Fact checked by Nick Blackmer
Key Takeaways
- Most people who take GLP-1 weight loss drugs will stop dropping pounds between 9 and 12 months.
- A plateau does not mean the medication stopped working.
- Adhering to a healthy diet and getting enough exercise can help avoid muscle loss that can slow down weight loss and cause other health problems.
New weight loss medications like Wegovy and Zepbound have been heralded as game changers for treating obesity. While these drugs don’t outperform bariatric surgery—the gold standard for obesity treatment—they spur greater and more sustained weight loss than any prior medication.
But everyone hits a weight loss plateau at some point, no matter which weight loss intervention they use. After all, no one can keep losing weight forever, said Jamy Ard, MD, president of The Obesity Society and co-director of the Weight Management Center at Wake Forest Baptist Health.
Human brains are “hardwired” to prevent starvation, he added. Weight loss medications and other interventions may temporarily trick the body into consuming less energy than it uses, but the body’s protective mechanisms eventually catch up.
“That’s when you achieve a new plateau,” Ard said. “The things that led to weight loss now only cause you to stay stable. People can get frustrated with that if it happens before they hit a target weight goal.”
Related: Weight Loss Drug vs. Bariatric Surgery: Which One Is Better?
What Causes a Weight Loss Plateau?
A weight loss plateau occurs when someone hasn’t lost any weight for a month while keeping their diet, exercise, and other major lifestyle factors the same, according to Christopher Thompson, MD, director of endoscopy at Brigham and Women’s Hospital and co-founder of the weight loss company Bariendo.
Thompson said weight loss isn’t perfectly linear, and it’s normal for weight to fluctuate slightly day-to-day. A true plateau will occur when body weight stays steady over several weeks rather than a couple of days.
People lose weight in a calorie deficit, meaning they consume fewer calories than they burn over time. When the body doesn’t get as much food as it used to, the brain perceives the loss of calories to be a threat and pumps the brakes on the physiological processes that cause weight loss.
Wegovy and Zepbound work by mimicking GLP-1, a gut hormone that manages appetite and hunger. Tirzepatide, the active ingredient in Zepbound, also targets an additional hormone called GIP.
Stimulating GLP-1 and GIP levels through medication can slow digestion and reduce appetite, helping people lose 15% to 20% of their body weight.
But GLP-1 and GIP are just two of eight hormones that control hunger and weight. Within about a year, the other hormones will catch up, signaling your body to make changes to keep you from losing more weight, said Louis Aronne, MD, a professor and director of the Center for Weight Management and Metabolic Clinical Research at Weill-Cornell Medical College.
As your body tries to keep your weight in equilibrium, you may have more intense cravings and consume more calories, while your muscles may work more efficiently to burn fewer calories.
Aronne, who led the long-term study of tirzepatide, said that the drug may be more effective than semaglutide in part because it works on two different hormones, essentially keeping GIP from interfering when GLP-1 is in action.
Scientists are developing new obesity medications that target even more of the gut hormones in hopes of further delaying the weight loss plateau.
Related: New Weight Loss Drugs Are on the Way That Could Upstage Wegovy and Ozempic
When Does a Weight Loss Plateau Happen?
Regardless of the weight loss intervention, people tend to reach peak weight loss between about nine to 12 months, Ard said.
In the largest clinical trial of people taking tirzepatide, participants reached a weight loss plateau at an average of 70 weeks. Meanwhile, a two-year trial of people with obesity taking semaglutide (sold as Wegovy or Ozempic) showed an average weight loss of about 15%, which petered out just over a year after initiation.
It’s not possible to predict when, exactly, someone will hit a plateau. However, treatments that cause the greatest weight loss seem to have a longer-lasting impact, Ard said. For instance, bariatric surgery tends to be the most intensive intervention, but it leads to the most dramatic and sustained weight loss.
Some other factors that might determine when someone will hit a plateau include how long they have had obesity, whether they developed it as a child or as an adult, and whether they have comorbidities like type 2 diabetes, Ard said.
Not everyone will respond to the same medication to the same degree. Some people are so-called “super responders” to semaglutide and can lose lots of weight on the smallest dose. Their provider may slowly increase their dose so that they can continue to lose weight for a longer time than someone who loses modest weight at the highest starting dose.
Importantly, just because you stop losing weight while taking a GLP-1 doesn’t mean it’s stopped working. In fact, consistently taking the drug is important for keeping the body in equilibrium. In clinical trials, people who stop taking GLP-1s tend to regain 1% of their body weight per month or about 12% over a year.
Even modest weight loss can lead to significant health benefits. Losing at least 5% of body weight cuts the risk of developing diabetes and meaningfully improves blood pressure and cholesterol.
Losing 15% of body weight is the sweet spot, Aronne said. That’s the point at which people tend to reap most of the health benefits of obesity treatment.
“You don’t have to get to your ideal weight to improve your health,” Aronne said. “I give my patients [an] analogy: you got an A on a test, but you want the A plus and extra credit. We may not be able to do that right now, but the good news is, you’re in much better health.”
Related: What Is Obesity Treatment Like?
What Can You Do If You Hit a Weight Loss Plateau?
If you need to continue losing weight to reach your health goals, your provider may recommend taking an additional, non-GLP-1-based medication or undergoing bariatric surgery. Or if you plateau on one GLP-1 drug, like semaglutide, you may lose more weight by switching to a more potent medication, like tirzepatide.
However, your response to a medication doesn’t totally dictate how much weight you will lose and for how long. Eating well and exercising consistently can make a big difference in how great and sustained your weight loss is.
In a large clinical trial to test how semaglutide affects heart health, participants weren’t instructed to follow a particular diet or exercise regimen. Though they still saw a reduced risk of heart attack, stroke, liver failure, and diabetes, the participants also lost almost 7% less body weight, on average, than in an earlier study when they were told to modify their lifestyle. Diet and exercise may be responsible for that difference, Aronne said.
Sometimes, when people lose a lot of weight quickly, it’s because they’re “dumping muscle,” Thompson said.
Muscle is a “metabolically active” tissue, meaning it helps keep metabolism high and control blood sugar. A body with a high muscle-to-fat ratio will be better at burning calories and keeping diabetes and other health conditions in check.
“It’s like you’re downsizing from a large house to an apartment—you throw out stuff you don’t use,” Thompson said. “If a person is not working out and they’re not doing resistance training, the body is going to think it doesn’t need that muscle, and it’s going to dump it.”
Thompson said that it’s important to think beyond the scale and tend to your overall lifestyle while taking a weight loss drug.
“You have to be in it for the long haul,” he added. “Slow and steady wins the race here. You want that weight to come off slow and keep going.”
Read Next: A Vibrating Pill Could Be the Next Big Thing for Obesity Treatment—Here’s Why
What This Means for You
It’s normal to stop losing weight after nine to 12 months, regardless of which intervention or treatment you’re using.
Read the original article on Verywell Health.
