weight loss
∙5 minute read
Updated
A recent study has explored whether a higher dose of the weight-loss injection semaglutide, better known by the brand name Wegovy, could help people with obesity lose more weight than standard treatment options.
The research, called the STEP UP trial, was presented in June 2025 at the American Diabetes Association’s annual scientific meeting. Its findings have since helped support the licensing of a higher 7.2 mg dose. Whilst people did experience more side effects than at lower doses, those on 7.2 mg lost significantly more weight on average.¹
Wegovy has historically been prescribed at doses up to 2.4 mg once a week, but research has increasingly focused on whether higher doses could help some people achieve greater weight loss. In earlier research, this standard dose helped people lose on average 15% of their body weight in just 68 weeks.
The idea behind STEP UP was simple: if some people respond well to 2.4 mg, they tried to see whether increasing the dose could help people who hadn’t quite reached their weight-loss targets on the standard regimen.1
The trial included 1,407 adults with obesity (BMI 30 or above) but without type 2 diabetes. They were recruited from 95 clinics in 11 countries, including Canada, Germany, Greece, and South Africa.1
Participants were randomly assigned to one of three weekly injections for 72 weeks:1
7.2 mg semaglutide (now licensed following the STEP UP trial)
2.4 mg semaglutide (the standard dose)
Placebo (no active medicine)
Everyone also received lifestyle advice, including cutting 500 calories per day and aiming for at least 150 minutes of physical activity per week. The doses were increased gradually over the first 20 weeks to help the body adjust.
The main things researchers wanted to see were:1
The average percentage of body weight lost over 72 weeks.
How many people lost at least 5% of their starting weight.
They also looked at other targets: losing at least 10%, 15%, 20%, and 25% of starting weight, as well as changes in waist size. And, most side effects were mild to moderate and tended to appear during the early “dose-escalation” phase.
By the end of the trial:1
People who stayed on the 7.2 mg dose lost 20% of their body weight, with a third losing over 25%. On average, participants lost 18.7% of their starting weight (about 21 kg for someone starting at 113 kg) regardless of how strictly they adhered to treatment.
On the 2.4 mg dose, people lost 17.5% when adhering to treatment, which equates to around 15% weight loss on average.
In the placebo group, people lost 3.9% (or 2.4% if looking only at those who stayed on placebo).
When looking at milestones:1
| Weight loss threshold | Semaglutide 2.4mg | Semaglutide 7.2mg | Placebo |
|---|---|---|---|
| At least 5% | 82% | 91% | 37% |
| At least 10% | 67% | 82% | 21% |
| At least 15% | 48% | 67% | 8% |
| At least 20% | 31% | 48% | 3% |
| At least 25% | 15% | 31% | 0% |
People on the higher dose also saw a bigger drop in waist size of 11.7 cm on average, compared with 8.6 cm on the standard dose and 1.3 cm with the placebo.1 This means there’s less fat pressing against vital organs like the liver and heart, which helps them work more effectively.
Research has shown that a higher waist circumference is a stronger indicator of cardiovascular and metabolic risk than BMI alone. In simple terms, reducing abdominal fat can ease the strain on your body, improve digestion, blood sugar control, and circulation, and lower your overall risk of serious conditions like heart disease and type 2 diabetes.2
As with other GLP-1 medications, the most common side effects reported were digestive issues like nausea, vomiting, diarrhoea, and constipation.1
In most cases, the side effects went away even while people stayed on the medicine.
No deaths were reported and serious side effects occurred in just 6.8% of people on the new higher dose. This compares to 5.5% who were on the placebo.
This study shows that a higher dose of semaglutide can help some people lose more weight and achieve bigger milestones, such as 20% or even 25% of their starting weight. Weight losses of that size are usually only seen after bariatric surgery, making the results particularly significant.3
It’s important to note that the study also only included people without type 2 diabetes, so the results might not apply to everyone. Moreover, while clinical trials offer close monitoring and consistent lifestyle advice, real-world results can vary.
There's lots of ongoing research into weight loss medications, and the STEP UP trial has played a key role in expanding treatment options. The 7.2 mg dose of semaglutide has now been licensed, following evidence that it can support greater weight loss for some people.
That said, higher doses are not suitable for everyone. Any changes to treatment should always be made under medical supervision, with careful consideration of side effects, tolerability, and individual health needs.
Wharton, S, et al. (2025). Once-weekly semaglutide 7.2 mg in adults with obesity: the randomised, controlled, phase 3b STEP UP trial. 1966-LB poster. American Diabetes Association (ADA) 85th Scientific Sessions, Chicago, US, June 20 – 23, 2025.17.
Farhana A, Rehman A. Metabolic consequences of weight reduction. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.
Lager CJ, Esfandiari NH, Subauste AR, Kraftson AT, Brown MB, Cassidy RB, et al. Milestone weight loss goals (weight normalization and remission of obesity) after gastric bypass surgery: Long-term results from the University of Michigan. Obesity surgery. 2017;27(7): 1659–1666.
Clinical Pharmacist and Copywriter, Master of Pharmacy (MPharm)
