Are there any signs that Wegovy may not be working as expected?

Signs include no change in appetite, cravings as frequent as before, or weight not trending down across reviews despite steady use. Technique errors (not holding long enough, wrong site) and missed doses can also blunt effect. Medicines that increase appetite (e.g., some steroids or mental-health drugs), sleep loss, or untreated conditions (like thyroid issues) can interfere — your team can check these and adjust the plan.

Understanding how Wegovy’s effect is measured

Wegovy (semaglutide) is designed to work gradually. NICE TA875 and NHS England’s 2025 weight-management framework emphasise that effectiveness is measured through appetite reduction, portion control, and overall wellbeing — not only weight change. The medicine acts on GLP-1 receptors in the brain and gut to increase satiety and reduce food cravings. If hunger, snacking, or portion size remain unchanged after several consistent weeks, something may be disrupting the expected effect.

What to expect in the early months

In the first eight to twelve weeks, the focus is on tolerability and comfort while the body adapts to each new dose. NICE guidance notes that most people first notice smaller appetites or feeling full sooner, while weight loss builds more slowly. It’s normal to see fluctuations in the early months, especially if hydration or sleep patterns vary. NHS clinicians reassure users that steady, modest progress in the first phase often predicts stronger results by months four to six.

Technique and routine issues that blunt effect

Apparent non-response sometimes stems from small injection errors or inconsistent use. NHS training materials and MHRA guidance identify several common causes:

• Removing the pen too soon: the full dose isn’t delivered unless the indicator completes.

• Incorrect angle or depth: injecting too shallow or too deep can alter absorption.

• Skipping rotation: using the same spot repeatedly can cause small lumps that slow

  absorption.

• Missed or delayed doses: large gaps lower semaglutide levels and delay appetite control.

Clinicians may check your injection method or supervise a dose to confirm technique. Setting phone reminders and recording injection dates help maintain a consistent rhythm. Some users find that linking injection time to a weekly routine — such as Sunday evening — keeps them on track.

Medical and lifestyle factors that interfere

Certain medicines and health conditions can reduce Wegovy’s impact. NICE and NHS resources highlight that steroids, some antidepressants or antipsychotics, and anticonvulsants can increase hunger or water retention. Chronic stress, sleep deprivation, and irregular meals disrupt hormonal balance, counteracting GLP-1’s appetite-suppressing effect. Conditions such as thyroid underactivity, polycystic ovary syndrome (PCOS), or insulin resistance can also slow progress. If weight remains static, clinicians will typically review other medicines, nutrition, and sleep patterns before making any changes to the dose plan.

What follow-up reviews look for

Routine follow-ups every three to four months are essential. NHS services assess body weight, waist circumference, blood pressure, and pulse, while reviewing appetite changes and any side effects. NICE TA875 sets a general benchmark of around 5 % weight reduction after six months as a sign of benefit. If this isn’t reached, the team reassesses diet, activity, and adherence before considering next steps. In many cases, holding at the current dose longer allows the body to stabilise before moving on.

When clinicians consider adjustments

If injection technique is correct and adherence steady, but appetite control remains weak, clinicians may move to the next step on the dose ladder. NICE and SMC frameworks support a “treat-to-response” approach — dose increases are guided by comfort and observed benefit. Others may stay at a lower step if it brings steady progress without strong side effects. For those showing limited benefit even at 2.4 mg, teams investigate other influences such as metabolic conditions or interfering medicines before deciding whether to continue.

Recognising realistic progress

Some people feel Wegovy isn’t “working” because they expect rapid change. NHS clinicians explain that semaglutide supports gradual, sustainable weight loss — typically around 0.5–1 kg per week once the maintenance dose is reached. Focus should stay on consistency and overall wellbeing, not single weigh-ins. Dietitians often suggest monitoring appetite, food choices, and energy rather than only weight. A few people have found it helpful to keep a simple journal noting hunger levels and meal satisfaction to make progress visible between reviews.

Evidence on response variation

The STEP and SELECT trials demonstrated that semaglutide produces broadly consistent outcomes across age, sex, and BMI groups. Nature Medicine and Lancet Diabetes & Endocrinology (2024) confirm that the main differences in response come from adherence and lifestyle, not biology. NICE and NHS England therefore emphasise good technique, steady dosing, and regular contact with care teams rather than personalised dosing based on genetics or metabolism.

Staying on track

If you think Wegovy isn’t working as expected, bring your injection log and notes on side effects, sleep, and eating habits to your review. Clinicians can usually identify practical issues quickly — whether it’s timing, hydration, or medicine interactions. In most cases, small adjustments or reassurance restore progress and confidence. Remember that the goal is long-term change, not short-term speed.

The essential point

True non-response to Wegovy is uncommon. When progress slows, it’s usually linked to dosing gaps, technique slips, or other health factors. NICE, NHS, MHRA, and SMC guidance all align: consistency, proper injection, and honest follow-up are what sustain results. With patience and support, most users see meaningful change over time.