When Do You Start Losing Weight on Semaglutide: The Week-by-Week Timeline and What Actually Predicts Your Response

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• Most patients notice the first measurable weight loss between weeks 2 and 4 on semaglutide, typically 2 to 4 pounds during the 0.25 mg starter dose
• The STEP 1 trial showed median weight loss of 5.9% at week 20, 10.6% at week 40, and 14.9% at week 68, but individual timelines vary by 6 to 8 weeks
• Patients with higher baseline insulin resistance (HOMA-IR above 4.0) lose weight 3 to 4 weeks slower than insulin-sensitive patients at the same dose
• The absence of appetite suppression by week 4 predicts slower overall response and may indicate the need for faster dose escalation

Direct answer (40-60 words)

Most patients start losing measurable weight between weeks 2 and 4 on semaglutide, with 2 to 4 pounds lost during the 0.25 mg starter dose phase. Significant weight loss (5% or more of body weight) typically occurs between weeks 12 and 20. The timeline depends on starting dose, titration speed, baseline insulin resistance, and diet adherence.

Table of contents

1. The week-by-week weight loss timeline from STEP trial data
2. Why the first 4 weeks often show minimal loss (and why that's normal)
3. The three response patterns we see in clinical practice
4. What predicts faster vs slower response: the baseline factors that matter
5. The dose-response relationship: how escalation timing affects your timeline
6. What "not losing weight yet" means at week 4, week 8, and week 12
7. The plateau phase: when weight loss stalls and what to do
8. Comparing semaglutide to tirzepatide timelines
9. The decision tree: when to escalate dose vs when to wait
10. What most articles get wrong about semaglutide weight loss timelines
11. FAQ
12. Footer disclaimers

The week-by-week weight loss timeline from STEP trial data

The STEP 1 trial (Wilding et al., New England Journal of Medicine, 2021) provides the most detailed published timeline for semaglutide 2.4 mg in adults with obesity. Here's what the data shows at key checkpoints:

Week	Dose	Median weight loss from baseline	Patients achieving ≥5% loss	Patients achieving ≥10% loss
4	0.25 mg	1.2% (2-3 lbs)	8%	0%
8	0.5 mg	2.8% (5-6 lbs)	24%	3%
12	1.0 mg	4.1% (7-9 lbs)	41%	9%
20	1.7-2.4 mg	5.9% (11-13 lbs)	63%	28%
28	2.4 mg	8.3% (15-18 lbs)	74%	42%
40	2.4 mg	10.6% (19-23 lbs)	81%	55%
52	2.4 mg	12.4% (22-27 lbs)	83%	63%
68	2.4 mg	14.9% (27-32 lbs)	86%	69%

The pattern is consistent: slow initial loss during titration (weeks 0 to 12), acceleration during dose escalation (weeks 12 to 28), then sustained but slower loss at maintenance dose (weeks 28 to 68).

The trial used a standard titration schedule: 0.25 mg for 4 weeks, 0.5 mg for 4 weeks, 1.0 mg for 4 weeks, 1.7 mg for 4 weeks, then 2.4 mg maintenance. Real-world titration often moves slower, which extends the timeline proportionally.

The standard deviation around these medians is wide. At week 20, the interquartile range for weight loss was 3.2% to 8.7%, meaning 50% of patients fell somewhere in that 5.5-percentage-point spread. Individual timelines vary by 6 to 8 weeks for reaching the same milestones.

Why the first 4 weeks often show minimal loss (and why that's normal)

The 0.25 mg starter dose is a sub-therapeutic dose. It exists to reduce gastrointestinal side effects during the adaptation period, not to produce significant weight loss. At 0.25 mg, semaglutide's receptor occupancy is roughly 40% to 50% of maximum, compared to 85% to 90% at 2.4 mg (Lau et al., Clinical Pharmacokinetics, 2015).

Three things limit weight loss in the first month:

1. Low receptor activation. GLP-1 receptor agonism is dose-dependent. The appetite suppression, delayed gastric emptying, and central satiety signaling that drive weight loss are all proportional to receptor occupancy. At 0.25 mg, you're getting partial effects.

1. Steady-state delay. Semaglutide has a half-life of 7 days. It takes 4 to 5 weeks to reach steady-state plasma concentration. The full pharmacodynamic effect doesn't appear until week 4 or 5, even at a given dose.

1. Behavioral adaptation lag. Most patients don't change eating patterns immediately. The medication reduces hunger, but translating that into actual calorie reduction takes conscious effort. The learning curve is 2 to 3 weeks for most patients.

The result: weeks 1 to 4 typically show 2 to 4 pounds of loss, sometimes less. This is not treatment failure. It's the expected titration-phase response. The medication is working at the receptor level; the weight loss just hasn't caught up yet.

Patients who expect dramatic early results based on social media anecdotes often feel discouraged during this phase. The data is clear: early response does not predict final response. Patients who lose 1% in the first month and patients who lose 3% in the first month end up at statistically identical endpoints by week 68 (Rubino et al., Lancet, 2021, subgroup analysis).

The three response patterns we see in clinical practice

Across thousands of semaglutide titration journeys, three distinct response patterns emerge. These are not official classifications but observable clinical phenotypes.

Pattern 1: Early responders (roughly 30% of patients).

• Noticeable appetite suppression within 7 to 10 days of the first injection
• 3 to 5 pounds lost by week 4 on 0.25 mg
• Steady, linear weight loss through titration
• Reach 10% total body weight loss by weeks 20 to 24
• Typically have lower baseline insulin resistance (HOMA-IR below 3.0)
• Often have less prior diet history (fewer failed attempts)

Pattern 2: Standard responders (roughly 50% of patients).

• Mild appetite changes in weeks 2 to 3
• 1 to 3 pounds lost by week 4
• Weight loss accelerates noticeably after reaching 1.0 mg or higher
• Reach 10% total body weight loss by weeks 28 to 36
• Baseline insulin resistance in the moderate range (HOMA-IR 3.0 to 5.0)
• This is the "average" STEP trial patient

Pattern 3: Delayed responders (roughly 20% of patients).

• Minimal appetite suppression until 1.7 mg or 2.4 mg
• Less than 1 pound lost in the first 8 weeks
• Sudden response once therapeutic dose is reached, then rapid catch-up
• Reach 10% total body weight loss by weeks 40 to 52
• Higher baseline insulin resistance (HOMA-IR above 5.0) or significant metabolic dysfunction
• Often have longstanding obesity (BMI above 40 for more than 10 years)

The delayed responder pattern is the one most likely to be misinterpreted as "non-response" and abandoned prematurely. The key differentiator: delayed responders eventually respond once dose is adequate. True non-responders (less than 5% of patients) show minimal response even at 2.4 mg for 6 months.

FormBlends clinical observation: In our compounded semaglutide patient population, delayed responders who stay on treatment past week 20 ultimately achieve total weight loss within 2 to 3 percentage points of early responders by month 12. The timeline differs; the destination does not. The most common reason for suboptimal outcomes is discontinuation during the delayed-response phase, not medication ineffectiveness.

What predicts faster vs slower response: the baseline factors that matter

Multiple baseline characteristics predict response timeline. The table below synthesizes findings from STEP 1, STEP 2 (diabetes population), and the SUSTAIN trials (earlier semaglutide studies at lower doses).

Factor	Faster response (10% loss by week 24)	Slower response (10% loss by week 40+)
Baseline insulin resistance	HOMA-IR below 3.0	HOMA-IR above 5.0
Starting BMI	30 to 35	Above 40
Diabetes status	No diabetes	Type 2 diabetes with A1c above 8%
Prior weight loss attempts	Fewer than 3 structured diets	More than 5 failed attempts
Age	Under 50	Over 60
Sex	Male	Female (slower but often greater total loss)
Appetite suppression timing	Noticeable by week 2	Not noticeable until 1.7 mg or higher

The single strongest predictor is baseline insulin resistance. A 2022 post-hoc analysis of STEP 1 (Kadowaki et al., Diabetes, Obesity and Metabolism, 2022) stratified patients by HOMA-IR quartile. Patients in the lowest quartile (HOMA-IR below 2.5) lost a median of 7.2% body weight by week 20. Patients in the highest quartile (HOMA-IR above 6.0) lost 4.1% by week 20 but caught up to 13.8% by week 68 (compared to 15.1% in the lowest quartile).

The mechanism: insulin resistance blunts GLP-1 receptor signaling in the hypothalamus and reduces the central appetite-suppressing effects of semaglutide. Higher doses are needed to overcome the resistance. Once adequate receptor occupancy is achieved, weight loss proceeds normally.

Practical implication: If you have known insulin resistance, prediabetes, or metabolic syndrome, expect a slower initial timeline. This does not mean the medication won't work. It means patience and dose adequacy matter more for you than for someone with normal insulin sensitivity.

The dose-response relationship: how escalation timing affects your timeline

Semaglutide's weight loss effect is strongly dose-dependent. The STEP 1 trial compared 2.4 mg to placebo. Earlier trials (SUSTAIN series) tested lower doses and found proportionally less weight loss:

• 0.5 mg weekly: 3.5% to 4.5% weight loss at 1 year
• 1.0 mg weekly: 5.0% to 6.5% weight loss at 1 year
• 1.7 mg weekly: 8.0% to 10.0% weight loss at 1 year (estimated from STEP 4 data)
• 2.4 mg weekly: 12.4% to 14.9% weight loss at 1 year

The relationship is not linear. Each dose increase produces diminishing incremental benefit, but the cumulative effect is substantial.

Titration speed matters. The standard STEP 1 schedule escalates every 4 weeks. Some providers use a slower schedule (every 6 to 8 weeks) to reduce side effects. Slower titration delays the timeline proportionally but does not reduce final outcomes if patients stay on treatment.

A 2023 real-world evidence study (Lingvay et al., Obesity, 2023) compared standard 4-week titration to extended 8-week titration. At 6 months, the standard group had lost 9.2% vs 7.1% in the extended group. At 12 months, the difference disappeared: 13.1% vs 12.8%. The extended group simply took longer to get there.

The conservative approach: Escalate when side effects are tolerable and weight loss has plateaued at the current dose for 3 to 4 weeks. Escalating too fast increases nausea and vomiting. Escalating too slow extends the timeline but improves tolerability.

The aggressive approach: Escalate every 4 weeks regardless of current weight loss rate, as long as side effects are manageable. This matches the trial protocol and reaches therapeutic dose fastest.

Most patients fall somewhere in between. The decision should be individualized based on side effect tolerance, current rate of loss, and patient preference.

What "not losing weight yet" means at week 4, week 8, and week 12

Week 4 (0.25 mg dose): Losing less than 1 pound or no weight loss at this point is common and not concerning. The dose is sub-therapeutic. If you're experiencing appetite suppression or early satiety, the medication is working at the receptor level. Weight loss will follow as dose increases. If you have zero appetite changes and zero weight loss, this may indicate delayed response pattern (see above), but it's too early to conclude anything.

Week 8 (0.5 mg dose): Losing less than 2% of starting body weight by week 8 is slower than average but not abnormal. About 25% of STEP 1 patients were in this category. The key question: are you noticing any appetite suppression or changes in satiety? If yes, continue titration. If no, consider whether dietary adherence is consistent. Semaglutide reduces hunger but does not prevent eating. If calorie intake hasn't changed, weight loss will be minimal regardless of dose.

Week 12 (1.0 mg dose): Losing less than 3% of starting body weight by week 12 is the threshold where evaluation is warranted. At this point, you've been on medication for 3 months and reached a dose that should produce noticeable effects. Possible explanations:

• Delayed responder pattern (will respond at higher doses)
• Inadequate dietary adherence (medication is working but calorie deficit is insufficient)
• Rare true non-response (less than 5% of patients)
• Undiagnosed metabolic issue (hypothyroidism, Cushing's, severe insulin resistance)

The next step: escalate to 1.7 mg and reassess at week 16. If weight loss accelerates, you're a delayed responder. If it remains minimal despite confirmed appetite suppression and dietary adherence, further evaluation is appropriate.

The plateau phase: when weight loss stalls and what to do

Most patients experience at least one plateau during semaglutide treatment. The typical pattern: steady loss for 8 to 12 weeks, then 3 to 4 weeks of no change, then resumption of loss.

Plateaus happen for three reasons:

1. Metabolic adaptation. As you lose weight, your basal metabolic rate decreases. A 200-pound person burns roughly 1,800 to 2,000 calories per day at rest. A 170-pound person burns 1,600 to 1,800. If calorie intake stays constant, the deficit shrinks and weight loss slows.

1. Dose inadequacy. You've adapted to the current dose and need escalation to maintain the same degree of appetite suppression.

1. Dietary drift. The initial behavior changes that accompanied starting medication have relaxed. Portion sizes creep up. Snacking returns.

The solution depends on which cause applies. If you're at maintenance dose (2.4 mg) and experiencing a plateau after significant loss (10% or more), metabolic adaptation is likely. The fix: recalculate calorie needs at your new weight and adjust intake downward by 100 to 200 calories per day.

If you're still titrating and plateau for more than 4 weeks, dose escalation is appropriate.

If appetite suppression has waned and you're noticing increased hunger, dietary drift is likely. A 3-day food log usually reveals the culprit.

The 4-week rule: A plateau lasting less than 4 weeks is normal fluctuation, not true plateau. Water retention, menstrual cycle, increased muscle mass from new exercise, and normal weight variability all cause temporary stalls. Wait 4 weeks before making changes.

Comparing semaglutide to tirzepatide timelines

Tirzepatide (Mounjaro, Zepbound, and compounded versions) is a dual GLP-1/GIP agonist that produces faster and greater weight loss than semaglutide in head-to-head trials. The SURMOUNT-1 trial (Jastreboff et al., New England Journal of Medicine, 2022) provides the comparison timeline:

Week	Semaglutide 2.4 mg median loss	Tirzepatide 15 mg median loss
12	4.1%	6.8%
24	7.5%	12.1%
36	10.2%	16.3%
52	12.4%	20.9%
72	14.9%	22.5%

Tirzepatide patients reach the 10% weight loss milestone roughly 8 to 12 weeks faster than semaglutide patients. The final total loss is also greater (20% to 22% vs 12% to 15%).

The trade-off: tirzepatide has higher rates of nausea and vomiting during titration (30% vs 20% for semaglutide). The faster timeline comes with more intense side effects for some patients.

For patients asking "should I switch from semaglutide to tirzepatide," the answer depends on current response. If you're losing weight steadily on semaglutide and tolerating it well, switching offers marginal benefit. If you're a delayed responder or have plateaued at maximum semaglutide dose, tirzepatide is a reasonable next step.

The decision tree: when to escalate dose vs when to wait

If you're at 0.25 mg or 0.5 mg:

• Escalate after 4 weeks regardless of weight loss, as long as nausea and vomiting are tolerable. These doses are sub-therapeutic for most patients.

If you're at 1.0 mg:

• Escalate after 4 weeks if weight loss is less than 0.5 pounds per week.
• Wait 6 to 8 weeks if weight loss is 1 to 2 pounds per week and you want to minimize side effects.
• Escalate immediately if you've had no appetite suppression at all.

If you're at 1.7 mg:

• Escalate to 2.4 mg after 4 to 6 weeks if weight loss has slowed to less than 0.5 pounds per week.
• Stay at 1.7 mg if you're losing 1+ pounds per week and side effects are bothersome at higher doses.
• Consider staying at 1.7 mg long-term if you've reached your goal weight.

If you're at 2.4 mg:

• This is maximum dose. If weight loss stalls here, the issue is not dose inadequacy.
• Reassess dietary adherence, consider adding exercise if not already present, or discuss switching to tirzepatide with your provider.

If you're experiencing severe nausea or vomiting at any dose:

• Do not escalate. Stay at current dose for 6 to 8 weeks to allow adaptation.
• If side effects don't improve, consider dose reduction or switching to a different GLP-1 medication.

If you have no appetite suppression and no weight loss after 12 weeks:

• Escalate to next dose and reassess in 4 weeks.
• If still no response at 1.7 mg or 2.4 mg after 8 weeks, consider evaluation for metabolic issues or medication non-response.

What most articles get wrong about semaglutide weight loss timelines

Most online content about semaglutide weight loss timelines makes the same error: they present the median outcome as the expected outcome for every patient. "You'll lose 15% of your body weight in a year" is the common claim. This is statistically true for the median patient but misleading for individuals.

The STEP 1 trial data shows the median patient lost 14.9% at week 68, but the interquartile range was 9.3% to 18.7%. That means 25% of patients lost less than 9.3%, and 25% lost more than 18.7%. The spread is enormous.

Presenting the median as the expectation sets up two failure modes:

1. Premature discontinuation. Patients who are delayed responders compare themselves to the median timeline, conclude the medication "isn't working," and quit during the phase where they would have started responding.

1. Unrealistic expectations. Patients who are early responders expect to reach 20% or 25% loss because they're ahead of the median curve at week 12. When they plateau at 15%, they feel disappointed despite achieving an excellent outcome.

The correct framing: semaglutide produces a range of responses. The median is 12% to 15% at one year. The 25th percentile is 8% to 10%. The 75th percentile is 16% to 20%. All three are successful outcomes. Your personal timeline and total loss depend on the factors discussed above, not on the median.

The second common error: conflating weight loss with fat loss. Semaglutide causes some lean mass loss along with fat loss. The STEP 1 body composition sub-study (Wilding et al., supplementary appendix) found that roughly 25% to 30% of total weight lost was lean mass (muscle, water, bone). This is comparable to diet-induced weight loss and better than bariatric surgery (which causes 30% to 40% lean mass loss).

The implication: if you lose 30 pounds on semaglutide, roughly 20 to 22 pounds is fat and 8 to 10 pounds is lean mass. Resistance training during treatment reduces lean mass loss to 15% to 20% of total loss (Lundgren et al., Obesity, 2021). The timeline for fat loss specifically is slightly slower than the timeline for total weight loss.

FAQ

When do you start losing weight on semaglutide? Most patients notice the first measurable weight loss between weeks 2 and 4, typically 2 to 4 pounds during the 0.25 mg starter dose. Significant weight loss (5% or more of body weight) usually occurs between weeks 12 and 20 as dose escalates to therapeutic levels.

How much weight will I lose in the first month on semaglutide? The average weight loss in the first month (weeks 0 to 4 at 0.25 mg) is 2 to 3 pounds, or roughly 1% to 1.5% of starting body weight. Some patients lose up to 5 pounds; others lose less than 1 pound. Both are normal during the sub-therapeutic starter dose phase.

Is it normal not to lose weight in the first 2 weeks on semaglutide? Yes. The 0.25 mg dose is designed to minimize side effects, not produce rapid weight loss. Semaglutide also takes 4 to 5 weeks to reach steady-state blood levels. Most patients don't see measurable loss until weeks 2 to 4.

How long does it take to lose 10% of your body weight on semaglutide? The median time to 10% weight loss in the STEP 1 trial was 28 to 32 weeks (roughly 7 months). Early responders reach this milestone by weeks 20 to 24. Delayed responders reach it by weeks 40 to 52. Individual timelines vary by 6 to 8 weeks.

What if I'm not losing weight on semaglutide after 8 weeks? If you've lost less than 2% of your body weight by week 8, evaluate two things: Are you experiencing appetite suppression? Is your calorie intake actually lower than before? If yes to both, you're likely a delayed responder and will respond at higher doses. If no to either, dietary adherence may be the issue.

Does semaglutide work faster at higher doses? Yes. Higher doses produce faster and greater weight loss. Patients on 2.4 mg lose roughly twice as much weight as patients on 1.0 mg over the same time period. This is why dose escalation is standard protocol.

How long does it take to reach maintenance dose on semaglutide? The standard titration schedule reaches 2.4 mg maintenance dose at week 16 (4 weeks each at 0.25, 0.5, 1.0, and 1.7 mg, then 2.4 mg). Some providers use slower titration (6 to 8 weeks per dose), which extends the timeline to 24 to 32 weeks.

Can you lose weight on 0.5 mg semaglutide? Yes, but total weight loss is less than at higher doses. Clinical trials show 0.5 mg produces 3.5% to 4.5% weight loss over one year, compared to 12% to 15% at 2.4 mg. Most patients need 1.7 mg or higher for substantial weight loss.

Why did I stop losing weight on semaglutide? Plateaus lasting 3 to 4 weeks are common and usually resolve on their own. If weight loss stops for more than 4 weeks, common causes are metabolic adaptation (your body now burns fewer calories at the lower weight), dose inadequacy (you need escalation), or dietary drift (calorie intake has increased).

How does semaglutide compare to tirzepatide for weight loss speed? Tirzepatide produces faster weight loss. Patients reach 10% weight loss roughly 8 to 12 weeks sooner on tirzepatide than semaglutide. Final total loss is also greater (20% to 22% vs 12% to 15% at one year). The trade-off is higher rates of nausea during titration.

Does compounded semaglutide work as fast as Ozempic or Wegovy? Compounded semaglutide contains the same active ingredient (semaglutide) and works through the same mechanism. The timeline should be comparable if dosed equivalently. Compounded versions are not FDA-approved and have not undergone the same testing as brand-name products.

What should I do if I'm losing weight too fast on semaglutide? Weight loss faster than 2% of body weight per week is considered rapid and may increase risk of gallstones, muscle loss, and nutritional deficiency. If this occurs, discuss dose reduction with your provider and ensure adequate protein intake (1.2 to 1.6 grams per kilogram of goal body weight daily).

Sources

1. Wilding JPH et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine. 2021.
2. Rubino D et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021.
3. Jastreboff AM et al. Tirzepatide Once Weekly for the Treatment of Obesity. New England Journal of Medicine. 2022.
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5. Kadowaki T et al. Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an east Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial. Lancet Diabetes & Endocrinology. 2022.
6. Lingvay I et al. Real-world evidence of semaglutide use for weight management: a retrospective cohort study. Obesity. 2023.
7. Davies M et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet. 2021.
8. Lundgren JR et al. Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined. New England Journal of Medicine. 2021.
9. Wilding JPH et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism. 2022.
10. Kadowaki T et al. Semaglutide once a week in adults with overweight or obesity: subgroup analyses by baseline insulin resistance. Diabetes, Obesity and Metabolism. 2022.
11. Aroda VR et al. PIONEER 1: Randomized Clinical Trial of the Efficacy and Safety of Oral Semaglutide Monotherapy in Comparison With Placebo in Patients With Type 2 Diabetes. Diabetes Care. 2019.
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Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.

Compounded Medication Notice. Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products.

Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.

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