Wegovy dosage for weight loss: understanding the step-up schedule

Which dose you start on, and why it isn't the therapeutic one

The opening dose of the Wegovy schedule (0.25 mg weekly) isn't there to produce weight loss. Its job is settling your system. Semaglutide slows gastric emptying and acts on appetite centres in the brain, and at full strength those effects can arrive quite abruptly. Starting low gives your body four weeks to adjust before the dose rises. You'll then move through 0.5 mg, 1.0 mg and 1.7 mg in roughly four-week steps, guided by your prescriber.

This is a question our prescribers hear most weeks: 'can I move up faster if I feel fine?' The honest answer is that the titration schedule isn't about how you feel on day one, it's about what tends to happen around weeks three and four of each new strength. Pushing through steps too quickly is where nausea and diarrhoea become harder to manage. The dose escalation process for Wegovy is designed to make long-term treatment more sustainable, not to slow your progress.

For most people, the standard escalation reaches the 2.4 mg maintenance dose around month five. The NHS medicines guidance for semaglutide outlines this progression clearly and is worth reading alongside your Patient Information Leaflet. NHS guidance on semaglutide covers the schedule in plain language.

The decision between 2.4 mg and 7.2 mg maintenance

For years, 2.4 mg was the ceiling. In January 2026 the MHRA approved a 7.2 mg maintenance option for Wegovy, initially delivered as three 2.4 mg pens weekly. A dedicated single-dose 7.2 mg pen followed in April 2026. Clinical data reported average weight loss of around 20.7% over 72 weeks at 7.2 mg, which brings results notably closer to the highest tirzepatide doses in trials.

The 7.2 mg pen carries its own eligibility rule: it is approved for adults with a BMI of 30 or above only, the lower BMI threshold that applies to the 2.4 mg dose does not extend to the higher-strength pen. Starting dose remains 0.25 mg regardless; titration up to 7.2 mg still follows the step-wise schedule your prescriber sets.

Whether moving to 7.2 mg makes sense depends on your response at 2.4 mg, your tolerance of side effects, and your prescriber's clinical judgement. It isn't simply available on request, and a clinical review is required before any dose increase. If you're weighing up the options, our guide to all Wegovy dose strengths covers the full picture, and speaking with a prescriber is the only way to know what applies to you.

What the evidence says about dose and weight loss outcomes

The STEP 1 trial, published in the New England Journal of Medicine, reported an average weight reduction of around 15% over 68 weeks at the 2.4 mg maintenance dose in adults with obesity, alongside lifestyle changes. That figure comes from a population, not a guarantee for any individual, some people lose more, some less, and how consistently someone takes the medication matters significantly.

For the semaglutide 25 mg tablet (the oral form, Wegovy tablets), trial data from the OASIS 4 study showed an average of roughly 13.6% weight loss over 64 weeks in participants regardless of adherence, rising to about 17% among those who stayed fully adherent. The 25 mg Wegovy tablet follows a separate escalation from 1.5 mg daily, reaching its own maintenance dose, a different schedule from the injection, handled through its own clinical pathway.

These differences matter for the decision about which formulation and which dose suits you. To get a sense of how the costs stack up across the options, the Wegovy pricing page gives honest context. Ultimately, the weight-loss dosage for Wegovy that works best is the one a clinician has matched to your health picture, not the highest available, necessarily, but the right fit.

When a prescriber might pause or reduce your dose

Moving up the dose ladder isn't automatic. If side effects at a given strength are significant, your prescriber may hold at that dose for longer before increasing, or suggest stepping back temporarily. Side effects are typically most pronounced in the first few weeks after a dose change: nausea, loose stools, fatigue and indigestion are the most commonly reported. They usually ease as your body adjusts, but severe or persistent stomach pain, particularly any that radiates toward the back, warrants urgent medical attention given what is known about pancreatitis risk with GLP-1 medicines. Report any side effects you're unsure about to your prescriber promptly, and you can also flag concerns via the MHRA Yellow Card scheme.

If you've been on the maintenance dose for six months and lost less than 5% of your starting weight, continuing treatment is something your prescriber will need to review. That review isn't a failure, it's the system working as it should. Not every medicine suits every person, and clinical oversight exists precisely to catch that early. For a broader look at how semaglutide dosing compares across different treatment options, the semaglutide dosing page sets out the wider context.