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Plateaus and Weight Loss Slow Downs on Wegovy, Ozempic,  Zepbound & Mounjaro? What to Do

by Richard Lipman MD

Weight loss plateaus and weight loss slow downs on Zepbound, Mounjaro, Ozempic/Wegovy can occur. A weight loss plateau is when you stop losing weight despite a consistent diet and exercise regimen that has previously  helped you lose weight.  Wegovy and recently the new medication Mounjaro  and Zepbound lead to very rapid weight loss often as much as 3-4 lbs per week. It takes about 3 weeks to  reach that level. At that time the dieter  will experience fullness, appetite suppression and rapid weight loss. Mounjaro reviews show greater weight loss than the other two new drug Ozempic and Wegovy. Switching from Wegovy to Mounjaro and Zepbound may lead to 5-8% increase in weight loss. Despite the rapid weight loss slow downs occur and are normal process of dieting and weight loss. The body actually resists the weight loss because it thinks it’s being “starved to death.”

How to Know if You Have Reached A Weight Loss Plateau on Ozempic, Zepbound, Mounjaro and Wegovy

Weight loss plateaus and short slow downs occur with all diets. Those patients with diabetes or a  family history of obesity seem to have early weight loss slow downs.  Weight loss is  dependent on starting weight, age and gender. The higher the starting weight the greater the weight loss. Men lose faster than women and younger people faster than older ones.  For example, a 22 year old man weighing 280 lbs loses faster than a 55 year old woman weighing 150 lbs.  Average weight loss with these drugs ranges from 15 to 25% of starting weight. If you are not experiencing these effects or finding your weight loss is slowing down, you need to consider these potential issues:

Normal Slowing of Metabolism with Weight Loss

Its normal for weight loss to slow down during Semaglutide and every other weight loss  program.  Typically after losing 20 lbs the body begins to resist further weight loss by reducing metabolism.  Reduction in lean body mass(less with semaglutides than other diets) and caloric needs  also play a role. Typically weight loss may slow down, often to only 1-2 lbs a week for a few weeks. Using semaglutides rarely does the plateau last more than 3 weeks. This period should be spent examining the program for food and drink mistakes rather than rushing to increase the dosage of the injections.

weight loss slow downs on a diet

A latter plateaus often occurs late in the weight loss plan as the goal is approached. Again check for food mistakes and have patience.

Action to Take When You Reached a Plateau on Zepbound, Mounjaro, Ozempic/Wegovy:

Medication Problems Causing Weight Loss Slow Downs and Plateaus

1. Is the product expired, or discolored?–look at the pen, the window shows you the inject-able liquid, look at the expiration date on the pen. Remember the pen cannot site out in the heat (like a mailbox or hot car) for long. Inside a home or air conditioned car is acceptable, inside a refrigerator is better.

2. Not rubbing the injection site for a few seconds permits medication leakage. The pens have tiny needles that deliver the medications just under the skin. Often they are under pressure and part of the injection liquid can leak back thru the needle track on to the skin.

Pinching the skin on the belly too hard & injecting in to it can cause leakage of drug back out along the very short needle tract because of the pressure simply from the pinching. Like the former problem, rub the injection site for a several seconds and breakup the needle tract.

needle tract from sub cutaneous injection of ozempic/wegovy

Skin subcutaneous Injection diagram illustration

4. Greater weight loss for many occurs when taking the medication on Saturday morning since most people eat more on weekends. If nausea is experienced, it is often in the first 2 days after the injection.. The nausea on Saturday and Sunday will limit food intake. Significant weight loss often occurs right after the injection.

5. When taking high doses 2.0 mg/wk or more per week of Semaglutides-Ozempic or Wegovy,more weight loss may occur when the injections are split between two days, i.e. Saturday am and Wednesday am. This also May reduce side effects.

Food/Drink Choices During Zepbound, Mounjaro, Ozempic/Wegovy Treatment Causing Slow Weight Loss and Plateaus

These medications work by slowing gastric emptying time, i.e. the outlet of the stomach is functionally narrowed which permits only slow release of gastric contents. This prevents spikes in sugar and rapid absorption of calories and hunger. Here is how this is partially bypassed which can cut expected weight loss:

1.Eating high calorie energy dense foods as nuts, seeds, candy, nut butters, salad dressings, chips, pretzels and oils can also slip thru the “stomach barrier” rapidly get absorbed and add to the daily calories quickly. (see app #7 for list of these high calorie foods/condiments.)

2. Eating issues such as binge eating, emotional eating, and “grazing” (i.e. continuous snacking) can interfere with these drugs and lead to less weight loss than expected.

3. Drinking excessive water, especially carbonated water and even zero sugar sodas can “push”” food thru the stomach narrowing because of the pressure of the liquids. This markedly reduces the “delayed gastric emptying” allowing for possible increase in calorie absorption, spikes in sugar and hunger. A simple system to partially restrict water during meals is no water 30 minutes before to 30 minutes after meals. Excessive water also causes more nausea and often vomiting.drinking too much water with meals can slow weight loss

4. Skipping meals, one large meal a day can lead to low blood sugar(made worse because these medications are designed to lower blood sugar) especially in the afternoon, fatigue and eating high calorie, high sugar snacks and large evening meals. Skipping meals also leads to a slow down in weight loss.  A common way to see if this is happening is when you say to yourself at the end of the day, “I didn’t eat all day so I am entitled to a big dinner.” This is exactly what you don’t want–large meals that bypass the delayed stomach emptying pouring large amounts of carbs into the small bowel where it gets quickly absorbed and if not metabolized turns to fat. The dieter wants to try as much as possible to end up with 3-4 small meals over the day and as much as possible equally distributed. This is he same type of eating that is used after gastric bypass.

5. Less specific for these medications is the lack of exercise and mild nutritional deficiencies. Multi-vitamins, potassium, magnesium and zinc are suggested if there is rapid weight loss or dieting for a long period of time.

6 Watch the “danger” days for the drug–5-6 days after the injection, blood level fall which permits more eating. This might occur commonly on Friday night if injections are on Saturday morning.