How much weight to expect to lose in the first month on semaglutide (Wegovy, Ozempic)

Key Points

• Results are usually modest at best on the first month of semaglutide
• Research shows people typically lose about 3-4% of their body weight in the first month on semaglutide
• People with type 2 diabetes often lose less weight than those without diabetes
• Combining semaglutide with healthy eating and physical activity maximizes weight loss results

You’ve heard all the semaglutide success stories, tales of people losing significant amounts of weight “easily” with Ozempic or Wegovy. Whether you’re still weighing if you’ll try the medication or are about to start, you’re probably wondering what’s actually realistic to expect for your first month on the drug. 

It's natural to be eager for results when you begin a new medication, especially one that's gotten so much attention for dramatic weight loss success. But having realistic expectations based on solid research – not social media anecdotes – can help you stay motivated and stick with your treatment plan.

Let's explore what science tells us about the first month on semaglutide and what you can realistically expect when you start.

What is semaglutide & how does it work?

Semaglutide is the active ingredient in both Wegovy and Ozempic. While they contain the same ingredient, Wegovy is FDA-approved specifically for weight management in people with obesity or overweight plus weight-related health conditions. Ozempic is approved for type 2 diabetes management, though doctors sometimes prescribe it off-label for weight loss. Wegovy has a higher maximum dose of 2.4mg (versus 2mg for Ozempic).

Semaglutide works by mimicking a hormone called GLP-1 that helps regulate your appetite and blood sugar. It makes you feel fuller faster when eating and keeps you feeling satisfied longer between meals.

Research shows that people taking semaglutide naturally reduce their daily calorie intake by about 24% compared to those not taking the medication. You're simply less hungry and less interested in food, which makes eating less happen more naturally. This, of course, is what leads to weight loss.

First month on semaglutide: What to expect

When you start semaglutide, your doctor will likely begin you on a low dose – typically 0.25mg once weekly for the first month. This isn't the dose that produces significant weight loss. Instead, it's designed to help your body adjust to the medication and minimize side effects like nausea.

“You may find you are less interested in food and may feel fuller sooner,” says Maria Karalis, RD. ”You may also experience some of the most common side effects, like nausea, mild bloating, constipation or diarrhea.”

After the first month, your doctor will gradually increase your dose, usually to 0.5mg weekly, then 1.0mg, and possibly higher depending on which medication you're taking and how your body responds. This gradual increase is called titration.

Because you're starting at this low dose, your first-month results will typically be more modest than what will happen in later months. This is completely normal.

What research shows about first-month weight loss on semaglutideb

So, what do the numbers actually look like? According to clinical trials, people taking semaglutide can expect to lose about 3-4% of their starting body weight in the first month.

In one of the major studies on semaglutide for weight loss, participants lost an average of approximately 3.8% of their body weight after just 4 weeks of treatment.

What does that mean in actual pounds? If you weigh 200 pounds, a 3.8% loss would be about 7-8 pounds in that first month. For someone weighing 250 pounds, it would be around 9-10 pounds.

This might not sound dramatic, but it's actually a solid start compared to many other weight loss approaches. And remember, this is just the beginning – weight loss continues and often accelerates as the dose increases.

By the three-month mark, participants in the same study had lost about 9.6% of their body weight. By 68 weeks (approximately 16 months), the average weight loss reached nearly 15%.

Is semaglutide weight loss different for people with diabetes?

If you have type 2 diabetes, you might see somewhat different results. Research shows that people with diabetes typically lose less weight on semaglutide compared to those without diabetes.

In a real-world study from the Mayo Clinic, patients without diabetes lost about 6.3% of their body weight after three months, while those with type 2 diabetes lost around 3.9% in the same timeframe.

This difference continues over time. By six months, people without diabetes had lost 11.8% of their body weight, compared to 7.2% for those with diabetes. This doesn't mean the medication isn't working – it's just that diabetes and its treatments can sometimes make weight loss more challenging.

While weight loss can help diabetes treatment, it’s important to remember that improved blood sugar control is ultimately the most important marker to measure.

Why first-month semaglutide results may vary

While the clinical trials give us averages, your personal experience might differ. Several factors can influence your first-month results:

Starting dose & medication

As mentioned, the starting dose of 0.25mg is intentionally low. Higher doses lead to greater weight loss, so as your dose increases, you'll likely see better results.

So, while Wegovy and Ozempic contain the same active ingredient, they can come in different doses, which might affect your results.

Diet & exercise

In all semaglutide research, participants didn't just take the medication – they also followed guidelines for healthy eating and physical activity. The weight loss seen in these studies reflects the combination of semaglutide with lifestyle changes.

If you continue eating highly processed foods or large portions while taking semaglutide, your weight loss will likely be slower. It’s not a magic pill that makes you shed weight with no other lifestyle changes.

On the other hand, if you use your decreased appetite as an opportunity to make healthier food choices, you might see better results.

“Semaglutide weight loss is modest in the first month and varies from person to person. It truly depends on whether the person is following a reduced-calorie diet and participating in physical activity,” says Maria Karalis, RD. “Semaglutide is adjunctive therapy, meaning it is not meant to be used alone. It works best if someone is following a low-calorie diet, plus participating in regular physical activity.”

Individual response

Everyone's body reacts differently to medications. Some people experience strong appetite suppression right away, while others might take longer to respond. Your metabolism, hormones, starting weight, and even genetics can all play a role in how you react to the medication and how quickly you lose weight.

Tips to maximize your first-month results

While semaglutide works by reducing your appetite, you'll get the best results by actively supporting your body's weight loss efforts. Here are some strategies to help you make the most of your first month:

Focus on nutrient-dense foods

When you're less hungry, it's especially important to choose high-quality, nutrient-rich foods for the calories you do consume. Build your meals around lean proteins, vegetables, fruits, whole grains, and healthy fats.

Since you might be eating less overall, make every bite count nutritionally. This keeps your body properly nourished while you're losing weight.

Stay active

Physical activity complements semaglutide's effects. While exercise alone often doesn't lead to significant weight loss, combining it with semaglutide can help preserve muscle mass as you lose fat and improve your overall health.

Aim for at least 150 minutes of moderate activity each week, along with some strength training exercises. Even simple daily walks can make a difference.

Manage side effects proactively

Common side effects of semaglutide, especially nausea, can sometimes interfere with healthy eating. If you experience nausea:

• Eat smaller, more frequent meals
• Stay well hydrated
• Avoid fatty, spicy, or very rich foods
• Talk to your doctor if side effects become problematic

Be consistent with injections

Take your semaglutide injection on the same day each week. Consistency helps maintain steady levels of the medication in your body and supports continuous weight loss.

What if you don't lose much weight in the first month?

If your first month on semaglutide yields little or no weight loss, don't be discouraged. This is more common than you might think, and it doesn't mean the medication won't work for you.

Remember that you're starting at the lowest possible dose, and your body is still adjusting to the medication. Many people don't see significant results until they reach higher doses in months 2-3.

In fact, while some semaglutide study participants lost weight starting from the first month, the most dramatic results came later as doses increased.

Is there a point at which should you talk to your doctor about a lack of weight loss on semaglutide? If you've been on the medication for three months and haven't lost at least 5% of your body weight, it might be time to discuss whether the medication is working for you or if adjustments are needed.

Wrapping up: Your first month on semaglutide

Semaglutide represents a breakthrough in weight management, but it's not an overnight solution. That first month typically brings modest but meaningful weight loss of about 3-4% of your starting weight, with better results coming as your dose increases.

The journey with semaglutide is a marathon, not a sprint. The greatest benefits come from consistent use over time, combined with healthy eating habits and regular physical activity.

Having realistic expectations can help you stay motivated during this initial phase. Be patient with your body, celebrate small victories, and remember that the foundation you're building in these early weeks will support more significant weight loss in the months to come.

Frequently Asked Questions

Will I lose more weight on Wegovy than Ozempic in the first month?

Since both medications contain the same active ingredient (semaglutide) and typically start at the same dose (0.25mg weekly), first-month results are usually similar. The main difference is that Wegovy eventually reaches higher maximum doses than Ozempic, which may lead to greater weight loss over time.

Is it normal to feel less hungry but not lose weight in the first month?

Yes, this can happen. Some people notice appetite suppression before seeing changes on the scale. Your body might be adjusting to the medication, or you might be experiencing normal weight fluctuations that mask small losses. If you're feeling less hungry, the medication is working, and weight loss will likely follow as your dose increases.

How can I tell if semaglutide is working for me in the first month?

Besides weight loss, signs that semaglutide is working include feeling less hungry, feeling fuller faster when eating, having fewer food cravings, and being less preoccupied with thoughts of food. These appetite changes often precede noticeable weight loss.

Should I follow a specific diet while taking semaglutide?

While semaglutide doesn't require a specific diet, it works best when combined with healthy eating habits. Focus on whole, minimally processed foods, plenty of vegetables and fruits, lean proteins, and appropriate portion sizes. A registered dietitian can help create a custom nutrition plan that works with your medication to optimize results.

Want personalized support to meet your weight loss goals. Find a weight loss dietitian who accepts your insurance.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.