Still hungry on Wegovy 25mg — what's actually going on

What the OASIS 4 trial data tell us about appetite at the top dose

The phase 3 OASIS 4 trial, which Novo Nordisk cited when the MHRA approved oral semaglutide for weight management in June 2026, enrolled 307 adults with obesity or overweight and at least one weight-related condition. Over 64 weeks, participants taking 25mg oral semaglutide lost around 13.6% of body weight on average compared with about 2.4% on placebo. Among those who adhered fully to the regimen, average loss reached around 16.6%. That gap matters here: it tells you that how consistently you take the tablet, and under the right conditions, influences how much the medicine does.

The trial didn't measure hunger scores as a primary endpoint, but the weight-loss variance across participants points to real differences in how strongly individuals respond at any given dose. Reduced appetite is the mechanism through which semaglutide works, but the reasons hunger persists despite that mechanism are worth understanding before drawing conclusions about whether the dose is right for you.

The NHS medicines page for semaglutide explains that the medicine slows gastric emptying and signals fullness through GLP-1 receptors, effects that are real but that sit on top of your body's own hunger hormones, which don't simply switch off. [NHS: Semaglutide]

The absorption window: the detail most people miss

There is a misconception worth addressing plainly: many people assume that because 25mg is the highest dose, any remaining hunger must mean the medicine has failed. It usually doesn't. The more likely culprits are practical ones.

Oral semaglutide's absorption depends on tight conditions. The tablet needs to be taken first thing in the morning on an empty stomach, with a small amount of plain water, with at least 30 minutes before eating, drinking anything other than plain water, or taking other oral medicines. Coffee before the 30-minute window closes, a small sip of juice with the tablet, or taking it after a glass of milk, any of these reduce how much semaglutide actually reaches your bloodstream. More detail on how Wegovy works explains the mechanism, but the practical upshot is simple: a tablet taken in imperfect conditions is a lower-dose tablet in effect.

If your 25mg dose is being absorbed well, the appetite effect tends to be most noticeable in the hours after taking the tablet and tapers slightly through the day. Feeling hungrier in the evening is normal and not a sign of treatment failure. What you eat matters too: food choices on Wegovy can meaningfully extend or undermine the satiety effect across a day.

When hunger at 25mg is a signal worth discussing with your prescriber

There is a difference between hunger that is manageable and background noise, and hunger that feels indistinguishable from life before treatment. The former is expected. The latter is worth a clinical conversation.

A few things that can blunt semaglutide's appetite effect even at 25mg: chronic sleep deprivation raises ghrelin (a hunger-stimulating hormone) enough to partly override GLP-1 signalling; high stress does something similar via cortisol; diets very low in protein tend to increase hunger on any weight-loss medicine because protein is the most satiating macronutrient. Some people find appetite virtually disappears on this treatment, and others (even at the same dose) find it gentler. Both experiences sit within the trial evidence.

If after a month at 25mg your hunger feels unchanged from baseline, or if hunger has returned after working well at a lower dose, tell your prescriber. They may review your dose timing, assess whether a different treatment suits you better, or simply confirm the treatment is doing what it should at a slower pace. At nume, a GPhC-registered prescriber reviews every repeat order and every clinical query, a real clinician reads your case, not a bot.

For anyone considering starting oral semaglutide or switching from the injection, our guide to managing hunger on Wegovy is worth reading alongside our free consultation, which walks through eligibility and whether Wegovy tablets are the right fit for your situation. Prescription-only medicines deserve that level of review.