Why am I not losing weight on Victoza? Many patients prescribed Victoza (liraglutide) for type 2 diabetes expect weight loss but find the scales aren't shifting—or may even show weight gain. Whilst this GLP-1 receptor agonist can promote modest weight reduction through appetite suppression and improved glucose control, individual responses vary considerably. Several factors influence outcomes, including dosage, dietary habits, metabolic adaptation, and interactions with other medications. Understanding why weight loss may not occur on Victoza, and what steps to take next, is essential for managing expectations and optimising your diabetes treatment plan.

How Victoza Works for Weight Loss

Victoza (liraglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK primarily for the treatment of type 2 diabetes mellitus. Whilst weight loss is not its primary indication at the standard diabetes dose (up to 1.8 mg once daily), many patients do experience modest weight reduction as a secondary benefit during treatment.

The mechanism by which Victoza may promote weight loss involves several physiological pathways. Liraglutide mimics the action of naturally occurring GLP-1, a hormone released from the gut in response to food intake. It works by increasing insulin secretion and suppressing glucagon in a glucose-dependent manner, whilst also activating GLP-1 receptors in the brain—particularly in areas that regulate appetite and satiety. This helps to reduce hunger and increase feelings of fullness after meals. Additionally, it slows gastric emptying (though this effect may diminish over time), meaning food remains in the stomach longer, which can contribute to reduced calorie intake throughout the day.

Clinical trials have demonstrated that patients using Victoza for diabetes management typically lose between 2 to 3 kg over the course of treatment, though individual responses vary considerably. It is important to note that Victoza is not licensed as a weight-loss medication in the UK. A higher-dose formulation of liraglutide (3.0 mg daily, marketed as Saxenda) is available specifically for weight management in certain patient groups, prescribed under different criteria.

Weight loss on Victoza tends to occur gradually over several months rather than immediately. The medication works best when combined with lifestyle modifications, including a balanced diet and regular physical activity. Understanding these mechanisms helps set realistic expectations about the degree and timeline of potential weight changes during treatment.

Common Reasons Why Weight Loss May Not Occur on Victoza

Despite Victoza's potential to support weight reduction, many patients find they do not lose weight—or may even gain weight—whilst taking the medication. Several common factors can explain this phenomenon.

Calorie compensation is perhaps the most frequent reason. Whilst Victoza reduces appetite in many individuals, some patients may unconsciously or consciously increase their food intake at times when they do feel hungry, effectively negating the appetite-suppressing effects. Additionally, some people may reward themselves with higher-calorie foods, believing the medication will compensate for dietary indiscretions. High-calorie drinks, including alcohol and sugary beverages, can also significantly offset the medication's effects.

Dosage considerations also play a role. Victoza for diabetes is typically initiated at 0.6 mg daily and gradually increased to 1.2 mg or 1.8 mg. The weight-loss effects tend to be dose-dependent, and patients on lower maintenance doses may experience minimal or no weight reduction. This is considerably lower than the 3.0 mg dose used specifically for weight management.

Metabolic adaptation can occur over time. The body may adjust to the medication's effects, and the initial appetite suppression some patients experience may diminish after several months of treatment. Furthermore, as blood glucose control improves with Victoza, the calories previously lost through glycosuria (glucose in urine) are retained, which can offset weight loss.

Medication interactions should also be considered. Some patients with type 2 diabetes take multiple medications, and certain drugs—particularly insulin, sulphonylureas, or some antidepressants—are associated with weight gain that may counteract Victoza's effects. Insulin and sulphonylureas may also increase the risk of hypoglycaemia when combined with GLP-1 receptor agonists, potentially requiring dose adjustments. The overall medication regimen, rather than Victoza alone, determines the net effect on body weight.

Factors That Influence Victoza's Effectiveness

Individual response to Victoza varies considerably, and numerous factors influence whether a patient will experience weight loss during treatment.

Baseline characteristics matter significantly. Research suggests that patients with higher initial body weight or BMI may experience more substantial weight loss on GLP-1 receptor agonists. Conversely, those closer to a healthy weight range may see minimal changes. Age, sex, and ethnicity can also influence treatment response, though these effects are less predictable on an individual basis.

Dietary habits and physical activity levels remain fundamental to weight management, regardless of medication. Victoza is not a substitute for lifestyle modification but rather a tool to support it. Patients who maintain high-calorie diets—particularly those rich in processed foods, sugary beverages, or excessive portions—are unlikely to lose weight even with optimal appetite suppression. Similarly, sedentary behaviour limits the calorie deficit necessary for weight loss. NICE guidance consistently emphasises that pharmacological interventions for weight management should be accompanied by dietary changes and increased physical activity.

Hormonal and metabolic factors can create resistance to weight loss. Conditions such as hypothyroidism, polycystic ovary syndrome (PCOS), or Cushing's syndrome can impair weight loss efforts. Some emerging research suggests genetic variations may affect GLP-1 receptor function or metabolic rate, though this is not currently used in routine clinical practice to predict response to liraglutide.

Treatment duration and adherence are also crucial. Weight loss on Victoza typically begins within the first few months, with an initial review of response often conducted around 3 months. Patients who expect rapid results within the first few weeks may become discouraged prematurely. Furthermore, inconsistent dosing—such as frequently missed injections—will reduce the medication's effectiveness. Gastrointestinal side effects, particularly nausea, sometimes lead to suboptimal adherence, which can limit weight-loss outcomes.

When to Speak with Your GP About Victoza and Weight

If you are not experiencing the expected benefits from Victoza, or if you have concerns about your weight whilst taking the medication, it is important to discuss this with your GP or diabetes specialist nurse.

Schedule a review if:

• You have been taking Victoza at the maximum tolerated dose for 3 months or longer without any weight loss, particularly if weight management was a treatment goal

• You are gaining weight unexpectedly whilst on Victoza, especially if this is accompanied by worsening blood glucose control

• You are experiencing persistent side effects (such as nausea, vomiting, or abdominal pain) that are affecting your ability to maintain adequate nutrition or adhere to the prescribed dose

• You develop severe, persistent abdominal pain (with or without vomiting)—stop taking liraglutide and seek urgent medical advice as this could indicate acute pancreatitis

• You notice symptoms of gallbladder disease such as pain in the upper right abdomen, yellowing of the skin or eyes, or fever

• You develop a neck lump, persistent hoarseness, or difficulty swallowing

• Your diabetes control has not improved as expected, or you are experiencing hypoglycaemic episodes, especially if you also take insulin or sulphonylureas

Your GP can conduct a comprehensive review of your treatment regimen, assess whether other medications might be contributing to weight gain, and evaluate whether dose adjustment is appropriate. They may also screen for underlying conditions that could be hindering weight loss.

If you experience persistent vomiting, ensure you maintain adequate hydration and seek medical advice if you cannot keep fluids down, as this can affect kidney function.

In some cases, your GP might consider whether referral to specialist services is warranted—such as to an endocrinologist, a specialist weight management service, or a dietitian. For patients who meet specific criteria and for whom weight loss is a primary treatment goal, discussion about higher-dose liraglutide (Saxenda) or alternative weight management strategies may be appropriate, though this would be prescribed under different guidelines and is not available to all patients through the NHS.

If you experience any suspected side effects from Victoza, you can report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

Alternative Approaches to Support Weight Management

When Victoza alone does not produce the desired weight loss, a comprehensive, multifaceted approach to weight management becomes essential.

Dietary modification remains the cornerstone of any weight management strategy. Rather than restrictive dieting, focus on sustainable changes: increasing intake of vegetables, fruits, whole grains, and lean proteins whilst reducing processed foods, sugary drinks, and excessive portion sizes. The NHS Eatwell Guide provides evidence-based recommendations for balanced nutrition. Some patients benefit from structured programmes such as referral to a registered dietitian or NHS-supported weight management services, which may be available through your GP.

Physical activity should be gradually increased according to individual capability. UK Chief Medical Officers' guidelines recommend that adults aim for at least 150 minutes of moderate-intensity activity per week, such as brisk walking, cycling, or swimming, plus muscle-strengthening activities on at least 2 days per week. Additionally, try to reduce sedentary time by breaking up long periods of sitting. For those with mobility limitations or other health conditions, even small increases in daily movement can contribute to energy expenditure and metabolic health.

Behavioural strategies can address the psychological aspects of eating and weight management. Techniques such as mindful eating, keeping a food diary, identifying emotional eating triggers, and setting realistic, incremental goals have evidence supporting their effectiveness. Some patients benefit from cognitive behavioural therapy (CBT) approaches, which may be accessible through NHS talking therapies services.

Medication review and optimisation should be conducted with your healthcare team. If other medications in your regimen are contributing to weight gain, alternatives may be available. For diabetes management specifically, your GP might consider adjusting your overall treatment plan, potentially incorporating other medications with weight-neutral or weight-loss effects.

Sleep quality and stress management are often overlooked factors in weight management. Poor sleep and chronic stress can disrupt hormones that regulate appetite and metabolism. Addressing these through good sleep hygiene and stress-reduction techniques may support your overall weight management efforts.

Remember that sustainable weight loss is typically gradual—0.5 to 1 kg per week is considered a healthy rate according to NHS guidance. Setting realistic expectations and focusing on overall health improvements, rather than the number on the scales alone, can help maintain motivation for long-term success.

Frequently Asked Questions