Weeks 1–4: still at starting dose, body adapting. Here's what to expect by week.
About this article
Reviewed byDr. J. Bottoni, M.D.
RoleEditor-in-Chief, Medicine
First publishedMay 20, 2026
Last reviewedMay 20, 2026
Page typeIn-depth editorial guide
Sources15+ cited sources
Week 1
Initiation. Mild GI symptoms common. Appetite reduction noticeable by end of week. Weight loss minimal (0–2 lb typical).
Week 2
Symptoms stabilize. Appetite reduction more consistent. Weight loss begins (1–3 lb additional).
Week 3
Adaptation. Most patients tolerating starting dose well. Weight loss continuing at 1–2 lb/week. Energy and mood often improving.
Week 4 — last week of starting dose
Patient is ready for first dose escalation. Communicate with prescriber about tolerance. Most patients escalate to 0.5 mg sema or 5 mg tirz.
Total month 1 weight loss
Typical: 2–6 lb. Substantial weight loss usually begins months 2–4 as dose escalates.