Semaglutide below max dose: real-world data

A prospective observational study published in Scientific Reports on 4 June 2026 followed 56 adults with obesity in Slovakia who received semaglutide at doses below the approved 2.4 mg maintenance target. At six months, the 30 patients who completed follow-up had lost a mean of 11.35% of their body weight^[1]. That figure sits below the 14.9% reported in the STEP-1 randomised controlled trial at 68 weeks^[2], but it was achieved on lower doses, in a routine clinical setting, and without the structured lifestyle support a trial protocol provides.

What 'submaximal' means here

The Wegovy (semaglutide) label specifies a titration schedule that starts at 0.25 mg weekly and climbs through 0.5 mg, 1 mg, and 1.7 mg before reaching the 2.4 mg maintenance dose at week 17^[3]. The label also permits 1.7 mg as an alternative maintenance dose for patients who cannot tolerate the top step. In practice, many patients never reach 2.4 mg. They stop titrating because gastrointestinal side effects (nausea, vomiting, diarrhoea) become unacceptable, because the dose they are on is already producing weight loss, or because local supply and cost constrain the available pen strengths.

The Slovak group (Miertova, Lecky, Focko, Bolek et al.) enrolled patients at a tertiary care hospital in Martin, Slovakia, whose clinicians capped the dose once weight was falling at 2 to 5 kg per month. The resulting cohort was on doses below the top of the label, and the question was whether that mattered for clinically meaningful outcomes.

The numbers at three and six months

At three months, mean weight loss was 6.45%. At six months it was 11.35%. Mean BMI fell from 40.3 to 35.5 kg/m2, and waist circumference dropped by 13 cm across the two measurement points^[1]. All results were statistically significant (p < 0.01). The cohort was predominantly female (42 of 56), with a mean age of 49 years. Thirty patients completed the full six-month follow-up; the remainder were assessed only at three months.

What this does not tell us

The sample is small (n = 56 enrolled, n = 30 completing six months), single-centre, and lacks a comparator arm. There is no randomisation and no placebo group, so there is no way to separate the drug's effect from the dietary and physical-activity guidance patients received alongside it. The 26 patients who did not complete the six-month follow-up are not accounted for in the headline figure, and loss to follow-up in obesity trials is a known source of bias.

The study did not report detailed adverse-event data, so we cannot judge whether side-effect burden was genuinely lower at submaximal doses compared with the full titration schedule. And six months is short. The weight-loss trajectory in the STEP programme continued through 68 weeks before plateauing, and the discontinuation data from STEP-4 showed that stopping semaglutide leads to substantial weight regain. Whether submaximal dosing changes that regain picture is unknown.

Why this matters for the real-world picture

Randomised controlled trials recruit selected populations, enforce strict titration protocols, and deliver structured lifestyle support. The patients sitting in a clinic in Martin, Slovakia, are not that population. Real-world evidence like this fills a gap by showing what happens when clinicians use semaglutide on their own terms. The 11.35% six-month figure suggests that submaximal doses still produce clinically meaningful weight loss, even if they fall short of the STEP-1 headline. For clinicians managing side-effect burden or for patients in healthcare systems where the top dose is not reimbursed or reliably available, that is useful information.

It also puts a number on a pattern that obesity-medicine practitioners describe anecdotally: not every patient needs the maximum dose to benefit. The same research group published a related 12-week pilot in 2025 (Pec, Jurica et al., Pharmaceuticals) looking at adipocytokine and metabolic markers on submaximal doses, so this line of investigation has continuity.

Where to read more

The semaglutide page on this site covers the full trial programme (STEP-1 through STEP-8, SELECT, FLOW) and the approved dosing schedule. The EMA's centralised authorisation for Wegovy^[4] details the label across the EU and EEA. For the foundational RCT data on the full 2.4 mg dose, the STEP-1 publication^[2] remains the reference point. This study adds one more data point, not a definitive answer, to the question of how much drug is enough.