Is there a loading phase when starting Wegovy?

There isn’t a one-off loading dose; instead there’s a gradual dose-escalation (titration) phase. You start low and step up in stages every few weeks until you reach a maintenance dose. This approach reduces side-effects such as nausea and gives you time to practise new eating routines as appetite shifts. If symptoms are persistent, clinicians can hold at a step or extend it before moving up.

Why there is no single loading dose

Some medicines start with a “loading dose” to quickly build levels in the body, but that isn’t the case for Wegovy. Because semaglutide acts on receptors in the brain and gut that influence appetite and digestion, a sudden high dose would raise the chance of side effects like nausea, vomiting, or bloating. Clinical research showed that people tolerated the medicine far better when it was introduced slowly. Rather than prioritising speed, the design of the treatment pathway prioritises safety, comfort, and long-term adherence.

The titration schedule

Treatment begins with a very low weekly dose of 0.25 mg, stepping up over time through 0.5 mg, 1.0 mg, and 1.7 mg before reaching the maintenance dose of 2.4 mg. Each step usually lasts four weeks, though prescribers can adjust this if needed. Most people reach the maintenance dose after about four to five months. This titration method was used in the pivotal STEP trials, which provided the evidence NICE drew upon when recommending semaglutide for weight management in specialist services.

Managing side effects during titration

The gradual increase is designed to reduce side effects, which are most likely when the dose changes. Nausea, constipation, diarrhoea, or bloating are the most commonly reported issues. Staying longer at a step, or pausing before the next increase, gives the body time to adapt. Prescribers often advise practical adjustments such as eating smaller meals, choosing lighter foods, and drinking fluids steadily across the day. These measures don’t remove side effects entirely, but they make them manageable while still moving toward the effective maintenance dose.

Building habits alongside dose increases

The titration period is also about habit-building. Appetite tends to change gradually, giving people a chance to practise eating more slowly, reducing snacking, and adjusting portion sizes. Clinicians encourage using this stage to embed sustainable behaviours, rather than focusing solely on the scales. By the time the full dose is reached, many people already have a routine that makes long-term results easier to maintain. This “learning period” is part of what makes Wegovy an aid to behaviour change, not just a stand-alone medicine.

Why patience pays off

Some may feel frustrated that results are not immediate, but the slower pace is deliberate. In the STEP 1 and STEP 4 trials, weight loss occurred progressively, with the largest reductions seen once participants reached the higher doses. On average, people lost around 10–15% of their starting body weight at one year when Wegovy was paired with structured lifestyle support. These results highlight that slow and steady escalation is more sustainable than a sharp initial effect. Clinical guidance now reflects this, ensuring people are counselled to expect gradual progress.

Flexibility in clinical practice

Although the pathway is structured, it is not rigid. If someone struggles with side effects, clinicians may hold them at a lower dose for several extra weeks, pause progression, or, in some cases, maintain them at a lower dose if it proves both tolerable and effective. This flexibility is embedded in UK specialist services, which are designed to personalise treatment rather than apply a one-size-fits-all approach. Continuation rules—such as achieving at least 5% weight loss after three months on the maximum tolerated dose—help guide whether treatment remains worthwhile.

How reviews are built in

Structured reviews are part of the titration journey. In England, services typically check progress at three months and again at six months, aligning with NICE’s continuation criteria. Scotland’s SMC and Wales’s AWTTC apply similar principles, though referral and commissioning routes may differ. These reviews assess both side effects and effectiveness, ensuring that the titration process not only reaches the right dose but also delivers meaningful benefit. This built-in oversight keeps treatment safe and targeted to those who are responding.

What the evidence shows overall

There is no loading phase with Wegovy. Instead, the medicine is introduced gradually in small weekly doses that step up over several months until the maintenance level is reached. This design helps people tolerate treatment, limits side effects, and provides space to develop healthier eating habits alongside appetite changes. Evidence from clinical trials confirms that this approach produces sustained results—on average 10–15% weight loss at one year—when combined with lifestyle support. What the evidence shows overall is that steady dose escalation, not a single loading shot, is the safe and effective pathway to long-term outcomes.