How long do you spend on semaglutide for weight loss?

Introducing our new program: Mayo Clinic Diet for Weight-Loss Medications.

For people taking semaglutide for weight loss, the recommended duration of treatment can vary depending on several factors, including the individual's health status, weight-loss goals, and response to the medication.

Semaglutide in clinical trials

The clinical trials typically involved participants taking semaglutide for 68 weeks or more.

During these trials, participants experienced significant reductions in body weight, often exceeding 10 to 15% of their starting weight. Additionally, semaglutide has been found to have positive effects on blood glucose levels, blood pressure, and other cardiometabolic risk factors, making it a valuable medication for individuals with type 2 diabetes or other medical conditions related to excess weight.

STEP 1 clinical trial

The STEP 1 trial, published in the New England Journal of Medicine in 2021, was a randomized, double-blind, placebo-controlled study that evaluated the efficacy and safety of semaglutide 2.4 mg for weight management in 1,961 adults with overweight or obesity, including those who had previously undergone bariatric surgery.

The key findings of this landmark study included:

• Significant weight loss: Participants who received semaglutide 2.4 mg experienced a mean weight loss of 14.9% from baseline, compared to only 2.4% in the placebo group after 68 weeks.
• High responder rate: 86% of participants in the semaglutide group achieved weight loss of at least 5%, and 75% achieved weight loss of at least 10%, compared to 32% and 15% in the placebo group, respectively.
• Improvements in cardiometabolic risk factors: Semaglutide treatment was associated with significant reductions in waist circumference, blood pressure, triglycerides, and improvements in glycemic control and quality of life measures.
• Favorable safety profile: The most common adverse events were gastrointestinal in nature, such as nausea and diarrhea, which were generally mild to moderate and decreased over time.

The magnitude of weight loss achieved with semaglutide was unprecedented among pharmacologic interventions for obesity, making it a game-changer in the field of obesity management. These findings have led to the approval of semaglutide 2.4 mg (marketed as Wegovy) by regulatory agencies, including the FDA, for chronic weight management in adults with overweight or obesity.

Already taking GLP-1s? Discover our companion to weight-loss medications from the experts at Mayo Clinic.

How long do you need to use semaglutide for weight loss?

When using semaglutide injections for weight loss, it is generally recommended to continue the treatment for an extended period, as maintaining weight loss can be challenging. Semaglutide works by targeting the GLP-1 receptors in the body, which can help regulate appetite, food intake, and metabolism, leading to sustained weight loss over time.

The duration of semaglutide treatment for weight loss can vary, but many healthcare providers recommend a minimum of 12 to 24 months for chronic weight management. This allows individuals to achieve their target weight-loss goals and then transition to a maintenance phase, where the dosage or frequency of semaglutide injections may be adjusted to help maintain the weight loss.

The STEP 1 trial provides detailed data on the percentage body weight change from baseline at multiple timepoints for participants taking semaglutide 2.4 mg injections versus placebo. Below are the key expected weight loss numbers.

Expected weight loss timeline:

• After 4 weeks: Some weight loss is typically seen within the first 4 weeks of starting semaglutide, but the amount can vary widely between individuals. The STEP 1 trial reported an average weight loss of 3.8% after 4 weeks on the 2.4 mg semaglutide dose.
• After 12 weeks: At the 3-month mark in the STEP 1 trial, participants on semaglutide 2.4mg had lost an average of 9.6% of their baseline body weight, compared to 2.8% with placebo.
• After 6 months: In the same STEP 1 trial at 6 months, those on semaglutide 2.4mg had lost an average of 13.8% of their initial weight versus 3.7% with placebo.
• After 12 months: Individuals can expect to lose approximately 15 to 17% of their baseline body weight on average after one year of treatment with the 2.4mg once-weekly semaglutide injection when combined with lifestyle interventions. Of course, the weight loss response is variable, with some losing more than 20% and others experiencing a more modest 5 to 10% reduction.
• When weight loss may plateau: For most people, the weight loss achieved with semaglutide starts to plateau around 9 to 12 months of treatment if the individual adheres to the medication and lifestyle recommendations. The overall weight loss sustained at 1 to 2 years is often 10 to 15% in responders.

How long do you need to use semaglutide for type 2 diabetes?

For individuals with type 2 diabetes or high cholesterol, semaglutide may be prescribed for both weight loss and the management of these medical conditions. In these cases, the duration of treatment may be longer, as the medication is addressing multiple health concerns simultaneously.

Weight-loss medication is not a quick fix

It's important to note that semaglutide is not a quick fix for weight loss, and it should be used as part of a comprehensive weight management plan that includes lifestyle changes, such as a healthy diet and regular physical activity. The common side effects of semaglutide, such as nausea, vomiting, diarrhea, and constipation, may also need to be managed during the course of treatment.

Factors that may impact how long you might take semaglutide for

Being aware of the commitment and duration of a new medication is important. This is a question best suited for your prescribing provider, but here are a few items to keep in mind:

1. Efficacy

How long you take a weight-loss drug depends on whether your body is responding to it. If you’ve lost adequate weight and aren’t struggling with side effects, your prescribing provider may suggest that you take the drug long-term. Since the medications often help by decreasing your appetite, they can be beneficial in both losing weight and maintaining weight loss. If you haven’t lost at least 5% of your body weight after taking the full dose of a drug for three to six months, your provider may discontinue or change your weight loss treatment. Together, the two of you may decide to try a different drug to see if it works better or stop using medications altogether.

2. Tolerance

As you just read, all medications come with the potential for side effects. Some people don’t experience any side effects whereas others might find them to be overwhelming. If you’re finding your medication is more bothersome than you can bear, especially if it is interfering with your daily life and activities, let your health care team know. Your prescribing provider might be able to adjust the medication dosage to reduce your symptoms. Another option is to try a different weight-loss drug to see if it’s effective and you tolerate it better.

3. Administration

Many weight-loss medications require that you inject yourself with the medication. You may face challenges such as needle phobia or have difficulty with proper injection techniques. Injection site reactions such as redness, swelling or itching can also be a deterrent. While these reactions are usually mild and transient, they can still be uncomfortable. Contact your provider to ensure you have thorough training on proper injection techniques to ensure a confident, accurate and comfortable self-injection. A different type of needle also may help reduce discomfort during injections. Make sure to alter your injection sites regularly and use mild, non-irritating cleansers to help keep the sites clean and reduce the likelihood of a reaction.

4. Cost

Weight-loss medications can be costly, and they’re not always paid for by insurance or covered long-term. You might consider exploring financial assistance programs as some pharmaceutical companies offer patient assistance programs or co-pay assistance programs to help reduce the cost of the medications. Your prescribing provider may also be able to prescribe alternative medications or therapies that are more affordable or have better insurance coverage.

5. Health status

It may be necessary to stop the medication if you have a change in health conditions. That’s why it’s important to have ongoing conversations with your health care team to assess your medication. Keep in mind that a lifestyle intervention program, like the Mayo Clinic Diet, can continue to support you on your weight-loss journey regardless of whether you’re taking a weight-loss medication. Stick with the program, even if you don’t take the drugs.

Work with your doctor

It is crucial for individuals considering semaglutide for weight loss to work closely with their healthcare provider to determine the appropriate treatment plan, including the duration and dosage. Regular follow-up visits and monitoring will help ensure the safe and effective use of this anti-obesity medication.

The Mayo Clinic Diet for Weight-Loss Medications

The FDA approved GLP-1s for weight loss as part of a weight-management program: they were never designed to be taken alone.

Our new program, the Mayo Clinic Diet for Weight-Loss Medications, offers two options:

• If you’re already taking weight-loss medication, we're here to support you
• If you’re seeking medication, we now offer end-to-end clinical care provided by the Amwell Medical Group® via the Healthy Weight Platform

Need access to GLP-1s? The Mayo Clinic Diet platform now offers clinical care for members interested in adding weight-loss medication to their journey.