#GLP1 #WeightLoss #Ozempic #Mounjaro #ObesityMedicine
Not losing weight on a GLP-1? The problem usually isn't you, and it usually isn't the medication either. It's the variables nobody checked.
I'm Dr. Mohammed Paika, a physician board-certified in Internal Medicine and Obesity Medicine. I've spent about 15 years as a hospitalist, and I'm also a certified personal trainer and nutrition coach. In this video, I walk you through 8 evidence-based reasons the scale can stall on semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound), plus a bonus. They range from diabetes and insulin resistance to medications that quietly cause weight gain, eating too little, muscle loss, sleep apnea and dose problems. At the end, I share my 4-question test to tell whether your GLP-1 is working, stalling or needs to be changed.
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Comprehensive education on GLP-1 medications, nutrition, exercise, muscle preservation, side effects & long-term success. Includes the companion eBook, quizzes, 12-week exercise program, certificate & future course updates at no additional cost.
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⏱️ TIMESTAMPS
0:00 Why your GLP-1 isn't working (the 2 a.m. patient)
1:47 Reason 1: Your starting point was different
3:47 Reason 2: Diabetes, insulin resistance and PCOS
5:13 Reason 3: Medications quietly working against you
6:57 Reason 4: You're eating too little, not too much
8:47 Reason 5: The quiet calorie creep
10:07 Free GLP-1 Diet Cookbook
10:33 Reason 6: You're losing muscle, and the scale can't tell you
12:29 Reason 7: The exercise myth, and what works instead
14:06 GLP-1 Masterclass
14:41 Reason 8: Sleep, stress and sleep apnea
15:55 Bonus: Dose, timing, injection site and refills
17:35 The 4-question test: is your GLP-1 working?
19:36 What to watch next
📚 REFERENCES
Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med. 2021;384:989-1002.
Davies M, et al. Semaglutide 2.4 mg in adults with overweight or obesity and type 2 diabetes (STEP 2). Lancet. 2021;397:971-984.
Jastreboff AM, et al. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1). N Engl J Med. 2022;387:205-216.
Garvey WT, et al. Tirzepatide in people with obesity and type 2 diabetes (SURMOUNT-2). Lancet. 2023;402:613-626.
Look M, et al. Body composition changes with tirzepatide in SURMOUNT-1. Diabetes Obes Metab. 2025.
Mosenzon O, et al. Clinically relevant weight loss independent of early response to semaglutide 2.4 mg (STEP 4). J Endocr Soc. 2021;5(Suppl 1).
Lincoff AM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT). N Engl J Med. 2023;389:2221-2232.
Malhotra A, et al. Tirzepatide for obstructive sleep apnea and obesity (SURMOUNT-OSA). N Engl J Med. 2024;391:1193-1205.
Lichtman SW, et al. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. N Engl J Med. 1992;327:1893-1898.
Nedeltcheva AV, et al. Insufficient sleep undermines dietary efforts to reduce adiposity. Ann Intern Med. 2010;153:435-441.
Fothergill E, et al. Persistent metabolic adaptation 6 years after "The Biggest Loser" competition. Obesity. 2016;24:1612-1619.
LaForgia J, et al. Effects of exercise intensity and duration on excess post-exercise oxygen consumption. J Sports Sci. 2006;24:1247-1264.
Pontzer H, et al. Constrained total energy expenditure and metabolic adaptation to physical activity. Curr Biol. 2016;26:410-417.
Greendale GA, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4:e124865.
Magkos F, et al. Effects of moderate and subsequent progressive weight loss on metabolic function. Cell Metab. 2016;23:591-601.
Wegovy (semaglutide) and Zepbound (tirzepatide) U.S. Prescribing Information.
Paika MK. GLP-1 Masterclass. 2026.
Paika MK. The Weight Equation: A Physician's Guide to the Science and Treatment of Obesity. 2026.
⚕️ MEDICAL & EDUCATIONAL DISCLAIMER: This content is for general educational and informational purposes only and is not medical advice or a substitute for care from your healthcare provider. Viewing this content does not create a doctor-patient relationship. Always consult a qualified healthcare professional before starting, stopping, or changing any medication, diet, exercise, or weight-loss plan. Individual results and risks vary. You assume responsibility for decisions made based on this content.
