Kimmy Meinecke blamed herself for stopping to lose weight. For two years, she had been taking a weekly injection of Ozempic to control her diabetes. The medication reduced her appetite so much that sometimes, for dinner, she would only eat yogurt or cheese and crackers. But one day the scale hit 240, 25 pounds below the weight she started at, and stayed there.
She was thrilled that her blood sugar levels had dropped, a result that was worth the side effects she experienced, including nausea and occasional bouts of dizziness. Still, Ms. Meinecke, a pastor in Spokane, Wash., expected to lose more weight and keep it off for longer.
His doctor, however, was not surprised to see his plateau. This is a point that everyone who takes drugs like Ozempic, Wegovy and Mounjaro will reach.
“If you think about it, it’s a good thing,” said Dr. Robert Gabbay, chief scientific and medical officer of the American Diabetes Association. “It would be dangerous if you continued to lose weight.”
But doctors say some people seek out these drugs to lose as much weight as possible – and are dismayed and disillusioned when they stop. Some people give up drugs after reaching their plateau. When they do, they tend to gain back the weight they lost.
“It’s not the magic drug that people like to tout,” Ms. Meinecke, 52, said.
Why do people hit weight loss plateaus?
The human body is built to combat weight loss. Smaller bodies generally require less energy, so the metabolism responds by slowing down as the pounds come off. These changes reduce the number of calories burned each day, said Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who has studied obesity; losing weight “turns down the thermostat”. This is one reason why many people regain weight even after bariatric surgery or during intense calorie restriction.
Medications like Ozempic mimic a natural hormone and slow the emptying of the stomach, so we feel full, faster and for longer. They also target areas of the brain that regulate appetite, thereby reducing food cravings. But questions remain about how exactly they work, including why some people reach a fixed point at one weight or another.
Another problem is that not everyone reacts the same way to these types of medications. In clinical trials of semaglutide, Ozempic and Wegovy’s compound, people with diabetes tended to lose less weight, less quickly, than people without the disease, Dr. Hagan said. A small proportion of those who take these drugs will not lose weight at all, he added.
When medications meet unrealistic expectations
Dr. Andrew Kraftson, clinical associate professor in the division of metabolism, endocrinology and diabetes at Michigan Medicine, said most people taking these medications will reach a plateau around 18 months after starting treatment.
Patients often come in with unrealistic expectations, he added, which leads to “difficult conversations.” Some come to him after reaching their plateau, thinking the medication isn’t working. “It’s not always about weight loss,” he said.
But Dr. Kraftson pointed out that even if a person was still technically classified as overweight, their blood pressure and cholesterol levels could be under control, and their blood sugar could have dropped because they were taking medication.
“I’m not trying to sound like a dream killer, but sometimes you really wonder, what is the hole we’re trying to fill?” he said, adding, “And will further weight loss really fill it up?”
Working to combat the plateau
Gary Czaplewski’s weight stabilized about six months after he started taking Wegovy last November. Since then, the Milwaukee, Wisconsin, private investigator has often wondered whether the challenges were worth the benefits of taking the drug.
Mr. Czaplewski, 49, lost about 35 pounds, but felt shooting pains when he first increased his dose – pain so severe that he returned to the weight-loss clinic where he received his injections, panicking, thinking he might have pancreatitis. The treatment costs him $600 a month, which he pays out of pocket, but he no longer craves foods like custard.
He tried to increase his physical activity to lose more weight. “It took more work than I expected,” he said. “I thought I would lose weight easier and for longer.”
When patients are unhappy with their weight loss, doctors have few options, Dr. Kraftson said. They can try adding an additional drug, but that could introduce a new group of side effects and interactions. They may prompt patients to further restrict their food intake and exercise more, but that can lead to disordered eating behaviors, he said, and pose a challenge for those who eat so little initially while they take these medications.
“You could tell someone they’re potentially going to lose 15 percent of their weight with Ozempic or Wegovy,” he said. “But once they get to 15 percent, it’s not like they’re like, ‘Oh, now I’m happy, great.'”