How the Wegovy maintenance plan works — and what to expect at each stage

Step 1, starting at 0.25mg: settling in, not treating yet

The first four weeks of any Wegovy plan are about adjustment, not weight loss. The 0.25mg starting dose exists because semaglutide slows the speed at which the stomach empties, and beginning at a full therapeutic dose would, for most people, mean significant nausea from the first week. Starting low lets the gut adapt gradually. The full Wegovy dose guide explains each strength in more detail.

During this period many people notice very little change on the scales, and that is expected. The prescriber is not being cautious for the sake of it, this phase genuinely reduces the chance of side effects interrupting treatment later. Common early experiences include mild nausea after the injection, reduced appetite, and occasionally looser stools. Most of these settle within a few days of each new pen. The NHS medicines page for semaglutide lists what to expect and what to report.

Injections go into the abdomen, thigh, or upper arm. Rotating the site each week is a good habit to build early, it reduces localised skin reactions and makes the process easier to sustain long-term. Your Patient Information Leaflet is the right reference for storage and injection-site detail.

Step 2 (titrating through 0.5mg, 1.0mg and 1.7mg: finding the effective range

The three middle steps) 0.5mg, 1.0mg, and 1.7mg, are where most people begin to notice meaningful appetite suppression. Each step lasts around four weeks, and the transition to the next is reviewed by a prescriber rather than automatic. If side effects are still significant at a given dose, staying at that level a little longer is sometimes the right call.

Gastrointestinal effects tend to be most noticeable after a dose increase, typically in the first few days, then ease. The pattern is fairly predictable: nausea is the most commonly reported experience, followed by constipation or diarrhoea, indigestion, and fatigue. Meals that are smaller and lower in fat tend to make the first few days after a step-up easier. Staying well hydrated matters too, particularly if nausea is reducing how much you eat or drink.

This is also the stage where the appetite-regulatory effect of GLP-1 receptor agonism becomes more tangible. Semaglutide binds to GLP-1 receptors in the brain as well as the gut, contributing to a genuine reduction in hunger signals rather than just slowing stomach emptying. Some people reach a point during titration where they feel well-controlled and weight loss is progressing; the experience at the 1mg level is a question our prescribers hear regularly.

Step 3 (reaching 2.4mg: the licensed maintenance dose

After roughly four to five months of titration, 2.4mg is the maintenance dose established in the STEP 1 trial) a 68-week study, published in the New England Journal of Medicine, in which participants on this schedule achieved an average body-weight reduction of around 15%. The question of whether you continue losing weight at maintenance is one worth reading separately, because the answer is more nuanced than a simple yes or no.

At 2.4mg the plan shifts from titration to sustained treatment, and understanding what the Wegovy maintenance dose involves can help you go into this phase with realistic expectations. This is where the NICE appraisal of semaglutide applies its two-year recommendation: if, after six months on the maintenance dose, fewer than 5% of starting body weight has been lost, continuing is worth discussing with your prescriber. The NICE guidance on semaglutide (TA875) sets out this threshold and the broader commissioning framework.

In April 2026 the MHRA approved a single-dose 7.2mg pen for adults with a BMI of 30 or above. Trial data at this higher dose reported an average weight loss of around 20.7% over 72 weeks, narrowing the gap with tirzepatide results. Whether the higher dose is appropriate is a clinical decision for your prescriber, availability can be confirmed at consultation. Information on costs is on our treatment page.

Staying on the maintenance dose: what good clinical oversight looks like

Treatment does not run itself. A responsible Wegovy plan involves a prescriber revisiting your progress before every repeat, checking that the dose remains appropriate, that side effects are not causing harm, and that the lifestyle support sitting alongside the medicine is still in place. There is no meaningful distinction between starting well and staying well, the ongoing review is the plan.

At nume, every repeat order goes through a fresh clinical review before it is approved. There is no subscription that dispatches automatically. If you order before noon on a working day and the review is complete, the pen leaves the same day and arrives the next working day via DPD, in plain packaging. The question of what the maintenance dose actually means for your treatment is explored further if you want the detail.

Some people reach the maintenance phase having transferred from another provider. Our clinical team, led by our clinical lead, reviews evidence of current treatment and recent dose history before any supply continues. It is a step that adds a few minutes and can matter quite a lot. Worth it. If you have questions ahead of starting, the FAQs cover the most common ones, or you can contact the team directly.