GLP-1 Not Working? The Checklist, in Order
Results vary a lot by dose and by person. In SURMOUNT-1, the average loss ran from 15% on tirzepatide 5 mg weekly to 20.9% on tirzepatide 15 mg weekly, against 3.1% on placebo. If you have lost little after several months on your full dose, talk to your prescriber.
- Average loss, top dose
- 20.9%
- On placebo
- 3.1%
- Trial length
- 72 weeks
- Trial
- SURMOUNT-1
Weight loss and half-life overview
Half-life in days: how long the body needs to clear half a dose, based on section 12.3 of each FDA label.
Body weight percentage. Because doses and lengths differed from trial to trial, read each result against the placebo listed on its page.
Start with the numbers when GLP-1 is not working
Each GLP-1 is shown at its top dose from the main weight trial. Different trials enrolled different people.
| Trial | Dose group | Average weight lost | Placebo or comparison | Weeks | Who was in it |
|---|---|---|---|---|---|
| STEP 1 | Semaglutide 2.4 mg weekly | 14.9% | 2.4% | 68 | Adults with obesity or overweight, without diabetes |
| OASIS 4 | Wegovy pill 25 mg daily | 13.6% | 2.4% | 64 | Adults with obesity or overweight, without diabetes |
| SURMOUNT-1 | Tirzepatide 15 mg weekly | 20.9% | 3.1% | 72 | Adults with obesity or overweight, without diabetes |
| SURMOUNT-2 | Tirzepatide 15 mg weekly | 14.7% | 3.2% | 72 | Adults with obesity or overweight and type 2 diabetes |
| SCALE Obesity and Prediabetes | Liraglutide 3.0 mg daily | 7.4% | 3% | 56 | Adults with obesity or overweight who did not have type 2 diabetes |
| ATTAIN-1 | Foundayo 17.2 mg daily | 11.1% | 2.1% | 72 | Adults with obesity or overweight, without diabetes |
| ATTAIN-2 | Foundayo 17.2 mg daily | 9.6% | 2.5% | 72 | Adults with obesity or overweight and type 2 diabetes |
| STEP 2 | Semaglutide 2.4 mg weekly | 9.6% | 3.4% | 68 | Adults with obesity or overweight and type 2 diabetes |
Sources: SURMOUNT-2 (PubMed), STEP 1 (FDA label (DailyMed)), ATTAIN-1 (FDA label (DailyMed)), SURMOUNT-1 (FDA label (DailyMed)), SCALE Obesity and Prediabetes (FDA label (DailyMed)), STEP 2 (PubMed).
What helps and why it stalls
- See which dose step you are on. Lower doses led to less weight loss in each trial listed above.
- Review the past month and count any doses you missed or took late.
- Keep a record of what you eat and drink for a few days. Liquid calories and grazing add up as your portions get smaller.
- Eat protein at each meal and continue strength exercise, so most of your weight loss comes from fat.
- Check your sleep and stress, since both affect appetite.
- Ask your pharmacist whether any of your other medicines may cause weight gain.
- Two topics for your prescriber: thyroid or blood sugar tests, and whether to change medicines if things have stalled for months.
In the trials, how many people stopped?
| Trial | Dose group | What happened | Drug | Placebo |
|---|---|---|---|---|
| STEP 1 | Semaglutide 2.4 mg weekly | Stopped for stomach or bowel side effects | 4.5% | Not listed |
| STEP 1 | All doses, label pool | Stopped for side effects | 6.8% | Not listed |
| SURMOUNT-1 | Tirzepatide 5 mg weekly | Stopped for side effects | 4.3% | 2.6% |
| SURMOUNT-1 | Tirzepatide 10 mg weekly | Stopped for side effects | 7.1% | 2.6% |
| SURMOUNT-1 | Tirzepatide 15 mg weekly | Stopped for side effects | 6.2% | 2.6% |
| SCALE Obesity and Prediabetes | All doses, label pool | Stopped for side effects | 9.8% | Not listed |
Sources: SURMOUNT-1 (PubMed), STEP 1 (PubMed), SCALE Obesity and Prediabetes (FDA label (DailyMed)), STEP 1 (FDA label (DailyMed)).