Semaglutide Dose for Weight Loss: Complete Dosing Guide
Understanding semaglutide dosing is essential for getting results safely. This guide covers the complete escalation schedule, maintenance doses, and how weight loss dosing differs from diabetes dosing.
What Is Semaglutide?
Semaglutide is a GLP-1 receptor agonist, a medication that mimics glucagon-like peptide-1, a hormone that controls appetite and blood sugar. Originally developed for type 2 diabetes, semaglutide is now FDA-approved for weight loss under the brand name Wegovy.
Semaglutide works by slowing gastric emptying, reducing hunger signals in the brain, and increasing feelings of fullness. These mechanisms lead to consistent, meaningful weight loss when combined with lifestyle changes.
The medication is administered as a once-weekly subcutaneous injection. Dosing starts very low to minimize side effects and gradually increases over 16 to 20 weeks until reaching the therapeutic maintenance dose of 2.4mg.
Standard Semaglutide Dosing Schedule
The FDA-approved escalation schedule for Wegovy follows a gradual titration protocol designed to minimize gastrointestinal side effects while maximizing efficacy:
| Week | Dose | Phase |
|---|---|---|
| Weeks 1-4 | 0.25mg once weekly | Initiation |
| Weeks 5-8 | 0.5mg once weekly | Escalation 1 |
| Weeks 9-12 | 1.0mg once weekly | Escalation 2 |
| Weeks 13-16 | 1.7mg once weekly | Escalation 3 |
| Weeks 17+ | 2.4mg once weekly | Maintenance |
This 16-week escalation schedule allows your body to adapt to the medication gradually. By the time you reach 2.4mg, most side effects (like nausea) have significantly improved compared to what you might have experienced at the starting dose.
Week 1-4: The 0.25mg Starting Dose
The 0.25mg starting dose is deliberately low. This dose does several important things:
- Allows your gastrointestinal system to adapt gradually
- Minimizes severe nausea or vomiting in the first weeks
- Lets you assess your tolerance and side effect profile
- Begins the appetite suppression effect immediately, though mildly
- Gives you time to adopt dietary changes without overwhelming hunger reduction
Many patients report feeling the appetite-suppressing effects even at this low dose. Some experience mild nausea or slight changes in food preferences. Most find the side effects manageable at 0.25mg.
Weight loss at this stage is typically modest—patients might lose 2 to 5 pounds in the first four weeks—but the appetite suppression is noticeable. This is your body's way of adapting to the medication.
Escalation Phase: Weeks 5-12
The next two dose increases (0.5mg and 1.0mg) represent significant escalations in medication strength. This is where most meaningful weight loss begins to occur.
Weeks 5-8: The 0.5mg Dose
At 0.5mg, appetite suppression becomes more pronounced. Many patients report noticing that their favorite foods are less appealing and that they feel full much faster. Weight loss typically accelerates to 5-10 pounds per month at this dose.
Nausea may temporarily increase when you first move to 0.5mg, but this usually subsides within a few days as your body adjusts. Some patients experience more vivid changes in food preferences—certain foods may suddenly taste different or be unappealing.
Weeks 9-12: The 1.0mg Dose
By 1.0mg, you're experiencing the medication's full appetite-suppressing power. Many patients report significant changes in eating patterns and food preferences. Weight loss can range from 5-15 pounds per month depending on diet and exercise.
Some patients reach their goal weight and stop at this dose, which is perfectly acceptable. Your doctor will monitor your progress and may recommend staying at 1.0mg if you're achieving excellent results and tolerating it well.
Final Escalation: Weeks 13-16
The jump from 1.0mg to 1.7mg is significant. At this dose, you're experiencing near-maximal appetite suppression. Most patients have adapted well to the medication's effects by now, so side effects are usually minimal despite the higher dose.
Weight loss at 1.7mg can be substantial. Many patients report that they need to actively remind themselves to eat enough to maintain adequate nutrition. This is where it becomes critical to focus on protein intake and nutrient density rather than quantity.
Some patients choose to stay at 1.7mg if they're achieving their weight loss goals and feel this dose is optimal for their lifestyle and side effect profile. There's no requirement to reach 2.4mg if another dose is working well for you.
Maintenance: 2.4mg Ongoing
The 2.4mg dose is the FDA-approved therapeutic dose for weight loss with Wegovy. This is typically what you'll continue indefinitely once you've escalated to it.
At 2.4mg, weight loss momentum continues for many months. Patients often see accelerating weight loss from months 3-6 of treatment. Some continue losing weight gradually for up to 12-16 months before reaching a plateau.
The 2.4mg dose is potent. Your appetite is significantly suppressed, and food motivation is substantially reduced. This dose requires strong discipline around nutrition because it's easy to undereat and develop nutritional deficiencies if you're not mindful.
Ozempic vs. Wegovy Dosing Differences
Although Ozempic and Wegovy contain the same active ingredient (semaglutide), their dosing protocols are different. Understanding these differences is important if you're considering either medication.
Wegovy Dosing (Weight Loss)
- Starting dose: 0.25mg
- Maximum dose: 2.4mg
- Escalation: Every 4 weeks for 16 weeks
- Purpose: Weight loss and weight management
- Typical weight loss: 15-22% of starting body weight at year one
Ozempic Dosing (Diabetes)
- Starting dose: 0.25mg or 0.5mg
- Maximum dose: 2.0mg
- Escalation: Every 4 weeks for 8-12 weeks
- Purpose: Blood sugar control in type 2 diabetes
- Typical weight loss: 5-10% of starting body weight
The key difference: Wegovy goes higher (2.4mg vs. 2.0mg) because weight loss requires higher drug exposure than diabetes management. Some patients use Ozempic off-label for weight loss, and some achieve results, though the maximum dose may not be sufficient for optimal weight loss.
Dose Adjustments and Special Situations
Slower Escalation
If you're experiencing significant side effects, your doctor can slow the escalation schedule. Instead of increasing every 4 weeks, you might stay on a dose for 6 or 8 weeks. This gives your body more time to adapt.
Slower escalation doesn't harm your results—it just prolongs your time to reach maintenance dose and may delay some weight loss, but many patients do very well with a slower approach.
Staying at a Lower Dose
You don't have to reach 2.4mg. Some patients achieve excellent weight loss results and feel best at 1.0mg or 1.7mg. If you're losing weight consistently and tolerating your current dose well, discussing staying at that dose with your doctor is completely reasonable.
Dose Reduction
If you've reached 2.4mg but experience severe side effects, your doctor can reduce you back down to 1.7mg or lower. This is more common than you'd think and often restores quality of life while maintaining most of your weight loss benefits.
Higher Doses Off-Label
Some doctors prescribe doses higher than 2.4mg (like 2.5mg or 3.0mg) off-label for patients who have reached a weight loss plateau. This is not standard protocol and isn't FDA-approved, so it depends entirely on your doctor's judgment and your insurance coverage.
What If You're Not Losing Weight?
Some patients don't experience significant weight loss even at full dose. Before giving up on semaglutide, consider these factors:
- Diet quality: Semaglutide reduces appetite, but it doesn't prevent weight gain if you're eating high-calorie foods. Focus on protein and whole foods.
- Time on dose: You need to be on maintenance dose (2.4mg) for at least 8-12 weeks to see full results. Weight loss accelerates over months, not weeks.
- Underlying conditions: Thyroid dysfunction, PCOS, or other metabolic disorders can reduce weight loss. Your doctor should have screened for these.
- Medication interactions: Some medications interfere with weight loss. Review this with your doctor.
- Activity level: Adding exercise, especially strength training, can improve results even if scale weight isn't moving.
If you've been on 2.4mg for 12+ weeks with minimal weight loss despite diet and exercise changes, discuss this honestly with your doctor. You might benefit from additional assessment or trying a different medication.
Related Dosing Guides
Semaglutide Dosing Chart provides a visual reference for all dose levels and escalation timelines.
Wegovy Dosing Schedule covers the official Novo Nordisk escalation protocol in detail.
Ozempic Dosing explains diabetes-specific dosing and how it differs from weight loss dosing.
Oral Semaglutide discusses Rybelsus, the oral formulation with a completely different dosing schedule.
Frequently Asked Questions
Frequently Asked Questions
The standard starting dose is 0.25mg injected subcutaneously once weekly. This low dose minimizes gastrointestinal side effects while your body adjusts to the medication.
You increase your dose every four weeks. Most people follow the standard escalation: 0.25mg for 4 weeks, then 0.5mg, then 1.0mg, then 1.7mg, then 2.4mg. Each dose is held for 4 weeks before moving up.
The therapeutic maintenance dose is 2.4mg once weekly. This is the FDA-approved dose for Wegovy. Some patients achieve good results at 1.7mg, but 2.4mg is the standard target dose.
Don't skip doses without talking to your doctor. If side effects are severe, your doctor may recommend staying on a lower dose longer or adding medication to manage nausea and vomiting. Skipping doses can cause the medication to become less effective.
Yes. Ozempic for diabetes goes up to 2.0mg and uses a different titration schedule. Wegovy reaches 2.4mg specifically for weight loss. Although they're the same medication, the dosing protocols are different based on their indications.
Your doctor may recommend staying on 2.4mg longer, as weight loss continues for months. Some doctors prescribe higher doses off-label (2.5mg or 3.0mg) if approved by insurance, though this isn't standard protocol. Discuss options with your healthcare provider.
Yes. Your doctor can reduce your dose if you're struggling. Going down a dose level usually helps manage nausea and vomiting. You don't have to reach 2.4mg if you're getting good results at a lower dose.
Final Thoughts
Semaglutide dosing follows a carefully designed escalation protocol that maximizes weight loss while minimizing side effects. The 16-week journey from 0.25mg to 2.4mg is intentional and evidence-based.
Your optimal dose might not be 2.4mg—many patients do excellently at 1.0mg or 1.7mg. Work with your doctor to find the dose that gives you good weight loss results while maintaining your quality of life and ability to eat adequate nutrition.
Remember that semaglutide is a tool that works best when combined with dietary changes, physical activity, and behavioral modifications. The medication suppresses appetite, but you still need to make conscious choices about what you eat.