Still hungry on semaglutide? 9 reasons why and what to do

Key Points

• Feeling hungry on semaglutide does not mean that the medication isn’t working. Some hunger is necessary for survival
• Your dose, meal timing, food choices, sleep quality, and stress levels all affect how hungry you feel on the medication
• Emotional eating habits may persist even when physical hunger signals are reduced
• Working with a registered dietitian can help balance hunger and nutrition on semaglutide

You started taking semaglutide (Ozempic or Wegovy) with high hopes. You’ve seen the success stories and heard about its powerful appetite-suppressing effects. So, it can be incredibly confusing (and frustrating) when you find yourself ravenous even after taking the meds.

If you’re asking, “Why am I still hungry on semaglutide?” You’re not alone. It’s a common experience, and it doesn’t mean the medication isn’t working.

While semaglutide is a powerful tool, hunger depends on many factors.

Let’s explore why you might still be feeling hungry on semaglutide, with insights from physician Gia Eapen, MD, and Registered Dietitian, Maria Karalis, RDN, LDN.

How does semaglutide affect hunger?

First, let’s quickly cover how semaglutide is supposed to work. Semaglutide mimics a natural hormone in your body called glucagon-like peptide-1 or GLP-1.

This hormone is made naturally in the body, and the gut releases it when you eat.

GLP-1 is a messenger that:

• Signals to your brain that you’re full
• Slows down how fast food empties from your stomach
• Helps regulate blood sugar by stimulating insulin release

When this mechanism doesn’t work correctly, you may end up feeling hungry all the time, eat more than you want to, and deal with constant thoughts of food.

Eapen, MD says, “By mimicking this hormone, semaglutide helps you feel fuller for longer, reduces food 'noise' or food cravings, and ultimately leads to eating less. However, it’s important to remember that semaglutide is like a regulator that moderates hunger signals; it’s not an on-or-off switch.”

9 reasons why you’re still hungry on semaglutide

Feeling hungry on semaglutide is not about willpower. Several biological and lifestyle factors could be at play.

1. Every person responds differently

“Semaglutide usually helps most people feel less hungry and eat less, but not everyone has the same experience, says Registered Dietitian, Karalis, RD. “Some people notice a big drop in their hunger and cravings, while others may not feel as much of a change. Even after taking semaglutide for two years, some people still report feeling hungry or having food cravings, even though they have lost weight and have better control over their eating.”

A study of four semaglutide trials found that 33% of people lost 20% or more of their body weight, but many others experienced different levels of weight loss.

While it's natural to compare your hunger experience or weight loss results with others, remember that everyone responds differently to the medication.

2. You just started semaglutide

Semaglutide treatment always begins with a low starter dose of 0.25 mg and gradually increases over several weeks or months. This is done to help your body adjust and minimize side effects.

Eapen, MD, says, “These starting doses may not help much with reducing hunger yet. You may not feel a significant difference in your hunger levels until you’ve been on the medication for a while and have reached a higher, stable dose.”

3. Your body adjusted to the current dose

Karalis, RD, says, “Over time, the body can adjust to the effects of medications like semaglutide. This means that the body’s natural systems—including hormones and nerve signals that control hunger—may change in a way that makes the medication less effective at reducing appetite.”

If you find your hunger rising after being on the same dose for a while, talk to your healthcare provider about whether your dose is right for you.

4. The "end-of-week effect"

Ozempic and Wegovy are once-weekly injections. Semaglutide has a half-life of about 7 days. This means that after about a week, about half of the drug has been cleared from your system.

For some people, this means the medication's effects can start to wane on days 5, 6, or 7, right before the next injection is due. If you consistently find yourself hungrier the day or two before your next dose, this could be one reason why.

5. Cannot increase to a higher dose

“Sometimes, people do not feel as much appetite reduction with semaglutide because they are not able to increase to a higher dose, or they may not tolerate higher doses due to side effects like nausea or stomach upset,” says Karalis, RD.

The American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society recommend that the dose of semaglutide should be increased slowly and individually, aiming for the highest dose that is both effective and well-tolerated (up to 2.4 mg weekly for obesity).

However, not everyone can tolerate the highest dose due to side effects, so some people remain at lower doses. Lower doses typically provide less appetite suppression and result in slower weight loss.

6. It’s “emotional” hunger, not physical

This is a big one. Hunger isn’t just a physical sensation; it can also be driven by emotions, habits, and environmental cues.

Semaglutide is proven to target physical hunger, but it cannot erase a lifetime of eating habits. In fact, it is even possible to binge eat on Ozempic.

Try to identify the type of hunger you’re feeling. Is it:

• Emotional hunger: Eating in response to stress, anxiety, boredom, sadness, or even as a treat when you’re happy or excited?
• Habitual hunger: Eating at a certain time of day or during a specific activity (like when you’re on the phone or watching TV) simply because you’re used to it?

Dealing with emotional eating may require different strategies, like mindful eating, mental health counseling, and finding healthier ways to cope with discomfort and negative emotions.

For disordered eating patterns like binge eating, consider seeking binge eating disorder treatment from a team of experts.

7. Your meals may need to be balanced

What you eat matters a lot, even on semaglutide. A meal low in protein and fiber gets digested fast, leaving you hungry sooner.

To feel truly full and satisfied, your meals need to send the right signals to your brain. This involves more than just calories.

The most satisfying foods are typically:

• High in protein: Protein is highly satiating and helps you feel full. It takes more energy to digest and triggers the release of hormones that signal fullness to your brain
• Rich in fiber: Dietary fiber adds bulk to your meals without adding calories and slows down digestion
• High-volume foods: High-volume, low-calorie foods physically stretch your stomach, which triggers nerve signals that tell your brain you're full. These foods, like whole vegetables and fruits, take up more space in your stomach with fewer calories and can help you feel more satisfied on less food

If your meals are largely made up of highly processed foods (most foods that come in a box or package), they are often low in protein, fiber, and volume and high in fat, sodium, and sugar. These types of foods can lead to persistent hunger.

8. Poor sleep and stress

Your lifestyle habits have a direct impact on your hunger hormones, ghrelin (the "hunger" hormone) and leptin (the "fullness" hormone).

• Lack of sleep: When you don't get enough sleep, your body produces more ghrelin and less leptin, leading to increased appetite and cravings, especially for high-calorie, high-carb foods
• Chronic stress: Stress increases the hormone cortisol, which can also drive up appetite and lead to cravings for "comfort food." High cortisol levels can also disrupt your sleep, leading to more food cravings

Even with semaglutide working in the background, a sleepless night or a stressful week can create hormonal shifts that are powerful enough to make you feel hungry.

9. Some level of hunger is necessary

Remember, some level of hunger is absolutely essential, even when you’re taking semaglutide to lose weight.

Hunger is a biological impulse that’s hard-wired in us to ensure our survival. It reminds us to seek the nutrients that we need to stay healthy.

Talk to your doctor about the hunger pangs you face and the diet you can eat when taking semaglutide. A registered dietitian can also help you navigate hunger and nutrition while on semaglutide.

How can a dietitian help you manage hunger on semaglutide?

1. Adjust dietary patterns

A registered dietitian can help if you're still feeling hungry on semaglutide by reviewing your eating patterns and suggesting changes like increasing protein and fiber intake to help you feel fuller and reduce persistent hunger.

They can also personalize their recommendations to fit your personal preferences, routine, and food budget.

2. Manage side effects

Registered dietitians can help you manage common side effects like nausea and constipation through meal planning, smaller, more frequent meals, and proper hydration.

This support can help you stay on track with your medication and work up to higher doses if needed.

3. Monitor weight loss

Dietitians can also watch for signs that you're losing too much or too little weight, muscle loss, or nutritional deficiencies.

They will recommend the right amount of protein based on your personal needs and lifestyle. They may also suggest resistance training or other strategies. Additionally, they work together with your medical team if any concerns come up.

Karalis, RD, says, “Individualized nutrition counseling and behavioral support from a dietitian have been shown to enhance weight loss and appetite control when combined with semaglutide. In particular, through structured programs or intensive lifestyle interventions, as demonstrated in the STEP 3 trial and supported by the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society.”

Start losing weight on semaglutide. Get a personalized semaglutide diet plan, covered by insurance.

Final thoughts: Still hungry on semaglutide

Feeling hungry while on semaglutide can be disheartening, but it's often a regular part of the process. Remember, the medication is designed to help reduce appetite, not eliminate it.

Success with semaglutide almost always involves pairing the medication with meaningful lifestyle changes. Understanding what's driving your hunger, whether it's your dose, timing, food choices, or other factors, is the first step toward finding the right solution.

If you're struggling to manage hunger or need help creating a sustainable eating plan, working with a registered dietitian can be incredibly helpful.

Frequently Asked Questions (FAQs)

Does hunger on semaglutide mean it's not working?

Not necessarily. It's completely normal to continue experiencing some hunger while taking semaglutide; the medication is designed to help control appetite rather than completely eliminate it, and ongoing hunger doesn't indicate treatment failure. Semaglutide works more like a volume control that turns down hunger signals rather than completely shutting them off.

How long does it take for semaglutide to suppress appetite?

Semaglutide treatment begins with a small starting dose of 0.25 mg that increases slowly over several weeks or months. You probably won't experience meaningful appetite reduction until you've been taking the medication for 4-8 weeks or more and reach a higher dose.

Can you override the full feeling on semaglutide?

Yes, absolutely. While semaglutide effectively addresses physical hunger signals, it doesn't eliminate learned eating behaviors developed over time. It's possible to binge eat or overeat when taking Ozempic or Wegovy. Practicing mindful eating can help you better recognize and honor your body's fullness signals.

Should you eat if you're not hungry on semaglutide?

It's important to still consume enough nutrients, even if your appetite is low. Severely under-eating can lead to fatigue, muscle loss, and nutritional deficiencies. A registered dietitian can help you create a plan to ensure you’re nourishing your body properly, even with a reduced appetite.

Find a weight loss dietitian near you who accepts your insurance.

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.