Weight Loss

Wegovy, Ozempic & Mounjaro: Why it’s hard to keep the weight off long term

November 14, 2023

Written by Chandana (Chandy) Balasubramanian

Medically reviewed by Gia Eapen, MD

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Key Points

  • Wegovy, Ozempic, and Mounjaro are trending drugs promising rapid weight loss
  • While weight loss is fast at first, weight may plateau later
  • People who stop taking the drugs can gain up to two-thirds of their weight back
  • A controlled nutritional program by a registered dietitian can help sustain weight loss, with or without weight loss medications

Wegovy, Ozempic, and Mounjaro are popular prescription drugs offering rapid and significant weight loss. Aggressive marketing by drug manufacturers has made the brands household names by now (Ozempic even has a catchy jingle). Celebrities have embraced them for weight loss, Elon Musk tweeted about it, and comedian Jimmy Kimmel even joked about Ozempic at the Oscars.

Clinical trials show that, on average, people who take Mounjaro, Ozempic, and Wegovy lose 15-16% of their body weight in over a year. But the real reason why the drugs are popular is because of individuals and influencers reporting much higher weight loss numbers online, similar to bariatric surgery. Additionally, people with type II diabetes experience a drop in their A1C blood sugar numbers to normal levels.

So, the medications do offer several benefits, but there is a catch (isn’t there always one?). Let’s explore why it can be hard to maintain weight loss over time and what you can do to sustain it.

1. When the drugs stop, you gain the weight back

Like other prescription medications, their effects wear off once you stop taking them. While drugs like Wegovy can jumpstart weight loss efforts, their effects are short-term. In fact, a study found that people who stopped taking Wegovy gained two-thirds of their weight back. This weight gain has a physical and psychological toll.

Note: Wegovy (semaglutide) is FDA-approved as a weight loss drug, but Ozempic (semaglutide) and Mounjaro (tirzepatide) are currently approved for people with diabetes. However, off-label, Ozempic, and Mounjaro are being prescribed for weight loss.

The dangers of weight cycling

Weight cycling happens when you lose weight fast and gain it back. It is common with fad diets and is also known as ‘yo-yo’ dieting because the weight bounces back when you cannot sustain it. This cycle can have severe effects on your physical and mental health.

Dr. Gia Eapen, MD says, “Studies show that weight cycling can increase your risk of diabetes. Weight cycling is also associated with a higher risk of cardiovascular disease and a much higher risk of death. A 2022 study of over 80,000 women (postmenopausal) even indicated a potential connection between endometrial cancer and weight cycling.”

Fighting weight plateaus

While some influencers may paint a rosy picture of weight loss on Ozempic, Mounjaro, and Wegovy, the reality can be different. People on anti-obesity medications do lose weight, but weight can plateau. There are many reasons why.

  1. Tolerance levels increase: Your body may build tolerance for the specific dose of the drug you’re taking, and you may need higher and higher doses to continue losing weight.
  2. Metabolism slows down with weight loss: Your body interprets rapid weight loss as the threat of starvation and slows your metabolism down. This means your body conserves energy by making it harder to burn calories.

If you would like to talk to someone about weight gain or weight plateaus, consider a Registered Dietitian. Fay is an easy way to find a Registered Dietitian near you, covered by your insurance.

2. Muscle loss can make it harder to stop gaining weight

Weight loss involves losing fat as well as muscle. Muscle loss can be minimized when weight loss is slow and combined with a nutrition and exercise plan. However, if a person on Ozempic or a similar drug does not actively exercise or balance their protein intake as they lose weight, they may experience more muscle loss.

Apart from keeping us strong, muscles cushion against weight gain. With the right fitness and diet plan, it may be easier to prevent gaining weight.

3. Side effects can lead to malnutrition, vision issues, and even cancer

Ozempic, Wegovy, and Mounjaro work by suppressing appetite. The medications also slow down the rate at which your food moves through your stomach and intestines, making you feel full after eating. These mechanisms help people lose weight.

The drugs also regulate blood sugar levels by raising insulin levels and insulin sensitivity and reducing the amount of sugar released by the liver. These medications are a class of drugs known as GLP-1 agonists because they mimic a hormone in our body called GLP-1 which regulates hunger, appetite, and cravings.

Unfortunately, there are several side effects to manage. These include:

  • Gastrointestinal (GI) problems: Many experience symptoms like nausea, vomiting, diarrhea, constipation, and stomach cramps. Chronic GI issues can worsen mental health conditions like anxiety and depression.
  • Malnutrition: Since the drugs suppress appetite and hunger, people may not feel like eating the foods they need to meet their nutritional needs. This may lead to dietary deficiencies and may require supplements or other interventions to maintain health.
  • Low blood sugar (hypoglycemia), pancreatitis, vision changes, gallbladder problems, kidney failure, and cancer.

Balancing the side effects and getting the nutrition you need can be challenging. Following a personalized nutritional plan with a Registered Dietitian guiding you through your weight loss journey can help.

Fay can help you find a Registered Dietitian near you, covered by your insurance.

4. There’s a risk of triggering eating disorders when you stop taking the meds

TikTok celebrity Remi Bader stated on the ‘Not Skinny But Not Fat’ podcast that once she went off Ozempic, her binge-eating disorder intensified as she regained her weight. Additionally, due to intense marketing by drug companies and influencers, many people are bombarded with messages about losing weight and being skinny, which may trigger disordered eating.

Dr. Eapen, MD elaborates, “Losing a significant amount of weight and gaining it back can be emotionally difficult. Without the medications, hunger and cravings return, and people can feel helplessness, shame, and guilt surrounding their weight. If this happens, it’s important to contact a mental health professional. You may also consider consulting a Registered Dietitian to discuss your concerns.”

5. Supply issues and insurance coverage gaps can interrupt your intake

If you’re thinking, “Well if the drugs are meant to be taken long-term, why would I stop taking them?” The reality is that many people are already battling this issue. Ozempic and Wegovy have been plagued by supply shortages. Many users were left without their meds for months. Their only options were to pay astronomical out-of-pocket prices (over $1000 a month), risk using non-FDA-approved generics, or do without and regain their weight.

Additionally, with the drugs costing an arm and a leg, you’re okay as long as your health insurance covers them. Changes in prescription or health plans may lead to continuity challenges.

For example, if your body builds tolerance to one brand at the highest dose, you may have to switch to another drug. This can be a huge concern if your insurance provider does not cover the new medication.

How to achieve sustained weight loss?

Gia Eapen, MD explains, “Obesity is a multifaceted chronic metabolic disease and has nothing to do with ‘willpower.’ Some believe that people who are obese or struggle with their weight or disordered eating do not care about their health. In fact, the opposite is true. Many think about their food intake all day, every day, but face an uphill battle against biological, psychological, and possibly genetic factors that affect their eating habits. Eventually, diet, exercise, and lifestyle play a strong role in sustained weight loss.”

The best way to ensure sustained weight loss is through a controlled nutritional plan that’s right for you, combined with an exercise program. This is true even if you are on prescription meds like Wegovy, Ozempic, or Mounjaro.

Fay interviews with medical professionals reveal that working with a dietitian nutritionist together with medication can be eight times more effective than medication alone. Also, lifestyle changes were needed in 80-95% of people looking to keep the weight off in a sustainable way.  

Consider reaching out to a Registered Dietitian to get a nutritional program for sustained weight management on your weight loss journey. Using Fay, schedule an appointment with a Registered Dietitian near you, covered by 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.


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Chandana (Chandy) Balasubramanian

Written by Chandana (Chandy) Balasubramanian

Chandana Balasubramanian is an experienced healthcare executive who writes on the intersection of healthcare and technology. She is the President of Global Insight Advisory Network and has a Master’s degree in Biomedical Engineering from the University of Wisconsin-Madison, USA.

Gia Eapen, MD

Medically Reviewed by Gia Eapen, MD