Wegovy (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist that can help with weight loss by reducing appetite and food intake. It mimics a hormone in the body that signals brain receptors involved in appetite regulation. While Wegovy takes time to work, some weight loss results may be seen in the first month (4 weeks) of treatment. Wegovy doses are slowly increased when you first start treatment to help reduce side effects like nausea or diarrhea. This article delves into the specifics of Wegovy dosage, expected weight loss results, and other essential information.
How Wegovy Works
Wegovy (semaglutide) is classified as a glucagon-like peptide-1 (GLP-1) receptor agonist. It works by acting like a hormone in your body that signals brain receptors involved in your appetite and food intake. It can reduce your appetite which may help you eat less and lead to weight loss.
Wegovy Dosage
The recommended starting dose for Wegovy is 0.25 milligrams (mg). You’ll need to take 0.25 mg once per week for the first 4 weeks of treatment. Starting at this dosage reduces the risk of side effects from Wegovy. If you tolerate the initial dose, your doctor may gradually increase the dosage as follows:
- Weeks 5 through 8: 0.5 mg
- Weeks 9 through 12: 1 mg
- Weeks 13 through 16: 1.7 mg
The maintenance dose of Wegovy (semaglutide) is 2.4 mg injected subcutaneously (under the skin) once-a-week, with or without meals. It comes in a pre-filled, single-dose pen.
Can I start Wegovy at 1.7 mg?
No. The recommended starting dose for Wegovy is 0.25 milligrams (mg). You’ll need to take 0.25 mg once per week for the first 4 weeks of treatment.
Read also: Sustainable weight loss using Wegovy
Wegovy's Maintenance Dosage
The typical maintenance (long-term) dosage of Wegovy can be up to 2.4 mg once per week. Your doctor will prescribe a maintenance regimen at the dose that helped you reach your goal weight. For some people, the maintenance dosage may be 2.4 mg once per week. For others, it may be 1.7 mg once per week. Your doctor will determine the best dosage for you after you hit your weight loss goal.
Weight Loss Results with Wegovy
First-Month Results
A 2021 study found that, on average, people lost more than 2% of their body weight in the first 4 weeks of using semaglutide. (Semaglutide is the active ingredient in Wegovy.) For example, if a person weighs 200 pounds (lb), a 2% reduction in body weight means they would lose 5 lb. For reference 1kilogram (kg) =2.205 lb. Keep in mind that the amount of weight you lose with Wegovy and how fast you lose it varies from person to person.
Long-Term Results
A long-term study published in 2024, involving 17,604 adults, found that weight loss with semaglutide continued for 65 weeks, and participants sustained their weight loss for up to 4 years. At 104 weeks, 67.8% of participants using semaglutide had lost 5% of their body weight or more, and 44.2% had lost 10% or more. Researchers compared this data with 21.3% and 6.9% of participants, respectively, who used a placebo. A smaller percentage of participants using semaglutide had lost 15% to 25% of their weight or more at this point in the trial. Semaglutide also reduced major cardiovascular events - including heart attack and worsening of heart failure - by 20% in people without diabetes who had cardiovascular disease, overweight, or obesity.
In clinical trials, most people taking 1.7-mg and 2.4-mg doses of Wegovy had lost 5% to 15% of their body weight after 68 weeks of treatment. In a small 2022 study, people with overweight or obesity had lost 5.9% of overall body weight after 3 months of using semaglutide. And after 6 months, they had lost 10.9%.
In adolescents 12 years of age and older, Wegovy led to a 16.1% decrease in body mass index (BMI) at week 68, compared to a 0.6% BMI decrease with placebo. In addition, 77% of patients in the Wegovy group had a BMI reduction of at least 5%.
Read also: Weekly Wegovy Progress
In randomized, placebo-controlled studies conducted by Novo Nordisk, the manufacturer of Wegovy, weight loss was assessed over a 68-week period in 1,961 adults taking either Wegovy or a placebo. In these studies, patients were classified as either obese (BMI ≥30) or with excess weight (BMI ≥27) with a weight-related medical problem (such as high blood pressure or high cholesterol). The average starting weight for both groups was about 232 lbs (105.4 kg). Adults taking Wegovy lost an average of 35 lbs (15.9 kg), or about 15% of their body weight. However, some people dropped out of the research studies.
Real-World Evidence from a Cohort Study
A cohort study, conducted at a referral center for weight management, retrospectively collected data on the use of semaglutide for adults with overweight or obesity between January 1, 2021, and March 15, 2022, with a follow-up of up to 6 months. A total of 408 patients with a body mass index (BMI) of 27 or more were prescribed weekly semaglutide subcutaneous injections for 3 months or more. The primary end point was the percentage of weight loss.
The study included 175 patients (132 women [75.4%]; mean [SD] age, 49.3 [12.5] years; mean [SD] BMI, 41.3 [9.1]) in the analysis at 3 months and 102 patients at 6 months. The mean (SD) weight loss after 3 months was 6.7 (4.4) kg, equivalent to a mean (SD) weight loss of 5.9% (3.7%) (P < .001), and the mean (SD) weight loss after 6 months was 12.3 (6.6) kg, equivalent to a mean (SD) weight loss of 10.9% (5.8%) (P < .001 from baseline). Of the 102 patients who were followed up at 6 months, 89 (87.3%) achieved weight loss of 5% or more, 56 (54.9%) achieved weight loss of 10% or more, 24 (23.5%) achieved weight loss of 15% or more, and 8 (7.8%) achieved weight loss of 20% or more.
The results of this cohort study suggest that weekly 1.7-mg and 2.4-mg doses of semaglutide were associated with weight loss similar to that seen in randomized clinical trials. The study also found that patients with type 2 diabetes had a lower mean percentage weight loss compared with those without type 2 diabetes at 3 months (3.9% vs 6.3%) and at 6 months (7.2% vs 11.8%).
The STEP Trials
The Semaglutide Treatment Effect in People With Obesity (STEP) trials have shown the efficacy of semaglutide for the treatment of obesity. In large RCTs, patients receiving semaglutide, 2.4 mg, lost a mean of 6% of their weight by week 12 and 12% of their weight by week 28.
Read also: Duration of Wegovy Treatment
The landmark STEP 1 trial studied 1,961 adults without diabetes taking Wegovy.
In the STEP 2 trial comparing 1 mg and 2.4 mg of semaglutide for patients with type 2 diabetes, similar weight loss trends compared with those in our study were seen. In 12 weeks, weight loss of approximately 4% was achieved among patients taking the 1-mg dose, and weight loss of approximately 5% was achieved among those taking the 2.4-mg dose. In addition, weight loss at 28 weeks approached approximately 7% for patients taking the 1-mg dose and 9.6% for those taking the 2.4-mg dose.
Do You Lose Weight on a Maintenance Dose of Wegovy?
Yes, it’s possible to continue losing weight while on a maintenance dose of Wegovy. The maintenance dose of Wegovy is up to 2.4 mg once per week. You can stay on your maintenance dose for several months as long as the drug is effective and you can tolerate its side effects. If you are unable to tolerate the side effects, your doctor may decrease your Wegovy dose to 1.7mg once per week.
Factors Affecting Weight Loss
It is important to remember-weight loss doesn’t happen overnight. Losing weight with Wegovy is a gradual journey, requiring sustained effort in order to see any meaningful impact on your health. Results happen over weeks, not days.
Multiple weight loss interventions have been developed during the past decades. Considering the scarcity of AOMs, choosing the most suitable and individualized therapy is important.
Individual Variation
Keep in mind that the amount of weight you lose with Wegovy and how fast you lose it varies from person to person.
Lifestyle Changes
Moreover, you need more than just medication to see the real benefits, with diet, exercise and other lifestyle modifications including sleep and stress management playing a huge part.
Managing Expectations and Potential Plateaus
After an initial weight loss, a plateau may occur at roughly 60 weeks (1 year and 2 months) of treatment. Significant weight loss with Wegovy is gradual. It can take more than a year to lose almost 15% of your weight with the highest dosage.
Ways to Increase Weight Loss with Wegovy
Here are five possible ways to increase weight loss while using Wegovy:
- Reduce your calorie intake: Reducing your calorie intake by 500 kilocalories per day may support weight loss.
- Increase your physical activity: Aiming for at least 150 minutes of moderate intensity exercise per week can help increase weight loss.
- Eat nutrient-dense foods: Nutrient-dense foods provide important vitamins and minerals and are lower in added sugars, saturated fats, and salt. Nutrient-dense foods help provide your body with the nutrients it needs without excess calories.
- Manage stress: Stress can change food intake and fat storage, potentially leading to weight gain. Finding healthy ways to manage stress may support weight loss.
- Get quality sleep: Inadequate sleep may increase the risk of obesity and increase energy intake. Getting 7 to 9 hours of sleep may help with weight loss.
Reasons You May Not Lose Weight with Wegovy
Possible reasons you may not be losing weight while using Wegovy include:
- Reaching a plateau: After an initial weight loss, a plateau may occur at roughly 60 weeks (1 year and 2 months) of treatment.
- Needing to give it more time: Significant weight loss with Wegovy is gradual. It can take more than a year to lose almost 15% of your weight with the highest dosage.
- Taking other medications: Other medications, such as beta-blockers, some diabetes drugs, and antipsychotics, may cause weight gain.
If you’re using Wegovy and not losing weight, you can talk with your doctor about factors that could be preventing weight loss. In some cases, your doctor may suggest changing your Wegovy dosage or taking a different weight loss drug, such as tirzepatide (Zepbound).
Common Side Effects
Stomach side effects are most common when starting treatment but decrease over time in most people.
Nausea and vomiting were the most encountered adverse events (64 patients [36.6%]), followed by diarrhea (15 patients [8.6%]) and fatigue (11 patients [6.3%]).
Long-Term Use and What Happens When You Stop
You can use Wegovy (semaglutide) as long as you need it for weight loss and weight management. You can continue taking Wegovy if you and your doctor determine that Wegovy is safe for you and you can tolerate its side effects.
Wegovy is a long-term treatment that you may use to maintain weight loss until you can manage its side effects. If you stop using Wegovy, you may regain the weight that you lost. If you had preexisting cardiovascular or metabolic conditions, these may also return.
A 2022 study found that 1 year after stopping semaglutide, participants had regained two-thirds of the weight they had lost by using the drug and making lifestyle changes. If you want to stop using Wegovy, it is important to continue any other lifestyle changes you’ve made to support weight loss, such as eating a low calorie diet and increasing your physical activity. You can talk with your doctor about how to stop Wegovy safely while avoiding weight regain and preventing health conditions from returning.
A Week-by-Week Guide to Weight Loss with Wegovy
Here, we share a rough outline of your first eight weeks, and beyond, when taking Wegovy, and the impacts you may start to see over the course of the prescription.
Wegovy Weeks 1 & 2
The first few weeks of taking Wegovy are all about getting used to the medication. These are the first steps on a long weight loss journey, and it's really important to start implementing habits and routines at this stage. This might include establishing a day of the week, and time, at which you take your injection. This sort of routine will ensure you don’t forget to take the medication. You’ll be starting on a dosage of 0.25mg. Although this is a small dosage, your body will start almost immediately recognise the effects of the medication. One of the key effects is the sensation of feeling full. Your appetite will be noticeably smaller than previously, and you will feel much fuller for longer after meals. At this stage, however, this sensation will start to wear off after 4 to 5 days of being on the drug. Your level of semaglutide in your body is not steady yet, so will fluctuate depending on how long it is since you took the injection. The other thing you may start to feel is some of the side effects of the drug-after all, your body is still getting used to the medication. Nausea, constipation, mild abdominal pain and diarrhoea are not uncommon at this stage. This shouldn't feel unexpected, and only need to be reported to a doctor or medical professional if they persist or worsen. You’re unlikely, at this stage, to start to see any meaningful loss in weight. You may potentially lose a couple of pounds here, but this will be too small to notice any physical change. So don’t be dismayed if you feel like you’re not seeing an instant impact.
Weeks 3 & 4
This is still early days in the course of your medication, but this is an important stage for committing to your weight loss journey. You are still, at this stage, on a 0.25mg dosage of Wegovy. This is the point where your body is starting to reach a more steady stage-rather than the levels of medication fluctuating in your body, it is becoming more constant. That means that the desired feeling of fullness should be more consistent throughout the week. Again, weight loss at this stage may start to be limited, but you may have lost somewhere around 5-6 pounds, or even more. It may still be too soon to see any physical signs of weight loss, but you are certainly heading in the right direction. Now is a really good time to double down on healthy habits. Many people talk about the 21/90 rule-that it takes 21 days to make a habit, and 90 days to make it a permanent lifestyle change. So if you’ve not done it already, which ideally you’d want to have done from the start, put some real consideration into the habits you want to implement permanently into your day to day life. How much sleep are you getting and how is your sleep hygiene? How frequently are you doing exercise, and what kind of exercise? What sort of meals are you eating, how are you approaching snacking, and are you allowing yourself treats? These are the sorts of questions that you should be asking yourself to formulate your habits going forward.
Weeks 5 & 6
After four weeks on a 0.25mg dosage, and if you are comfortably coping at this dosage, you should titrate your dosage up to 0.5mg. Your body gets used to medication at this level, and knows how to counteract it, so to see real results it is advised to increase the dosage. As a result, many doctors say that this is the point at which weight loss really starts to happen. This stage, you can imagine, is one of the more satisfying points in the journey. The benefits of four weeks of hard work are starting to show, and can be a timely reminder as to why you started taking Wegovy in the first place. It differs for each person, but you can expect to see roughly a 2 to 4% reduction in body fat. This means you’ll start to see physical signs of weight loss in different parts of your body-smaller stomach, more defined muscles in your legs and arms, and so on. This of course will be helped by the regular routine of exercise you are undertaking, which should be helping you to build muscle across the body. As you increase your dosage, you may start to see the return of certain side effects of the medication. This is expected, and there are a number of ways that you can help your body manage these side effects-such as keeping well hydrated, knowing which foods to avoid, and getting plenty of fresh air.
Weeks 7 & 8
At this point, you will still be at a 0.5mg dosage, provided that you are coping well with side effects. Weight loss should be well underway, and hopefully you will start to see some of the secondary benefits of losing weight and eating more healthily. This might include feeling generally fitter, whether this is when you are exercising or just in your day-to-day life. You might also expect to be sleeping better and see overall improvements in your mental health-both things that can be intrinsically linked to your physical health.
Weeks 9 & Beyond
You’ve now completed eight weeks on Wegovy! If you are coping well with medication, you’ll titrate the dosage every four weeks from this point onwards. The dosage schedule looks like:
- Weeks 9-12 at 1mg
- Weeks 13-16 at 1.7mg
- Weeks 17-onwards at 2.4mg
Eight weeks might already feel like a long time, but you have a long way to go. And it won’t be plain sailing from here. Maintaining healthy habits over a long period of time can still be a challenge, and may require creativity in order to keep it up. You may also find that, for a certain period of time, you’ll stop losing weight and may even start to put it back on. This is known as the weight loss plateau, a common feature in most weight loss journeys, and something that you can break through with the right approaches.
Monthly Breakdown of Expected Weight Loss and Dosage
Here’s a monthly breakdown of what to expect from Wegovy. Note that the expected weight loss and dose every month is based on trial data, and your results may be different. Depending on certain factors, your clinician may keep you on the 1mg Wegovy dose for longer than one month.
- Month 1: Dose: 0.25mg
- Month 2: Dose: 0.5mg | Expected weight loss: 4% body weight*
- Month 3: Dose: 1mg | Expected weight loss: 6% body weight*If your dose is increased beyond 1mg:
- Month 4: Dose: 1.7mg | Expected weight loss: 8% body weight*
- Month 5: Dose: 2.4mg | Expected weight loss: 10% body weight*
- Month 6 onwards: Dose: 2.4mg | Expected weight loss after 17 months: 17% body weight**
*Based on semaglutide over 68 weeks. Wilding, John PH, et al. "Once-weekly semaglutide in adults with overweight or obesity." New England Journal of Medicine (2021). Results measured in participants who adhered to the dosing schedule and reached the maximum dose of semaglutide.