How much weight do people lose on the 7.2 mg dose?

In the STEP UP trial, semaglutide 7.2 mg produced 18.7% weight loss at 72 weeks under the treatment policy analysis, compared with 15.6% for 2.4 mg and 3.9% for placebo. Novo Nordisk quotes 20.7% using the trial product estimand.

How much weight loss comes from the Wegovy pill?

OASIS 4 tested oral semaglutide 25 mg and reported 13.6% weight loss at week 64 versus 2.2% on placebo under the treatment policy analysis, or 16.6% under the trial product estimand.

Do people with type 2 diabetes lose less weight?

Yes, consistently. STEP 1 in people without diabetes showed 14.9% weight loss; STEP 2 in people with type 2 diabetes showed 9.6%. The same pattern shows up with tirzepatide and with CagriSema.

What percentage of people lose 20% or more?

It depends on the dose and trial. In STEP 8, 38.5% of semaglutide 2.4 mg participants lost 20% or more. In STEP UP, about one third of people on 7.2 mg reached 25% or more.

Does everyone lose weight on semaglutide?

No. In STEP 1, 86.4% lost at least 5% of body weight — which means roughly one in seven did not. Trials do not identify a reliable way to predict who responds strongly.

Why is my weight loss smaller than the trial numbers?

Real-world average weight loss is typically lower, mostly because many people never reach a full maintenance dose or stop early. A Cleveland Clinic study found 8.7% average one-year loss overall, but 11.9% among people who stayed on treatment and 13.7% among those who reached a high maintenance dose.

How does semaglutide compare to Ozempic for weight loss?

They are the same drug at different doses. Ozempic is approved for type 2 diabetes at up to 2 mg weekly, where weight loss in trials ran roughly 4 to 7 kg. Wegovy is approved for weight management at 2.4 mg or 7.2 mg, where weight loss is far larger.

How Much Weight Do People Lose on Semaglutide? The Numbers From Every Major Trial

Q: What is the average weight loss on semaglutide 2.4 mg?

In STEP 1, the registration trial for Wegovy, average weight loss was 14.9% of body weight over 68 weeks versus 2.4% on placebo. That was about 15.3 kg, or roughly 34 pounds, from an average starting weight of 105 kg.

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There is no single answer, because semaglutide comes in several doses and formulations, and the trials studied very different groups of people. A person with type 2 diabetes taking Ozempic at 1 mg is on a completely different part of the curve from a person without diabetes taking Wegovy at 7.2 mg.

This page lays out the actual trial figures, dose by dose and population by population, and then explains why the numbers you see in a clinic tend to be smaller.

Nothing here is advice about which dose anyone should take. That is a prescriber’s decision.

What is the average weight loss on semaglutide 2.4 mg?

The benchmark is STEP 1, the trial that led to Wegovy’s approval. It randomized 1,961 adults with obesity — or overweight plus a weight-related condition — and without diabetes to semaglutide 2.4 mg weekly or placebo for 68 weeks, alongside lifestyle support.

Average weight change was -14.9% with semaglutide versus -2.4% with placebo, a treatment difference of 12.4 percentage points. In kilograms that was -15.3 kg versus -2.6 kg, from a mean starting weight of about 105 kg [1].

Roughly 34 pounds, on average, over about sixteen months.

The proportions matter more than the mean:

Weight loss threshold	Semaglutide 2.4 mg	Placebo
5% or more	86.4%	31.5%
10% or more	69.1%	12.0%
15% or more	50.5%	4.9%

Half of participants lost at least 15% of their body weight. About one in seven did not reach even 5% [1]. Response varies widely, and no trial has produced a reliable way to predict which side of that line someone falls on.

How much does the dose change the result?

A lot. Here is the ladder, from lowest to highest, using each dose’s pivotal trial.

Semaglutide 1.0 mg (Ozempic, diabetes dose). Across the SUSTAIN program, weight loss ran roughly 4.5 to 6.5 kg over 30 to 56 weeks in people with type 2 diabetes — meaningful, but a fraction of what the obesity doses produce.

Semaglutide 2.4 mg (Wegovy). 14.9% in STEP 1 [1]; 15.2% at two years in STEP 5 [2]; 16.0% in STEP 3 when combined with 30 counseling visits and an initial low-calorie diet [3]; 15.8% in STEP 8 [4].

Semaglutide 7.2 mg (Wegovy HD). STEP UP randomized 1,407 adults with obesity and without diabetes to 7.2 mg, 2.4 mg or placebo for 72 weeks. Mean weight change was -18.7% at 7.2 mg versus -15.6% at 2.4 mg and -3.9% on placebo [5]. The extra 3.1 percentage points came with more nausea (70.8% versus 61.2% gastrointestinal events) and a notable increase in dysesthesia — odd skin sensations such as tingling — reported by 22.9% at 7.2 mg versus 6.0% at 2.4 mg. The FDA approved this dose as Wegovy HD in March 2026.

Oral semaglutide 25 mg (Wegovy tablet). OASIS 4 enrolled 307 adults without diabetes and found -13.6% at week 64 versus -2.2% on placebo [6]. The FDA approved the tablet in December 2025.

Oral semaglutide 50 mg. OASIS 1 tested a higher tablet dose in 667 adults and found -15.1% versus -2.4% on placebo at week 68 [7]. Novo Nordisk ultimately brought the 25 mg strength to market instead.

Why do I see two different numbers for the same trial?

This trips up almost everyone, and it is worth understanding because the gap can be three percentage points or more.

Trials report results using an estimand — a formal definition of the question being answered.

The treatment policy estimand counts every randomized participant, including people who stopped the drug or added another weight-loss treatment. It answers: what happened to people assigned this treatment?
The trial product estimand estimates what would have happened if everyone had stayed on the drug and used nothing else. It answers: what does this drug do when you actually take it?

The trial product number is always the larger one. Both are legitimate; they answer different questions.

STEP UP is the clearest example. The Lancet paper leads with -18.7% (treatment policy). Novo Nordisk’s approval announcement leads with 20.7% (trial product) [5]. OASIS 4 shows the same split: the New England Journal of Medicine reports -13.6% while the company reports 16.6% [6]. REDEFINE 1, the CagriSema trial, reports -20.4% in the journal and 22.7% in the press release [8].

When two sources seem to disagree about a trial, this is usually why — not because one of them is wrong.

How much do people with type 2 diabetes lose?

Consistently less, across every drug in this class.

STEP 2 ran the same 2.4 mg dose for the same 68 weeks in 1,210 adults with type 2 diabetes. Weight change was -9.6% versus -3.4% on placebo, and 68.8% reached 5% or more weight loss compared with 86.4% in STEP 1 [9].

STEP UP T2D repeated the comparison at the higher dose: 512 adults with obesity and type 2 diabetes lost -13.2% on semaglutide 7.2 mg versus -3.9% on placebo, with HbA1c falling 1.5 points more than placebo [10].

The same gap shows up with tirzepatide — about 21% in SURMOUNT-1 without diabetes versus 13-15% in SURMOUNT-2 with diabetes — and with CagriSema, at about 20% versus 14%. The reasons are not fully understood, but they likely involve differences in insulin dynamics, background medications that promote weight gain, and longer-standing metabolic changes.

What about specific populations?

Adolescents. STEP TEENS enrolled 201 people aged 12 to 17 with obesity. BMI fell 16.1% with semaglutide versus a 0.6% increase on placebo, and 73% lost at least 5% of body weight [11]. Note this trial reported BMI change rather than weight change, since adolescents are still growing.

East Asian populations. STEP 6, in Japan and South Korea, reported -13.2% at 2.4 mg [12]. STEP 7, in a predominantly East Asian population, reported -12.1% over a shorter 44-week course [13]. STEP 6 also measured deep abdominal fat by CT scan and found a 40.0% reduction versus 6.9% on placebo — a striking result given the smaller overall weight change.

People with prediabetes. STEP 10 found -13.9% weight loss at 52 weeks, with 81% reverting to normal blood sugar versus 14% on placebo [14].

People with knee osteoarthritis. STEP 9 found -13.7% alongside substantially greater pain relief than placebo [15].

People with heart disease and no diabetes. SELECT is the long-game data: -10.2% at 208 weeks versus -1.5% on placebo [16]. The lower figure compared with STEP 1 reflects a different population, less intensive lifestyle support and a much longer follow-up that includes everyone who stopped the drug.

How does semaglutide compare with other drugs?

Head-to-head randomized data exists in three places.

Versus liraglutide 3.0 mg (Saxenda). STEP 8 compared them directly in 338 US adults: -15.8% with semaglutide versus -6.4% with liraglutide, a 9.4 percentage point difference. Discontinuation for any reason was 13.5% versus 27.6% [4]. This is not a close contest.

Versus tirzepatide (Zepbound). SURMOUNT-5 randomized 751 adults with obesity and without diabetes to maximum tolerated doses of either drug for 72 weeks. Tirzepatide produced -20.2% versus semaglutide’s -13.7% [17]. Tirzepatide participants were roughly twice as likely to lose 25% or more (31.6% versus 16.1%). Two caveats: the trial was open-label and Lilly-funded, and it used the 2.4 mg semaglutide dose, which is now one step below the highest approved dose.

Versus CagriSema. REDEFINE 1 included a semaglutide-alone arm. Under the trial product estimand, CagriSema produced 22.7%, semaglutide alone 16.1%, cagrilintide alone 11.8% and placebo 2.3% [8]. CagriSema is not FDA approved. Novo Nordisk filed a New Drug Application on December 18, 2025, and as of September 2026 the drug remains under review, with the company guiding to an FDA decision in the fourth quarter of 2026.

There is no randomized head-to-head comparison of the Wegovy tablet against the Wegovy injection, or of semaglutide 7.2 mg against tirzepatide 15 mg. Cross-trial comparisons between different studies are suggestive at best.

Why is real-world weight loss lower than trial weight loss?

This is the most practically important section on this page.

A Cleveland Clinic team examined electronic health records for 7,881 adults with overweight or obesity and without type 2 diabetes who started injectable semaglutide or tirzepatide between 2021 and 2023. Mean one-year weight reduction was 8.7% — well below STEP 1’s 14.9% [18].

The reason was not that the drug works differently outside a trial. It was dose and persistence:

80.8% never reached a high maintenance dose.
People who stopped within three months lost 3.6%.
People who stopped between three and twelve months lost 6.8%.
People who did not stop lost 11.9%.
People who did not stop and reached a high maintenance dose lost 13.7% on semaglutide and 18.0% on tirzepatide — essentially trial-level results [18].

That last line is the finding worth remembering. The trial numbers are reproducible in ordinary care, but only for people who get to a full dose and stay there. Everything that gets in the way of that — side effects during escalation, insurance denials, prior authorization renewals, supply shortages, cost — pulls the average down.

Trial participants also receive free medication, scheduled visits, dietary counseling and a research nurse who calls when they miss a dose. Most patients do not.

What should you expect for yourself?

The honest answer is that a trial average tells you about a population, not about you.

What the data supports saying:

Most people who reach and stay on a full dose lose a clinically meaningful amount of weight — enough to improve blood pressure, blood sugar, cholesterol and, in several trials, symptoms of knee arthritis and heart failure.
A substantial minority lose very large amounts: half of STEP 1 participants lost 15% or more.
A minority lose little. Roughly one in seven in STEP 1 did not reach 5%.
Weight loss is not linear. It accumulates over roughly 60 to 68 weeks and then plateaus while treatment continues [2][16].
Weight comes back after stopping, in proportion to how much was lost.

If your own results differ from the numbers on this page, that does not mean something has gone wrong. It means you are an individual rather than an average. A healthcare provider can look at dose, timing, other medications and other conditions in a way that no published average can.

Sources

This article summarizes FDA labeling, published research and company information current as of September 14, 2026. It is not medical advice and does not replace a conversation with your own healthcare provider. How we research and verify.