Drug facts

Not losing weight on semaglutide?

By David Chen·Editor·Reviewed September 2026

How many people lost little¹

The percentages are the trial’s, among the 1,212 semaglutide and 577 placebo participants with a week-68 weight; the “less than” rows are the remainder. The average for the whole semaglutide group was a 14.9% loss, but an average hides both ends — roughly three in ten did not reach 10%.

The Wegovy label counts the same trial another way, including everyone randomized and estimating the weights that were missing. On that count 83.5% on semaglutide and 31.1% on placebo lost at least 5%.² Neither is wrong; they answer slightly different questions, and the full trial is on STEP 1.

The plateau is in the trial¹

STEP 1 describes weight loss on semaglutide as observed from week 4 onward, “reaching a nadir at week 60.” The curve bottomed out at about 14 months, two months before the treatment period ended. A longer trial ended in a similar place: STEP 5 recorded 15.2% at two years, close to STEP 1’s 68-week figure.⁴ Every published timepoint is on semaglutide results by month.

STEP 4 tested what happens if the drug is taken away once someone is on the full dose. After a 20-week run-in, people who continued lost a further 7.9% by week 68, while those switched to placebo regained 6.9%.³ The trial is on STEP 4.

The first 16 weeks²

The maintenance dose does not start until week 17. The Wegovy label calls weeks 1 to 4 the “Starting Dosage” and weeks 5 to 16 the “Dosage Escalation,” a ladder it says exists to reduce the risk of gastrointestinal side effects. STEP 1 saw weight loss from week 4, but its 68-week results came after a 16-week climb and 52 weeks at the maintenance dose. How long semaglutide takes to work goes through the timing.

Type 2 diabetes changes the numbers²

STEP 1 excluded diabetes. The Wegovy label’s Study 3 gave the same 2.4 mg to adults with type 2 diabetes: weight fell 9.6% over 68 weeks against 3.4% on placebo, and 67.4% lost at least 5% — so about a third did not. Ozempic, the diabetes brand, goes no higher than 2 mg, and at 1.0 mg SUSTAIN 7 recorded 6.5 kg over 40 weeks. Someone comparing their Ozempic result with a Wegovy headline is comparing different doses in a different population.

Still hungry²

The label describes semaglutide’s effect as working through appetite: “Semaglutide decreases calorie intake. The effects are likely mediated by affecting appetite.” In a part of STEP 5, a questionnaire at weeks 0, 20, 52 and 104 found hunger and fullness improved against placebo at week 20, and craving control improved at weeks 20, 52 and 104.⁵

One more label fact belongs here. For people with type 2 diabetes — especially those also taking insulin or a sulfonylurea — the Medication Guide lists hunger among the signs of low blood sugar, along with shakiness, sweating, dizziness and a fast heartbeat, and says to talk to a healthcare provider about how to recognize and treat it. Interactions covers the medicines involved.

What the label says about response²

One sentence, repeated for each indication: “Consider treatment response and tolerability when selecting the maintenance dosage.” For weight reduction in adults the maintenance dose is 1.7 mg or 2.4 mg, and the label allows a step to a 7.2 mg maximum for someone who has tolerated 2.4 mg for at least four weeks when more weight reduction is clinically indicated. The full ladder is on the dosage chart.

What the Wegovy label does not have is a deadline. Saxenda, the daily liraglutide injection, tells prescribers to check weight at 16 weeks and stop if a patient has not lost at least 4% of their starting weight.⁶ Nothing like that appears in Wegovy’s. The two drugs’ head-to-head is on liraglutide vs semaglutide.

Reasons specific to a compounded vial

This page reports what the trials and labels recorded. Whether to stay on a dose, change it or stop is a decision for a prescriber, and nothing here is advice on diet, exercise or dosing. See the medical disclaimer.