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No direct evidence comparing semaglutide tablets to semaglutide injection was identified, which was noted as being of interest to both clinicians and policy makers

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Phase 1: Pharmacological Loading (Weeks 1-4) Blood levels rising toward steady state Intermittent appetite suppression (strongest 1-3 days post-injection, wanes by day 6-7) Early weight loss (mostly water weight and reduced glycogen stores) Common side effects peak: nausea, fatigue, constipation Goal: Reach steady-state blood concentration without intolerable side effects Phase 2: Metabolic Transition (Weeks 5-12) Steady-state blood levels achieved Consistent appetite suppression throughout the week Fat loss begins in earnest (roughly 70% of weight loss is fat mass during this phase) Side effects typically improve as the body adapts Dose escalation occurs (2.5 mg → 5 mg → 7.5 mg) Goal: Find the minimum effective dose that produces 0.5-1% body weight loss per week Phase 3: Peak Velocity (Weeks 13-24) Maximum rate of weight loss Receptor density peaks Metabolic adaptations fully expressed (improved insulin sensitivity, increased fat oxidation) Patients often reach target maintenance dose (10 mg or 15 mg) Goal: Sustain adherence through the period of fastest change Phase 4: Plateau and Maintenance (Weeks 25-72+) Weight loss decelerates and eventually plateaus New metabolic set point established Focus shifts from losing weight to maintaining loss Some patients reduce dose to find minimum effective maintenance level Goal: Long-term weight stability at reduced body weight [Diagram suggestion: Four-quadrant visual showing the 4 phases with overlapping timelines