Semaglutide 1.0mg for maintenance — lower dose long-term viability

Figured it would be useful to have a check-in thread specifically for those of us who've been on semaglutide for 2+ years. There's TONS of info from people starting out but not as much from long-term users. How's everyone doing?

I'll start:

• Time on sema: 27 months
• Current dose: 1.7mg (tried 2.4, too many side effects, stepped back and stayed at 1.7)
• Starting weight: 243 lbs
• Current weight: 178 lbs (-65 lbs, -26.7% body weight)
• Weight trajectory: Lost rapidly months 1-8, slowed months 9-14, plateaued at ~180 since month 15. Small fluctuations but essentially stable.
• Side effects at this point: Essentially none. Occasional mild nausea if I overeat, but that's honestly a useful signal. No more constipation (resolved with magnesium). No hair loss.
• Biggest concern: Am I going to be on this forever? My insurance renewed coverage but what if they don't next year?

How's everyone else doing at the 2+ year mark?

28 months here, reporting in.

• Dose: 2.4mg
• Starting weight: 289 lbs → Current: 202 lbs (-87 lbs, 30.1% body weight)
• A1C: Started 7.2% (pre-diabetic/early T2D), now 5.1% for the last 4 readings
• Side effects: Very minimal at this point. Some food aversions that never went away — I cannot eat greasy food anymore. My stomach just says no. I consider this a feature, not a bug.
• Exercise: Started strength training at month 6 per advice from this forum. Best decision I ever made. DEXA scan shows I've maintained most of my lean mass despite the large weight loss.

Re: the "forever" question — I've made peace with it. My blood pressure, cholesterol, A1C, and inflammatory markers are all dramatically better. If I need a medication to maintain that, so be it. People take statins for decades without angst.

25 months. SW 214, CW 159 (5'4" F). Maintenance dose 1.0mg — I actually titrated DOWN from 1.7mg once my weight stabilized and my appetite suppression is still adequate at 1.0.

Saving $$ by needing less medication and my endo is supportive. Something to consider for those of you at higher doses who've plateaued — you might not need as much to maintain as you needed to lose.

Great thread. The long-term data is consistent with what we're seeing in practice and what STEP 5 showed — weight loss is maintained in patients who continue treatment, with the curve plateauing around 12-18 months.

A few things I recommend for my long-term patients:

1. Annual DEXA scan — monitor body composition, not just weight. GLP-1 agonists can cause muscle loss alongside fat loss, and at 2+ years I want to make sure lean mass is being preserved.
2. Comprehensive annual labs — beyond just A1C. Vitamin D, B12, ferritin, thyroid panel, complete metabolic panel. Chronically reduced food intake can lead to micronutrient deficiencies over time.
3. Bone density monitoring — emerging data suggests that rapid/significant weight loss can accelerate bone mineral density loss, especially in postmenopausal women. A baseline DEXA for bone density is reasonable.
4. Consider dose optimization — as the poster above mentioned, some patients can maintain on lower doses than what they needed to lose. This reduces cost and potential long-term risks.

The STEP 5 extension showed that 2-year use was safe with no new safety signals emerging, which is reassuring.[1] But we genuinely don't have 5-year, 10-year data yet. This medication class is still relatively new in the obesity/weight management context.

24 months. Just chiming in to say — the mental/emotional benefits are what I value most at this point, honestly more than the weight loss itself.

For 20 years I was trapped in a cycle of binge-restrict-shame-repeat. That cycle is GONE. I eat normally. I don't think about food 24/7. I don't binge. I don't restrict. I just... eat when I'm hungry and stop when I'm full. Like a normal person.

If I have to take a weekly injection for the rest of my life to maintain that freedom, it's worth every penny and every needle stick. Fight me.