Wegovy's minimum dose and why the 0.25mg starting point matters

What the STEP 1 trial tells us about how semaglutide was designed to be introduced

The dosing schedule used in clinical practice today was developed from the same titration structure tested in the STEP programme. In the STEP 1 trial published in the New England Journal of Medicine, participants with obesity began semaglutide at 0.25mg and escalated gradually over around 16 weeks before reaching the 2.4mg maintenance dose. Over 68 weeks, average body weight fell by approximately 15% in the semaglutide group. That result, however, came from the cumulative effect of the full escalation — not from the opening weeks at the lowest dose. The trial design made clear that the 0.25mg phase existed to protect tolerability, not to deliver the therapeutic effect itself.

The gastrointestinal side effects most people know about (nausea, loose stools, an unsettled stomach in the first days) are most likely to appear after a dose increase. Starting at the floor and climbing slowly gives your digestive system weeks to adapt at each level. This was a deliberate pharmacological choice, not a cautious afterthought. If you're reading this because you've just received your first pen and feel uncertain about what to expect, that's an entirely normal place to be. Most people tolerate the 0.25mg phase more comfortably than they anticipated.

The full Wegovy overview covers what the medicine is licensed for and how it fits into a broader weight management plan, including the diet and activity changes that run alongside treatment.

The licensed titration path from minimum to maintenance dose

The schedule approved by the MHRA for weight management in adults runs in approximately four-week steps: 0.25mg, then 0.5mg, then 1.0mg, then 1.7mg, and finally 2.4mg as the standard maintenance dose. From January 2026, the MHRA also approved 7.2mg as a higher maintenance dose for eligible adults; a dedicated single-dose 7.2mg pen received approval in April 2026. The NHS medicines information for semaglutide sets out the schedule and what to do if you experience side effects at any stage.

Each four-week period at a given dose is a minimum, not a fixed window. If you find 0.5mg or 1.0mg difficult (perhaps nausea is persistent or vomiting is interrupting daily life) your prescriber may decide to hold the current dose for another four weeks before moving up. The schedule is a framework, not a conveyor belt. This is one reason the relationship with your prescriber matters throughout treatment, not only at the start. For more on how the upper end of the schedule works, the page on Wegovy's maximum dose explains the 2.4mg and 7.2mg phases in detail.

People sometimes ask whether they can skip the lower doses if they have used semaglutide before and tolerated it well. That is a clinical question, not one with a standard answer; a prescriber would need to review your history before making that call. If you want a thorough explanation of what the maximum dose of semaglutide involves and how patients reach it, that page walks through the clinical reasoning in detail. Attempting to self-titrate (whether upward or by restarting at a higher dose) is outside the licensed guidance and not something a responsible prescriber would endorse without evidence of your prior treatment.

Why 0.25mg on its own rarely moves the scales much, and when to keep going

If you've been on 0.25mg for a month and noticed little change in weight, that is expected. The 0.25mg dose was never positioned as a therapeutic stage in the STEP trials; it is the entry point. Most of the meaningful weight loss in trial data accumulated once participants reached their maintenance dose and stayed there across many weeks. Stopping at 0.25mg because early results feel disappointing means leaving the treatment before it has begun in any meaningful clinical sense.

Equally, the absence of dramatic side effects at 0.25mg is a good sign, it suggests your body is tolerating the medicine, and a prescriber will take that as a basis for moving to the next step on schedule. Patients who do experience significant nausea at 0.25mg sometimes worry this means the medicine is wrong for them. In many cases it simply means a slower escalation pace is right, and understanding how the maximum dose of semaglutide is determined and who qualifies for it can help set realistic expectations for the full course of treatment. The guide to Wegovy dosing decisions explores this in more detail, including what questions are worth raising at your next review.

The pricing context is also worth knowing. Private treatment involves costs at each stage, so it's sensible to understand the full cost picture before you start rather than halfway through. Our treatment and pricing page is the clearest place to see what's included in a nume, sorry, in a nume private prescription, from the free consultation through to aftercare.

Starting on Wegovy at the minimum dose through a regulated private pharmacy

Wegovy is a prescription-only medicine. The only lawful route to it in the UK is a prescription issued following a clinical assessment, either through an NHS service or a regulated private provider. A GPhC-registered pharmacy can be verified on the GPhC pharmacy register before you share any personal or medical details.

At nume, every consultation is read by a GPhC-registered Independent Prescriber (a real clinician, not automated software) on the day it arrives. If semaglutide is appropriate, treatment is dispensed through our own registered pharmacy and delivered by DPD the next working day in plain, unbranded packaging. The prescriber's decision includes the starting dose, so you don't need to make any clinical calls yourself. Our clinical team page gives you the detail on who reviews consultations. If you have questions before you start, the FAQs cover the most common ones, and our team is reachable through the contact page seven days a week. When you're ready, check your eligibility through a free consultation.