The human body is built to fight back against weight loss. Smaller bodies usually require less energy, and so metabolisms react by slowing down as pounds come off. These changes reduce how many calories someone burns 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 many people regain some weight even after bariatric surgery or during intense calorie restriction.
Medications like Ozempic mimic a naturally occurring hormone and slow the emptying of the stomach, so that we feel fuller, faster and for longer. They also target the areas of the brain that regulate appetite, curbing cravings. But there are still open questions about exactly how they work, and that extends to why some people hit a set point at one weight or another.
Another wrinkle is that not everyone responds to these kinds of medications in the same way. In clinical trials of semaglutide, the compound in Ozempic and Wegovy, people with diabetes have tended to lose less weight, less quickly, than people who did not have the condition, Dr. Hagan said. A small proportion of those who take these drugs won’t lose weight at all, he added.
When medication meets unrealistic expectations
Dr. Andrew Kraftson, a clinical associate professor in the division of metabolism, endocrinology and diabetes at Michigan Medicine, said that most people taking these medications will hit a plateau around the 18-month mark after starting treatment.
Patients often come in with unrealistic expectations, he added, leading to “tough conversations.” Some come to him after they hit their plateau, believing that the medicine wasn’t working. “It’s not all weight loss all the time,” he said.
But, Dr. Kraftson pointed out that even if someone was still technically classified as overweight, their blood pressure and cholesterol could be under control, and their blood sugar might have dipped because they were taking medication.
“I don’t try to come across as the dream killer, but sometimes you really wonder, what is the hole we’re trying to fill?” he said, adding: “And will additional weight loss really fill it?”
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