Everyone's GLP-1 journey is different, but there are common patterns. Here's what many people experience—and what the data shows—at each stage.
Month 1
The Adjustment Phase
What Happens
Starting dose is low. Appetite may decrease noticeably. "Food noise" often quiets. Weight loss typically 2-5 lbs (partly water).
Side Effects
Nausea most common. May feel mild GI discomfort. Usually manageable. Many feel surprisingly good.
Months 2-3
Dose Escalation
What Happens
Moving through titration schedule. Weight loss accelerates. Many lose 5-10% of starting weight by month 3. Clothing fits differently.
Side Effects
May flare with each dose increase. Constipation common. Most people adapting. Some need to slow titration.
Months 4-6
Peak Effectiveness
What Happens
Reaching maintenance dose. Weight loss rate often peaks. Many at 10-15% loss. Energy improving. Blood work often improving.
Side Effects
Most have adapted. Side effects generally stable or improved. Focus shifts to maintaining protein intake.
Months 6-12
Continued Progress
What Happens
Weight loss continues but slows. Most reach 15-20%+ loss by month 12. Body recomposition visible. Many comorbidities improving.
Challenges
Plateau feelings common. Need to focus on muscle preservation. Some wonder if they can stop.
Year 2+
Maintenance Phase
What Happens
Weight stabilizes. Focus shifts from losing to maintaining. Some find lower doses sufficient. This becomes the new normal.
Key Questions
Long-term medication planning. Cost/access sustainability. Building habits that support maintenance.
Individual Variation Is Huge
Some people lose 25%+. Others plateau at 8%. Some have minimal side effects; others struggle. Response is influenced by genetics, starting weight, metabolic health, and factors we don't fully understand. Don't compare your month 3 to someone else's.
What Success Looks Like
Realistic expectations based on clinical trial data:
- Semaglutide (Wegovy): Average ~15% weight loss at 68 weeks. Top responders: 20%+. Lower responders: 5-10%.
- Tirzepatide (Zepbound): Average ~20% weight loss at 72 weeks. Top responders: 25%+.
- Timeline: Most weight loss occurs in first 12-18 months, then plateaus.
The Bottom Line
Month 1 is adjustment—low dose, mild effects, beginning of appetite change. Months 2-3 see dose escalation and accelerating weight loss. Months 4-6 often bring peak effectiveness. Months 6-12 continue progress at a slower pace. Year 2+ is maintenance. Individual variation is significant—some people respond dramatically, others modestly. Set expectations based on averages but don't be surprised if your journey differs.
Sources
- STEP and SURMOUNT clinical trial weight loss trajectories.
- Real-world patient experience patterns.
- Clinical practice observations on GLP-1 treatment timelines.