Does Ozempic cause weight gain?

Key Points

• Ozempic® typically doesn't cause weight gain while you're taking it – it's designed to help with weight loss.
• But studies have found that about 14% of people don't lose weight on Ozempic, and some may even gain weight due to specific, addressable reasons.
• Weight regain after stopping is common – people regain about two-thirds of lost weight within a year.
• Working with a registered dietitian before, during, and after taking semaglutide can help you maintain your results long-term.

If you're exploring Ozempic or Wegovy® for weight loss, you've probably heard the success stories. But you might also be worried about one thing: does Ozempic cause weight gain?

Ozempic is unlikely to cause weight gain while you're taking it. But weight regain after stopping the medication is a real concern that merits discussion.

Let's explore how these medications work, why some people don't lose weight on Ozempic (or even gain weight), and what you can do to maintain results for the long haul.

Can Ozempic cause weight gain?

Ozempic is unlikely to cause weight gain while you're taking your highest dose. Ozempic is approved for type 2 diabetes treatment, and Wegovy – which uses the same active ingredient, semaglutide – is approved for weight loss.

But it’s important to know: not everyone loses weight on Ozempic. Clinical trials show that about 14% of people don't lose weight, and some may even gain a small amount.

Why might you gain weight while taking Ozempic?

If you're not losing weight – or you're actually gaining – there are usually specific reasons:

1. Your dosage might be too low. If you're on a lower Ozempic dose, it might not fully suppress your appetite. This means you could still be in a caloric surplus.

You will start on a low dose (0.25 mg) and gradually increase it every four weeks. Some people need the higher doses (1 mg or 2 mg) to see significant appetite changes.

2. Side effects are reducing your activity levels. Nausea, fatigue, or stomach discomfort can make it hard to stay active. If you're moving less, you're burning fewer calories throughout the day.

It's completely natural to feel less motivated to exercise when you're dealing with side effects. But reduced activity can slow or stall weight loss.

💡 Tip: Try gentle movement like a walk or stretching on days when side effects are bothering you. Even 10 minutes counts.

3. You're eating differently to manage side effects. Some people change what they eat to cope with nausea or stomach issues. You might reach for bland, easy-to-digest foods like crackers, toast, or rice – which can be higher in calories and lower in protein.

While these foods help your stomach feel better, they might make it harder to stay in a caloric deficit.

4. Other medications are contributing. If you're taking insulin or certain diabetes drugs like sulfonylureas (glipizide or glyburide), these can cause weight gain. Your doctor needs to know about all medications you're taking.

Weight regain after stopping Ozempic

Weight gain becomes a bigger concern after you stop taking the medication. A trial of nearly 2,000 people published in 2022 showed that, one year after stopping 2.4 mg doses of semaglutide, participants had regained two-thirds of the weight they'd lost.

What does this mean in real numbers? If you lost 30 pounds on Wegovy, you might regain about 20 pounds within a year after stopping.

This happens because your hunger levels return to what they were before the medication. The appetite-suppressing effects wear off within a few weeks of your last dose.

But this won’t necessarily happen to you. What happens after you stop the medication depends on several individual factors:

• How much weight you lost and how quickly
• How much came from fat versus muscle
• What lifestyle changes you built while on the medication
• Whether you work with a registered dietitian to develop a maintenance plan

It's also important to remember that these drugs are relatively new. Ozempic was first FDA-approved in 2017, and we're still learning about long-term effects. We don't yet have decades of data on continuous use or what happens years after stopping.

The best way to handle life both on and off weight loss medication is to work with a dietitian covered by your insurance. They can help you build eating patterns that work for your body, not just rely on medication to suppress hunger.

What if you're not losing weight on Ozempic?

If you've been on Ozempic for several weeks and aren't seeing results, don't panic. There are specific steps you can take.

Check your dosage and timeline

Weight loss on Ozempic takes time. The most successful studies were over a year long. You might not see significant changes in the first few months, especially at lower doses.

Your doctor increases your dose gradually every 4 weeks. Most people don’t notice major appetite changes until they’ve reached the 2 mg or 2.4 mg dose.

💡 Tip: Keep a simple journal of your hunger levels at each dose to share with your doctor at check-ins.

Look at your overall eating patterns

Ozempic helps you feel full, but your food choices still matter. If you're not losing weight, a dietitian covered by your insurance can help you look at what you're actually eating throughout the day.

Common culprits that keep your overall caloric intake too high:

• Liquid calories (sweetened drinks, alcohol) that don't trigger fullness
• Grazing throughout the day even when not hungry
• Very low protein intake that leaves you feeling unsatisfied
• Eating past fullness out of habit or social situations

Consider medication timing and interactions

Talk to your doctor about:

• Whether other medications might be interfering with weight loss
• If your dose needs adjustment based on your response
• Whether underlying health conditions (thyroid issues, PCOS) need attention

A registered dietitian can work alongside your doctor to create a complete picture of what's happening and what adjustments might help.

Note: Do not make any changes to your dose without consulting a healthcare provider.

How do Ozempic and Wegovy cause weight loss?

Ozempic mimics a hormone called GLP-1 that's released in your digestive tract when you eat. GLP-1 does two important things:

First, it signals your pancreas to release more insulin, which helps lower blood sugar. This is why Ozempic is approved for type 2 diabetes.

Second, it acts on the part of your brain that controls appetite. This makes you feel full sooner and stay full longer.

As is the case with most weight loss medications, semaglutide doesn't change your metabolism. It's the feeling of fullness that helps people eat less and lose weight.

For many people – particularly those with obesity – Ozempic or Wegovy shows them what it actually feels like to feel satisfied for the first time. You might feel full after eating half your usual portion and genuinely not want more.

This isn't willpower. It's your brain receiving the "I'm full" signal properly.

Ozempic vs. Wegovy: What's the difference?

Ozempic is only FDA-approved for type 2 diabetes treatment. Wegovy, which uses the same active ingredient (semaglutide), is approved specifically for weight loss.

They're formulated in different doses and for different purposes. Your doctor will prescribe the one that matches your medical needs.

For both medications, you don't start at the full dose. You begin low and increase every four weeks until you reach an effective dose or the maximum dose. Your doctor determines the dose increases based on:

• Your weight loss progress
• How your body responds to the medication
• Improvements in diabetes markers (like A1C or insulin levels)
• Side effects you're experiencing

Should you use Ozempic or Wegovy?

If you're interested in Ozempic for diabetes or Wegovy for weight loss, start by talking to your doctor. Only a licensed medical provider can prescribe these medications.

While these drugs might seem wildly popular, only a small percentage of people are actually eligible to use them. This has led to off-brand versions being sold by compounding pharmacies, which might contain non-FDA-approved ingredients and haven't gone through the same safety testing.

If you're feeling frustrated by eligibility restrictions, you're not alone. The requirements are in place to protect your health, particularly your kidneys and pancreas.

If you are eligible, you'll start with a physical exam and blood tests. Your pancreas and kidneys need to be healthy enough to process the medication safely.

Note: Only your doctor can determine if Ozempic or Wegovy is right for you. Do not make any changes to your dose without consulting a healthcare provider.

How a registered dietitian can help

When it comes to weight loss – whether with medications like Wegovy and Ozempic or through lifestyle changes – a registered dietitian is the most qualified person to support you.

Here's what makes RDs different: they can provide evidence-based guidance, troubleshoot what's not working, and help you build habits that last beyond any medication.

Trying a new medication like Ozempic while also changing your eating patterns can feel overwhelming. You might feel confused about what to eat when you're barely hungry, or worried about losing muscle along with fat.

An RD can guide you through:

• What to eat when your appetite is suppressed (focusing on protein and nutrients)
• How to handle changing cravings and food preferences
• Strategies to preserve muscle while losing weight
• Planning for life after you stop the medication

They can also help you understand what's normal versus what needs medical attention. If you're experiencing severe nausea, unexpected weight gain, or other concerning symptoms, your dietitian can help you communicate effectively with your doctor.

Most importantly, they can help you develop a maintenance plan before you stop taking Ozempic. This is key to preventing the two-thirds weight regain that studies show.

You can find a weight loss dietitian covered by your insurance who specializes in obesity, weight management, and diabetes. Just enter your insurance information, filter by specialty, and explore your options.

You don't have to face this journey alone. Get started with a weight loss dietitian covered by your insurance today.

Final Thoughts

So, does Ozempic cause weight gain? Not usually while you're actively taking it.

The real challenge is weight regain after you stop. But this isn't inevitable. With the right support from a registered dietitian, you can build sustainable habits that help you maintain your results.

If you're not losing weight on Ozempic, there are specific reasons – and specific solutions. Lower dosages, side effects affecting activity, dietary changes, or other medications can all play a role.

The key is personalizing your approach. What works for someone else might not work for you, and that's where professional guidance makes all the difference.

Working with an RD covered by your insurance gives you expert support throughout your weight loss journey – before you start medication, while you're taking it, and especially during the transition off of it.

Frequently Asked Questions

Why am I gaining weight on Ozempic?

There are several possible reasons you might be gaining weight while taking Ozempic:

Your dose might be too low to fully suppress your appetite, meaning you're still eating more calories than your body uses. Side effects like fatigue or nausea might be making you less active, reducing the calories you burn throughout the day.

You might also be choosing different foods to cope with side effects – bland, starchy foods that are easier on your stomach but higher in calories. If you're taking other medications like insulin or sulfonylureas for diabetes, these can contribute to weight gain too.

A dietitian covered by your insurance can help you figure out what's going on and develop strategies that work with your body's response to the medication.

Will I gain all the weight back if I stop Ozempic?

Research shows that people typically regain about two-thirds of the weight they lost within a year of stopping semaglutide. If you lost 30 pounds, you might regain about 20 pounds.

But this isn't inevitable. What happens after you stop depends on the habits you build while on the medication and whether you have professional support during the transition.

The best strategy is to start working with a registered dietitian before you stop taking Ozempic. They can help you gradually build sustainable eating patterns, focus on protein and strength training to preserve muscle, and develop a realistic maintenance plan.

Weight maintenance after any weight loss – with or without medication – requires ongoing attention. But with the right support, you can maintain much more of your progress than average.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.