, and what can be done to get better results or explore different options. It all comes back to finding the approach that truly works for your body and your long-term health.
Rethinking How We Measure Weight Loss Success
When talking about weight loss medications like Wegovy and Zepbound, it’s important to define what “working” really means. Many expect dramatic results, but medically, success often looks different.
The main goal of these medications isn’t to reach a “normal” BMI. It’s to achieve enough weight loss to improve health. Even a modest 5% drop in body weight can lower blood sugar, blood pressure, and cholesterol. I typically aim for 10% with patients, since it tends to bring even more noticeable health benefits. Most weight-related conditions—like heart disease, diabetes, and sleep apnea—improve with a 15–20% loss. But for issues tied to the physical burden of excess weight, like breathing or mobility, even that might not be enough, which is why some may also need surgery.
In clinical trials, about 85% of people taking Wegovy lost at least 5% of their weight, and 70% reached 10%. With Zepbound, roughly 90% hit the 5% mark, 80% reached 10%, and half lost 20% or more. It’s also worth noting that people with type 2 diabetes generally lose a bit less weight, though still see health benefits.
So how do we know if a medication isn’t working? Typically, if there’s less than a 5% loss after 12 months (or three months on the highest dose), it may not be effective.
In the end, success isn’t about hitting an “ideal” weight. It’s about meaningful, realistic changes that lower health risks and improve quality of life. Setting clear expectations from the start helps people stay encouraged and focused on what matters most: better health.
Why Weight Loss Is Tougher With Type 2 Diabetes (Even on Wegovy or Zepbound)
For people with type 2 diabetes, losing weight is often more challenging—and that holds true even with powerful tools like Wegovy and Zepbound. Clinical trials consistently show that individuals with type 2 diabetes tend to have about a 10% lower success rate in reaching the typical weight loss milestones set for these medications.
That doesn’t mean people with type 2 diabetes can’t achieve meaningful weight loss. Many still see reductions of 5% to even 20% or more. It simply means they’re less likely, on average, to experience the same degree of weight loss as those without diabetes.
So why is this the case? The reasons aren’t completely understood. In a conversation on my podcast with Dr. Bays over a year ago, we talked about several possible explanations. Sometimes, it’s the other medications people with diabetes take that can make weight loss harder. Other times, it’s because managing diabetes often means juggling more health concerns, which can make it tougher to fully commit to the lifestyle changes needed for optimal results.
Personally, I think part of it comes down to how the body’s metabolism has been impacted over time. With type 2 diabetes, there’s often more extensive metabolic damage that’s built up, and getting the body to respond “normally” again can simply be a bigger uphill climb.
Because of this, people with type 2 diabetes might need to layer in additional strategies if they’re aiming for greater weight loss. Bariatric surgery can be an excellent option, often proving highly effective for managing both weight and diabetes. In some cases, adding other diabetes medications that also support weight loss may be necessary. Adjustments to diet, along with a focus on exercise including everyday movement, or what’s called non-exercise activity thermogenesis (NEAT)—can also make a meaningful difference.
It’s also important to recognize that sometimes it’s not about needing a completely new plan. If someone’s diabetes is well-controlled and their overall health is stable, accepting a smaller amount of weight loss might be perfectly reasonable. Not every situation requires an aggressive change; sometimes it’s simply about understanding why weight loss didn’t happen to the extent hoped for, and deciding whether it truly needs to.
Type 2 diabetes is one of the most common reasons people might not see the same level of results with medications like Wegovy or Zepbound as others do. Understanding this from the start helps set more realistic expectations and can guide what to do next whether that’s exploring other treatments, fine-tuning daily habits, or simply appreciating the progress that’s already been made.
Is Alcohol Hindering Your Progress? (And What to Do About It)
Patients sometimes don’t see the weight loss results they expect on medications like Wegovy or Zepbound. In my clinic, I notice a few common reasons. Beyond type 2 diabetes, which is usually the biggest factor, alcohol use is the next most frequent issue.
There has been plenty of buzz suggesting these medications might help cut down alcohol intake or other addictive behaviors. For some, that is true. I have had patients who were casual social drinkers, maybe enjoying a couple of glasses of wine each night, find it surprisingly easy to cut back or even stop once they started these medications.
But it is different for those with a more complicated relationship with alcohol. People who lean toward dependence or have true alcoholism often do not experience the same appetite-dampening effect. I have seen patients who are exercising, eating well, doing everything else right, but still drinking several drinks a day or bingeing on weekends. This not only blunts weight loss but can also be dangerous, especially if nutrition is lacking.
Some patients only see progress after directly addressing their drinking. One added naltrexone to help curb alcohol use, and suddenly the Zepbound she had invested so much into finally started working.
If cutting back on alcohol has been tough, it is worth talking openly with your prescriber. Sometimes Wegovy or Zepbound reduces cravings, but if not, seeing an addiction specialist or trying medications specifically for alcohol use might help. Generally, I recommend limiting alcohol to no more than one or two drinks a week, or ideally cutting it out. For heavy drinkers, more than six drinks daily, stopping abruptly can be risky without medical support.
How Snacking Can Undermine GLP-1 Medications
Impulsive snacking is another common hurdle I see. While these medications help people feel full faster and lower food thoughts by acting on the brain’s appetite centers, many patients still find themselves snacking without hunger.
But trouble starts when eating is not about hunger. A lot of people snack for pleasure or distraction. This is especially common in those with ADHD, who might reach for food to stimulate their brains and get a quick dopamine boost. Even without ADHD, snacking often becomes a mindless habit tied to certain activities, like working at a desk, watching TV, or just walking by the kitchen.
In these cases, the medication may not be enough on its own. It is not designed to stop eating that comes from boredom, stress, or habit. Tackling this often requires small behavioral changes, such as keeping tempting snacks out of sight or out of the house, pausing to ask if you are truly hungry before reaching for food, or finding other quick ways to get a little reward. This could be calling a friend, chewing gum, doing a few jumping jacks, or playing a short game on your phone.
If that is not enough, adding a medication like phentermine can sometimes help. For people with untreated ADHD, starting stimulant medication often reduces snacking, making Wegovy or Zepbound work much better.
In the end, understanding why snacking happens is key. Once the real reason is clear, it becomes much easier to come up with a plan that actually works whether that means changing your environment, adding another medication, or finding new ways to satisfy the need for a quick boost.
Don’t Let Side Effects Derail Your Progress on Wegovy or Zepbound
Another common reason people struggle to see results with Wegovy or Zepbound is simply because they are dealing with too many side effects. When someone feels constantly nauseous or ends up vomiting, it is tough to maintain a healthy, balanced diet. Let’s be honest, no one craves chicken, quinoa, and broccoli when they are nauseous. They are more likely to reach for crackers, bread, or ginger ale, foods that are easier on the stomach but not exactly supportive of weight loss goals.
Beyond food choices, frequent side effects can disrupt the whole routine. People often start skipping doses to avoid feeling sick or space out injections longer than recommended. Ironically, this can sometimes make side effects worse because the medication never has a chance to build up steadily in the system the way it is meant to.
When side effects are too strong, it is also harder to keep up with exercise or meal prep, two pillars that help drive better outcomes with these medications. So it is no surprise that nausea, fatigue, or digestive issues can end up stalling progress.
The good news is that side effects should not be a reason to give up. It is important to bring them up with your prescriber. There are plenty of ways to manage common issues. Anti-nausea medications, adding fiber for constipation, or boosting electrolytes for fatigue can all make a big difference. Sometimes the solution is as simple as adjusting your diet slightly, slowing the dose escalation, or planning meals around when you feel best.
If the side effects continue to be a problem, switching to a different medication may help. Just because one drug in this class caused side effects does not mean they all will. For example, if Wegovy caused nausea, you might tolerate Zepbound much better, or the other way around. Likewise, someone who struggled with constipation on one might have no issues with the other.
If you are struggling with side effects, do not just push through or quietly stop taking the medication. Talk to your healthcare provider. There are often practical adjustments or alternative options that can help you feel better and ultimately get the results you are looking for.
The Real Reasons Your Weight Loss Meds Aren’t Paying Off
One reason people sometimes fall short of their weight loss goals on Wegovy or Zepbound is not pairing the medication with the right lifestyle changes. Both are meant to be used along with a reduced-calorie diet and more physical activity. In my practice, the patients who see the best results are always the ones who commit to daily exercise and balanced eating.
These “rockstar” patients usually exercise close to an hour a day and follow something like the 80/20 rule with food. They are not rigid. They still enjoy pizza, dessert, and vacation treats, but most of their meals focus on protein, whole grains, fruits, and vegetables. This mix of medication and lifestyle is what really drives results. So if someone is taking the medication but not paying much attention to diet or has not started exercising, there is often room for improvement and likely better outcomes once those habits are in place.
Another issue is not eating enough. While cutting calories generally leads to weight loss, there is a point where eating too little can backfire. When intake drops very low, under 800 calories a day, the body may slow its metabolism to conserve energy. Some people on these medications have such reduced appetites, especially if they are used to restrictive dieting, that they barely eat. They might think, “I am not hungry, so I will just skip meals,” but this can stall progress, leave them feeling awful, and make it hard to stay active.
That is why I usually recommend at least 1,200 calories a day for most women and around 1,500 for most men, though individual needs can vary. It is also crucial to hit protein goals, ideally about 100 grams a day and definitely no less than 60. Without enough protein, people risk losing lean muscle instead of fat, won’t feel their best, and will not get the full benefit of these medications.
Sometimes the problem is simply not being on a high enough dose. It is common to hear from someone who stopped at 5 mg or 7.5 mg of Zepbound and decided it did not work. In reality, we often do not know if these medications will be effective until someone reaches the full dose and stays there for around three months. For Zepbound, that means getting to 15 mg for at least 12 weeks. For Wegovy, it is 2.4 mg for the same period. If someone has reached that point and still has not lost weight, it may not be the right medication. But if they are only on a small dose, it is not surprising they have not seen the expected results. All the strong trial data assumes patients reached these full therapeutic doses.
Ultimately, getting meaningful weight loss from these medications depends on several pieces coming together. The right dose, enough of the right foods especially protein, regular activity, and adjustments for individual needs all play a role. If one of these is missing, it often explains why someone is not seeing the progress they hoped for.
Not Every Med Works for Everyone: Finding the Right Weight Loss Plan for You
At the end of the day, even after looking at every possible factor, whether it is alcohol use, type 2 diabetes, snacking habits, untreated ADHD, side effects, not eating enough, or not reaching a full dose, there is still a chance that Wegovy or Zepbound simply is not the right fit.
If you have truly gone through the checklist, no alcohol, no diabetes, no excessive snacking, no ADHD driving eating behaviors, no troublesome side effects, you are on the maximum dose, and you are consistently getting enough protein and calories, yet still not seeing at least a 5 percent weight loss, or ideally closer to 10 percent for many dealing with obesity, it may just mean this particular medication does not work for you.
It can be frustrating, but it is also part of how medicine works. There is always a small group of people for whom a drug simply does not deliver, no matter how strong the overall data might look. The good news is this does not mean you are out of options.
Some people do better when combining these medications with others. If you have not tried alternatives like Contrave, phentermine, or a combination of phentermine plus topiramate, it might be worth talking about these with your healthcare provider. For those with a substantial amount of weight to lose, bariatric surgery could be a very effective choice and often leads to major improvements in health beyond just the scale.
It might also be time to see an obesity medicine specialist, someone who can take a deeper look at your unique history and tailor a plan. Unlike a quick primary care visit, these appointments often run 30 to 60 minutes and really dig into your story to figure out what is holding things back.
While Wegovy and Zepbound work incredibly well for most people, in fact better than many other medications I prescribe in family medicine, it is important to understand they are not a universal solution. For a small percentage of people, they simply are not the right tools.
If you have covered every angle and still are not seeing results, it may be time to look at a different path. Whether that means trying another medication, exploring surgery, or working closely with a specialist, there are still many ways to reach your health goals.
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