Starting Wegovy at 2.4 mg: what the dosing evidence actually says

What the STEP 1 trial tells us about dose escalation

The foundational evidence for Wegovy's dosing schedule comes from the STEP 1 trial, published in the New England Journal of Medicine, which followed adults with obesity over 68 weeks using the graduated titration protocol. Participants who reached and maintained the 2.4 mg dose achieved an average weight reduction of around 15%. That outcome depended on the titration working as designed: each dose step gave the body time to adapt to semaglutide's effects on gastric motility and appetite signalling before the next increase.

Starting at 2.4 mg would concentrate the most common adverse effects (nausea, vomiting, diarrhoea and reflux) into the first week, when the body has had no time to adjust. The STEP programme's titration design was deliberately built to protect tolerability, which in turn protects adherence. Poor adherence is one of the clearest predictors of reduced weight-loss outcomes at 68 weeks, so the schedule and the results are inseparable.

You can read more about the full Wegovy dose schedule and what each pen is designed to do across the titration pathway.

The four steps between 0.25 mg and 2.4 mg, and why each one exists

The licensed UK titration pathway runs: 0.25 mg for four weeks, then 0.5 mg, then 1.0 mg, then 1.7 mg, each for around four weeks, before reaching the 2.4 mg maintenance dose. The NHS medicines page for semaglutide sets this out clearly, and it mirrors the Summary of Product Characteristics.

The 0.25 mg dose is sometimes called a starter dose, but it would be more accurate to call it an acclimatisation dose: its job is to let your GI tract adapt to a medicine that meaningfully slows gastric emptying. The 0.5 mg step begins to produce some appetite suppression in most people. By 1.0 mg (a stage explored on our page on starting at 1.0 mg) many patients notice their hunger patterns shifting noticeably. The 1.7 mg step closes the gap to the therapeutic maintenance dose. Questions about the 1.7 mg stage come up often for patients who are close to maintenance and want to understand whether they can accelerate that final step.

None of these steps can be skipped on clinical grounds without prescriber oversight, and a legitimate UK prescribing service will not allow it.

What happens if weight loss stalls at 2.4 mg once you get there

A question our prescribers hear fairly regularly: "I've reached 2.4 mg and the weight loss has slowed, what now?" This is distinct from the question of starting at that dose, but it's worth addressing here because people sometimes conflate the two. Reaching 2.4 mg and finding that progress slows is a known pattern; there is now a licensed 7.2 mg maintenance dose approved by the MHRA for adults with a BMI of 30 or above, which some patients move on to under clinical supervision.

If you're at 2.4 mg and feel your progress has plateaued, the guide to weight loss stalling at 2.4 mg covers what the evidence says and what the options are. The cost implications of longer-term treatment are also worth understanding early; the Wegovy cost page sets out what private treatment typically involves financially.

Starting Wegovy through a regulated prescriber: what the process looks like

Because Wegovy is a prescription-only medicine, starting it legally means a prescriber assessing your medical history, current medicines, BMI and any weight-related conditions before any dose is issued. At nume, a GPhC-registered Independent Prescriber reads every consultation personally, the same day it's submitted. There is no automated approval.

The prescriber will confirm which starting dose is appropriate for you and establish the titration plan. They will also flag any interactions to be aware of: women taking oral contraceptives, for example, should know that NHS guidance recommends adding a non-oral method for the first four weeks of treatment, because semaglutide's effect on gastric emptying can reduce pill absorption. Your prescriber will walk through this with you.

Treatment, once approved, is dispatched the same day for orders placed before 12pm on a weekday, arriving with DPD the next working day in plain packaging. Your pen goes straight into the fridge door when it arrives, keeping it beside something you open every morning makes the weekly injection easy to build into a routine. For a broader look at how Wegovy works across the full treatment journey, the Wegovy overview is a good starting point, and if you're weighing up your options more generally, the weight-loss treatments page sets out what's available through nume.