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Wegovy (semaglutide 2.4 mg) is a once-weekly injectable medication licensed by the MHRA for chronic weight management in adults with obesity or overweight with weight-related comorbidities. Many patients wonder at what dose Wegovy starts working and when they can expect to see results. Weight loss typically begins during the early escalation phase, often within the first 4–8 weeks of treatment, even at the lower starting doses of 0.25 mg and 0.5 mg. However, the full therapeutic effect develops gradually over several months as the dose escalates to the 2.4 mg maintenance level. Understanding the dose escalation schedule and what to expect at each stage helps patients set realistic expectations and stay motivated throughout their weight management journey.
Quick Answer: Wegovy typically starts working within the first 4–8 weeks of treatment, even at the lower starting doses of 0.25 mg and 0.5 mg, with weight loss becoming progressively greater as the dose escalates to the 2.4 mg maintenance level.
Wegovy (semaglutide 2.4 mg) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed by the MHRA for chronic weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related comorbidity. Understanding how Wegovy works at a pharmacological level helps explain why the dosing schedule is structured as it is.
Semaglutide mimics the action of naturally occurring GLP-1, a hormone released from the intestine after eating. It works through multiple mechanisms to promote weight loss:
Appetite suppression: Acts on receptors in the brain's appetite centres (hypothalamus and brainstem) to reduce hunger and increase feelings of fullness
Delayed gastric emptying: Slows the rate at which food leaves the stomach, prolonging satiety after meals
Reduced food cravings: Decreases the reward response to food in brain regions associated with food preference
Improved glycaemic control: Enhances glucose-dependent insulin secretion and suppresses inappropriate glucagon release, though it's important to note that in the UK, Wegovy is not licensed specifically for glycaemic control
The medication is administered as a once-weekly subcutaneous injection, typically into the abdomen, thigh, or upper arm. This convenient dosing schedule is possible due to semaglutide's long half-life of approximately one week, allowing steady therapeutic levels to be maintained between doses.
It is important to understand that Wegovy does not work at a single fixed dose. The treatment follows a carefully designed escalation protocol that gradually increases the dose over several months. This approach serves two purposes: it allows the body to adapt to the medication's effects, thereby minimising gastrointestinal side effects, and it enables clinicians to identify the lowest effective dose for each individual patient.
Wegovy is contraindicated during pregnancy, in patients with a personal or family history of medullary thyroid carcinoma, in those with Multiple Endocrine Neoplasia syndrome type 2, and in patients with a history of pancreatitis.
LOSE WEIGHT WITH MEDICAL SUPPORT — BUILT FOR MEN
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Wegovy treatment follows a structured five-month dose escalation schedule as recommended by the manufacturer and endorsed by NICE guidance (TA875). This gradual titration is essential for tolerability and is not optional—patients must follow this schedule unless advised otherwise by their prescribing clinician.
The standard escalation protocol is:
Month 1: 0.25 mg once weekly (starting dose)
Month 2: 0.5 mg once weekly
Month 3: 1 mg once weekly
Month 4: 1.7 mg once weekly
Month 5 onwards: 2.4 mg once weekly (maintenance dose)
Each dose level is maintained for four weeks before progressing to the next increment. This allows sufficient time for the body to adjust to increasing semaglutide levels and for side effects—particularly nausea, vomiting, and diarrhoea—to settle before further escalation.
If a patient experiences intolerable side effects at any dose level, NICE guidance permits delaying the escalation by an additional four weeks at the current dose. If the 2.4 mg dose is not tolerated, patients may be maintained at 1.7 mg, but the benefit should be reassessed every 3 months as per the SmPC.
Patients should be aware that missing doses can affect treatment. According to the SmPC, if a dose is missed and the next scheduled dose is more than 5 days away, the missed dose should be taken as soon as possible. If more than 5 days have passed, the missed dose should be skipped and the next dose taken on the regularly scheduled day. The dosing schedule should not be changed.
The pre-filled Wegovy pens are colour-coded for each dose strength to help prevent dosing errors, and patients receive comprehensive training on injection technique before starting treatment.
According to NICE TA875, treatment should be discontinued if a weight reduction of at least 10% of initial body weight has not been achieved after 72 weeks (including the dose escalation period).
A common question from patients is: "At what dose does Wegovy start working?" The answer is that weight loss typically begins during the early escalation phase, often within the first 4–8 weeks of treatment, even at the lower starting doses of 0.25 mg and 0.5 mg.
Clinical trial data from the STEP (Semaglutide Treatment Effect in People with obesity) programme demonstrates that weight reduction is dose-dependent but begins early. Many patients notice reduced appetite and smaller portion sizes within the first few weeks of starting treatment at 0.25 mg. However, the magnitude of weight loss increases progressively as the dose escalates toward the 2.4 mg maintenance level.
In the pivotal STEP 1 trial (Wilding et al., 2021, NEJM), participants showed:
Measurable weight loss by week 4 (still on 0.25 mg dose)
Continued progressive weight loss throughout the 20-week escalation period
Peak weight loss typically occurring between weeks 60–68 of treatment
It is important to set realistic expectations: weight loss with Wegovy is gradual and sustained rather than rapid. The medication works by creating a modest daily calorie deficit through appetite suppression, which accumulates over time. During the first 20 weeks of the STEP 1 trial, participants lost approximately 0.3-0.6 kg per week on average, though this varies considerably between individuals.
Early response indicators that suggest the medication is working include:
Reduced hunger between meals
Feeling satisfied with smaller portions
Decreased food cravings, particularly for high-calorie foods
Reduced preoccupation with food
Patients should not be discouraged if weight loss seems slow initially. The full therapeutic effect develops over several months as the dose reaches maintenance levels and lifestyle modifications become established.
While clinical trials demonstrate average weight loss of 10–15% of initial body weight with Wegovy, individual responses vary considerably. Understanding the factors that influence treatment response helps set realistic expectations and identify patients who may need additional support.
Biological factors affecting response include:
Baseline metabolic rate: Individuals with lower resting metabolic rates may experience slower weight loss
Insulin resistance: Patients with significant insulin resistance or type 2 diabetes may have different response patterns
Genetic factors: Variations in GLP-1 receptor genetics and metabolic pathways influence drug efficacy
Hormonal status: Conditions such as polycystic ovary syndrome (PCOS), hypothyroidism, or menopause can affect weight loss trajectory
Medication interactions: Certain medications (e.g., corticosteroids, some antipsychotics, insulin) may counteract weight loss effects
Lifestyle factors are equally important:
Dietary adherence: Wegovy reduces appetite but does not eliminate the need for healthy food choices
Physical activity levels: Combining treatment with regular exercise enhances weight loss and preserves lean muscle mass
Sleep quality: Poor sleep or sleep disorders can impair weight loss through hormonal disruption
Stress management: Chronic stress and elevated cortisol levels may reduce treatment efficacy
Alcohol consumption: Alcohol provides empty calories and may reduce medication effectiveness
NICE guidance emphasises that Wegovy should be prescribed as part of a comprehensive weight management programme including dietary advice, physical activity support, and behavioural interventions. Patients receiving multidisciplinary support typically achieve better outcomes than those relying on medication alone.
Patients with type 2 diabetes who are taking insulin or sulfonylureas may require dose adjustments of these medications to reduce the risk of hypoglycaemia when starting Wegovy. Additionally, rapid weight loss increases the risk of gallstone formation, particularly in those with existing risk factors for gallbladder disease.
It is also worth noting that weight loss is rarely linear. Patients commonly experience plateaus where weight stabilises for several weeks before resuming downward trajectory. These plateaus are a normal part of the weight loss process and do not necessarily indicate treatment failure.
The evidence base for Wegovy comes primarily from the STEP clinical trial programme, which enrolled over 4,500 participants across multiple international studies. These trials provide robust data on weight loss outcomes at different dose levels and help answer the question of when and at what dose Wegovy becomes clinically effective.
In STEP 1, the landmark 68-week trial in adults with obesity (without diabetes):
Participants on semaglutide 2.4 mg lost an average of 14.9% of initial body weight
86% of participants lost at least 5% of body weight (the threshold for clinically meaningful weight loss)
69% lost at least 10% of body weight
50% lost at least 15% of body weight
Placebo group lost only 2.4% on average
Dose-response analysis from the STEP trials demonstrates that:
The 0.25 mg starting dose produces modest but measurable appetite suppression and early weight loss
The 1 mg dose (reached at month 3) shows substantial efficacy, with many patients achieving clinically significant weight loss
The 1.7 mg dose provides further benefit over 1 mg
The 2.4 mg maintenance dose produces optimal weight loss outcomes in the majority of patients
Subgroup analyses revealed consistent efficacy across:
Different age groups (18–65+ years)
Both sexes (though women showed slightly greater average weight loss)
Various ethnic backgrounds
Different baseline BMI categories
The STEP 2 trial specifically studied people with type 2 diabetes and overweight/obesity. These participants achieved an average weight loss of 9.6% at 68 weeks with the 2.4 mg dose—somewhat lower than in STEP 1 but still clinically significant and superior to comparator treatments.
The trials also demonstrated improvements in secondary outcomes including blood pressure, lipid profiles, and glycaemic control in those with prediabetes or diabetes. While these are important benefits, it should be noted that Wegovy is specifically licensed for weight management rather than cardiovascular risk reduction in the UK.
Starting Wegovy treatment is a significant commitment that typically extends for at least 12 months, and many patients continue long-term weight maintenance therapy. Understanding what to expect at each stage helps patients stay motivated and manage potential challenges.
First 4–8 weeks (0.25–0.5 mg doses):
During this initial phase, most patients notice reduced appetite and early satiety. Some experience mild gastrointestinal side effects such as nausea, particularly in the first few days after each dose increase. These typically improve within a few days. Weight loss of 2–4 kg is common during this period. Patients should focus on establishing healthy eating patterns and staying well hydrated.
Weeks 8–20 (escalation to 2.4 mg):
As the dose increases, appetite suppression becomes more pronounced. Weight loss accelerates, and patients typically lose 5–10% of initial body weight by the end of the escalation phase. This is when lifestyle modifications become crucial—regular physical activity and balanced nutrition optimise results. Some patients experience constipation at higher doses; increasing fibre and fluid intake usually helps.
Months 5–12 (maintenance phase):
On the 2.4 mg maintenance dose, weight loss continues but may slow compared to earlier months. This is normal physiological adaptation. Patients should expect to reach their maximum weight loss between 12–18 months of treatment. Regular monitoring with your healthcare team is essential during this phase.
When to contact your GP or prescriber:
Persistent vomiting preventing adequate fluid intake
Severe abdominal pain (could indicate pancreatitis—rare but serious)
Signs of gallbladder problems (right upper abdominal pain, particularly after eating)
Symptoms of hypoglycaemia if taking other diabetes medications
Rapid heart rate or palpitations
Changes in vision
Mood changes or suicidal thoughts
Severe dehydration
Any unusual swelling or lump in the neck
Women of childbearing potential should use effective contraception when taking Wegovy, as the medication is contraindicated in pregnancy.
NICE recommends discontinuing Wegovy if patients do not achieve at least 10% weight loss after 72 weeks of treatment (including the dose escalation period), as continued treatment is unlikely to provide sufficient benefit to justify ongoing therapy.
Successful long-term weight management with Wegovy requires viewing it as a tool within a broader lifestyle change, not a standalone solution. Patients who engage with dietary support, increase physical activity, address psychological factors related to eating, and attend regular follow-up appointments achieve the best sustained outcomes.
If you experience any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.
It takes five months to reach the full 2.4 mg maintenance dose of Wegovy, following a structured escalation schedule that increases the dose monthly from 0.25 mg to 0.5 mg, 1 mg, 1.7 mg, and finally 2.4 mg. This gradual titration minimises gastrointestinal side effects and allows the body to adapt to the medication.
Yes, if you experience intolerable side effects, NICE guidance permits delaying dose escalation by an additional four weeks at your current dose. If the 2.4 mg dose is not tolerated, you may be maintained at 1.7 mg, though your clinician should reassess the benefit every three months.
If you miss a dose and your next scheduled dose is more than five days away, take the missed dose as soon as possible. If more than five days have passed, skip the missed dose and take your next dose on the regularly scheduled day without changing your dosing schedule.
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