GLP-1 'not working': what the science says about plateaus

What did @kareniskarma actually say?

Honestly? Not much, medically speaking. The transcript captured is song lyrics, not health advice. The caption, however, tells a real story: the creator says their GLP-1 medication is "not working" and attributes it to falling back into old habits "without a reminder of what we need to be doing on a daily basis." That framing is worth taking seriously, because it reflects a genuinely common and genuinely misunderstood experience on GLP-1 therapy.

The video appears to be a lifestyle check-in rather than a clinical claim. The creator is not prescribing anything, not diagnosing a problem, and not blaming the medication outright. They're pointing at behavior. That's a meaningful distinction. But the phrase "my GLP-1 is not working" does carry implicit assumptions about how these medications function that deserve scrutiny.

Does the science back this up?

The core idea here, that behavioral habits still matter on GLP-1 therapy, is solidly supported. GLP-1 receptor agonists like semaglutide and tirzepatide reduce appetite and slow gastric emptying, but they do not override all behavioral patterns. The STEP 1 trial (Wilding et al., 2021, New England Journal of Medicine) showed significant weight loss on semaglutide, but also showed that participants who discontinued the drug regained most of their weight within a year, which tells you the medication is not doing the work alone.

More directly relevant: a 2022 analysis by Rubino et al. in NEJM found that ongoing behavioral support alongside GLP-1 therapy produced better outcomes than medication alone. The idea that slipping back into old eating patterns can blunt results is not anecdotal. It is consistent with how these drugs work mechanistically. They lower the hedonic pull of food, but they do not eliminate it entirely, and high-calorie, ultra-processed food intake can offset the caloric deficit the drug helps create.

What did they get wrong (or right)?

They got the behavioral piece right. Framing habit relapse as a reason for stalled progress is accurate and, frankly, underemphasized in a lot of GLP-1 content online. Credit where it's due.

What's slippier is the phrase "my GLP-1 is not working." That framing can mislead viewers into thinking medication failure is a common, expected outcome rather than a signal worth investigating with a clinician. There are real, clinical reasons a GLP-1 might underperform: subtherapeutic dosing, injection technique errors, medication storage issues, or individual pharmacokinetic variation. Maalej et al. (2023, Obesity Reviews) noted that response variability to semaglutide is real and not fully explained by behavior alone.

Attributing everything to habit without ruling out clinical factors is an incomplete picture. The creator may have done that investigation privately, but the public caption sends a message that "old habits" are the default explanation, which is not always true.

What should you actually know?

If your GLP-1 results have stalled or the medication feels like it stopped working, the answer is not just "try harder with your habits." Talk to your prescriber. There are several legitimate clinical checkpoints: Is the dose appropriate for your current weight? Is the medication being stored correctly? Are you injecting into scar tissue? These are real variables.

At the same time, the creator's instinct about behavioral drift is not wrong. A 2023 paper by Chao et al. in Obesity Science and Practice found that patients who paired GLP-1 therapy with structured behavioral interventions lost significantly more weight than those on medication alone. GLP-1s are a tool, not a replacement for understanding your eating patterns.

If you're on a GLP-1 and feeling like it's lost its effect, document what changed: sleep, stress, diet quality, alcohol intake. Bring that log to your provider. That's more useful than assuming the drug stopped working or that you just need more willpower.