People Who Lose Weight, Those Who Plateau, and Those Who Suffer Side Effects: The Turning Point of Weight Loss Drugs

People Who Lose Weight, Those Who Plateau, and Those Who Suffer Side Effects: The Turning Point of Weight Loss Drugs

Wegovy and Zepbound have now become entities that cannot be dismissed with the light term "slimming pills." In the movement to treat obesity as a chronic disease, these drugs are extending their effects into areas that traditional weight loss methods have struggled to reach, transforming both the medical and social landscapes.


However, amidst this enthusiasm, there is a reality that tends to be overlooked. Even with the same medication, the results are surprisingly not uniform. Some people experience visible changes within a few months, saying, "Thoughts of food disappeared from my mind." Others, who started with high expectations, see little change in weight and worry, "Maybe it doesn't work for me." Yet others lose weight but struggle with nausea, constipation, and fatigue, making continuation itself difficult.


This individual variation cannot be explained by a lack of willpower or effort alone. Obesity itself is a complex condition involving appetite, metabolism, hormones, sleep, stress, genetics, and behavioral habits. Recent reviews suggest that differences in response to GLP-1-based treatments may involve early weight changes, genetic backgrounds, differences in gut and brain signaling, and even gut microbiota. In other words, variation in drug efficacy is not an exception but rather a natural occurrence.


Of course, the average effect of the drug itself is significant. Semaglutide demonstrated significant weight loss at 68 weeks in a trial published in NEJM. Furthermore, a 2025 NEJM paper comparing tirzepatide and semaglutide directly showed an average weight loss rate of 20.2% for tirzepatide and 13.7% for semaglutide at 72 weeks, with the former showing greater weight loss. Looking at this alone, one might think, "Then Zepbound is the only choice." However, an average is just an average. In actual practice, which drug is easier for the individual to continue and leads to results is a separate issue.


Looking at social media, this "world not visible through averages" becomes clear. Posts related to Wegovy highlight voices such as "I lost weight quickly in the first few weeks, but then it stopped," "There's almost no change with a low dose," and "Side effects are too strong to increase the dose." Regarding Zepbound, while there are surprises like "Appetite suppression is so strong I forget to eat" and "Obsession with food has quieted," there are also fluctuations like "Effectiveness varies day by day," "Hunger returns later on," and "It's tougher than expected." If one were to summarize the atmosphere on social media in one word, it would be the sense that **"it's not about whether it works or not, but that the way it works varies too much from person to person."**


Particularly symbolic is the difference in how people perceive the "feeling of appetite disappearing." For some, it is a life-changing liberation. The constant "food noise" quiets, and they feel they can choose their eating behaviors for the first time. However, for others, it diminishes the joy of eating and disrupts their life rhythm, leaving them confused about what to eat. Even if the physiological changes brought by the drug are similar, how one feels and integrates them into life is entirely different.


Side effects also strongly emphasize individual differences. According to FDA information on Wegovy, nausea, diarrhea, vomiting, constipation, abdominal pain, headache, and fatigue are listed as representative side effects. These symptoms are particularly likely to occur during the dose-increasing phase, turning into real-life concerns such as "I can't eat," "I can't concentrate at work," and "It's hard to plan outings." On social media, there are many posts focusing more on managing side effects than on weight loss itself. It's not just about whether weight is lost, but whether the way it's lost disrupts daily life that becomes the dividing line for continuation.


Another point that cannot be overlooked is that even if weight is lost, "what is being lost" is not uniform. Recent reviews have shown that weight loss with GLP-1-based drugs and GIP/GLP-1 agonists involves not only fat but also a certain proportion of lean body mass. Of course, the overall benefit of fat reduction is significant, but if one pursues rapid weight loss without sufficient protein intake or strength training, the quality of body composition may not be optimal. The anxiety seen on social media, such as "I can't exert as much strength as I thought" and "I feel like I've lost muscle because I'm eating too little," is not unrelated to this background.


So why is there such a difference? There is no single answer. First, the starting point of obesity varies from person to person. Those suffering from intense hunger, those primarily stress eating, those affected by sleep disorders, and those with strong insulin resistance may respond differently to the same medication. Next, there are differences in the speed of dose increase and the target dose. The low-dose period is a preparatory stage for the body to adapt, and some may feel "it's not working" during this time. Furthermore, even if the drug is effective and reduces food intake, if nutritional balance is disrupted or activity levels decrease, it may not lead to the desired results. The drug is powerful but not omnipotent.


 

What is important here is not to believe that only the success stories or failure stories on social media are true. Dramatic before-and-after stories catch the eye. However, what clinical trials show is that they are "generally effective," not that everyone loses weight at the same speed, to the same extent, and with the same comfort. Conversely, just because there are many posts about stagnation or side effects, it is premature to conclude that the drug as a whole is disappointing. While social media is extremely valuable as an accumulation of experiences, it is also a place where cases with loud voices tend to stand out.


Another frequent question on social media is "How long should it be continued?" This is both a cost issue and a treatment perspective issue. Regarding weight changes after stopping the medication, the STEP 1 extension trial of semaglutide reported that about two-thirds of the lost weight was regained one year after discontinuation. For tirzepatide, while the continuation group maintained or further reduced weight, the discontinuation group showed significant weight regain. In other words, for many people, these drugs are becoming subjects to consider as part of chronic disease treatment, rather than "short-term events."


This reality can be harsh at times. Continuing expensive medication does not mean everyone will reach their ideal weight. It is easy to regain weight if stopped. There are side effects. Still, that does not mean they are without value. Just as we do not say that hypertension or dyslipidemia medications are "meaningless because they only work while being taken," obesity treatment is also beginning to be reconsidered from the perspective of continuous management. The problem is that society is not yet fully accustomed to this premise.


Ultimately, what Wegovy and Zepbound confront us with is the fact that "obesity is not simply a failure of self-management." And at the same time, it is the rather obvious reality that "even with advances in treatment, the human body remains individual." The same medication works differently. The way weight is lost is different. The difficulties are different. Therefore, what is needed is neither magical expectations nor cynicism, but treatment design that assumes individual differences..


Social media is a mix of hope and anxiety. There is the joy of being freed from food noise, as well as voices tired of stagnation and side effects. Both are genuine. What is truly being questioned in the era of weight loss drugs is not "who lost the most weight," but who can continue their health in a way that suits them without strain. The answer is not determined by the name of the drug alone.


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