Your Guide to Starting a GLP-1 for MASH
Health ConditionsLiver Disease

What to Expect When Using a GLP-1 for MASH

What to Expect When Using a GLP-1 for MASH
iStock
By
Updated on January 13, 2026
by
Semaglutide, best known as a prescription weight loss medication and classified as a GLP-1 agonist, is approved by the U.S. Food and Drug Administration (FDA) to treat metabolic dysfunction–associated steatohepatitis (MASH).

 Weight loss is one of the best treatments for this serious and chronic liver condition.

By supporting weight loss and blood sugar control, semaglutide can reduce liver fat, inflammation, and scarring caused by MASH, explains A. Sidney Barritt IV, MD, the director of hepatology at UNC School of Medicine in Chapel Hill, North Carolina.

As with other prescription drugs, you’ll get the most out of it if you understand how it works and what to expect. Find out more about when and how to use semaglutide so it can improve your liver health as much as possible.

How to Take Semaglutide

Semaglutide is primarily available in two forms: injection and pill. The injection is the only form currently FDA-approved to treat MASH, but your doctor may prescribe the oral form to support weight loss.

Injectable Semaglutide (Wegovy)

The injectable form of semaglutide is typically administered with a prefilled dosing pen into the upper arm, thigh, or stomach area. It’s best to use a different injection spot each time.

“Skipping doses is a bad idea because it diminishes the effectiveness of the medication,” says Nestor da la Cruz-Munoz, MD, the director of metabolic and bariatric surgery at HCA Florida Weight Management and Metabolic Wellness in Miami.

It doesn’t need to be administered at the exact same time of day, but sticking with a similar timeframe, such as Sundays before bedtime or Wednesdays before you brush your teeth, can make it easier to remember to do it.

If you miss a dose, take it as soon as possible if your next planned dose is more than 48 hours away. If it’s sooner than that, wait to take the next one at your regular scheduled time. You also shouldn’t double up on doses.

 If you have questions or need to make adjustments to your dosing schedule, talk with your doctor.

Oral Semaglutide (Ozempic, Wegovy)

Oral semaglutide (Rybelsus, Wegovy) is a daily pill you’ll take first thing in the morning at least 30 minutes before you eat or drink.

 If you miss a dose, don’t double up. Instead, skip the missed dose and take the next one as usual.

It Takes Months to Reach Your Maximum Dose

You’ll likely ease into this medication by starting off on a low dose of semaglutide, just 0.25 milligrams (mg) for the injection. From there, your doctor will slowly up your dose every month or so, until you reach the recommended maintenance injection dose of 2.4 mg per week. This process typically takes about four months before you hit the maximum recommended dose.

If you’re taking oral semaglutide, the concentration will be higher (up to 25 mg) to make sure enough of the medication survives your digestive process to be effective. You’ll still titrate up your dose over time, though.

The slow increase lessens side effects like nausea, vomiting, constipation, or diarrhea, which may help people stick with their treatment plan.

 But you may not need to wait until you reach your maintenance dose to start reaping semaglutide’s benefits. People may start losing weight within the first few weeks, and the scale starts trending downward in earnest after a month or two.

You May Have Gastrointestinal Side Effects

GI-related side effects are pretty common when starting semaglutide: Around 40 percent of patients report symptoms like nausea and vomiting.

 Many people also experience constipation, diarrhea, stomach pain, heartburn, or frequent burping.

 In published trials, side effects are generally mild and manageable.

“These [issues] occur because semaglutide slows down digestion,” says Jessica Cutler, MD, a weight loss surgeon with the Maryland Bariatric Center at Mercy Medical Center in Baltimore.

Many people find that these symptoms ease up as they reach their maintenance dose.

 Fortunately, there are things that may help you feel more comfortable in the meantime. Dr. Cutler recommends:
  • Eat smaller, more frequent portions.
  • Limit rich or greasy foods, as well as spicy foods.
  • Slow down when eating.

Your Eating Habits Will Change

Don’t be surprised if you notice you’re getting fuller faster or just not feeling that hungry once you start taking semaglutide. The drug slows the rate at which your food is digested, which is one of the ways it helps with weight loss — and in turn, it decreases harmful liver fat.

But eating less overall may raise the risk for nutritional deficiencies. Getting less protein, in particular, can accelerate the loss of lean muscle tissue, which can be an issue for GLP-1 users.

 Because of this, it’s important to make every bite count by prioritizing nutrient-dense foods.

“My recommendations are the same for any patient on these medications: emphasize protein and nonstarchy vegetables in the diet,” says Mir Ali, MD, a board-certified bariatric surgeon and the medical director of MemorialCare Surgical Weight Loss Center in Fountain Valley, California.

When taking semaglutide, try to consume at least 20 to 30 grams of lean protein at each meal (as long as you're not told to limit protein intake by your doctor). This can be from foods like poultry, fish, eggs, beans, soy, or low-fat dairy.

 Also consider eating five or six mini meals instead of three bigger meals, which may help you fit in more nutrients.

Rapid Weight Loss Can Be Unflattering

Even though you’re taking this medication to treat a liver condition, you’ll likely experience weight loss, and it may be fairly drastic. Ultrafast fat loss, which happens often with semaglutide, can leave your body from unwanted places, like your face or butt. These effects result from reduced collagen and elastin, and while they may be unwelcome, they’re not harmful to your health.

This effect will likely stick around as long as your weight loss is maintained, but eating a wholesome diet and getting regular exercise can help you look and feel your best, experts say. Taking steps to support your skin health, like drinking plenty of water, wearing sunscreen, and following a skin-care routine, can also help.

Semaglutide Affects How You Experience Cravings

If you’re accustomed to feeling distracted by intense food cravings, this drug may make those feelings a thing of the past. Research shows that mental food noise drops by nearly fourfold when people start taking semaglutide.

“There is a central effect in the brain that may decrease appetite and food cravings,” explains Dr. Barritt.

Emerging research suggests this effect could extend to other behaviors that give fast, feel-good rewards, too, including alcohol consumption, smoking, recreational drug use, and even uncontrollable shopping behaviors.

In fact, the first randomized controlled trial of semaglutide’s effects on alcohol use showed that people who took the drug experienced fewer alcohol cravings — and actually drank significantly less — than people who were given a placebo.

This effect may be especially valuable when you’re taking semaglutide for MASH, since drinking alcohol makes it harder for your liver to heal.

 Not only can alcohol hinder weight loss, “for MASH patients, alcohol can exacerbate MASH symptoms and progression of the disease,” Dr. Ali says.

You May Need to Use a GLP-1 Indefinitely

Semaglutide isn’t a short-term fix for conditions like obesity and diabetes, and that’s likely also true for MASH. Studies on users who take semaglutide for obesity or diabetes show that their weight and high blood sugar typically return when they stop the drug.

While we don’t yet have good data on what happens when people with MASH stop taking the medication, it’s reasonable to assume that their excess liver fat and scar tissue may come back, even if your MASH is in remission, says Ali.

The bottom line? MASH is a chronic condition that may require lifelong management. “Long-term use of these medications is necessary in most patients,” Ali says.

The Takeaway

  • Semaglutide is FDA-approved to treat MASH and works by supporting weight loss, improving blood sugar control, and reducing liver fat and inflammation.
  • This medication changes how your body and brain respond to food, often reducing hunger, speeding fullness, decreasing cravings, and sometimes even lowering urges for other addictive behaviors. Because appetite drops, it’s important to prioritize protein and nutrient-dense foods to prevent muscle loss and deficiencies.
  • Semaglutide leads to significant weight loss, which can bring gastrointestinal problems and cosmetic changes to your face and body, for better or worse.
  • MASH is a chronic condition, and stopping GLP-1s often reverses progress. Many users will need long-term or indefinite treatment to maintain liver improvements.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. FDA Approves Treatment for Serious Liver Disease Known as ‘MASH’. U.S. Food and Drug Administration. August 15, 2025.
  2. MASH Treatment. American Liver Foundation. June 12, 2025.
  3. Semaglutide Injection. MedlinePlus. August 15, 2025.
  4. Tips for Using Your Wegovy Pen. WeGoTogether. December 2024.
  5. WEGOVY (semaglutide) tablets, for oral use. U.S. Food and Drug Administration. December 2025.
  6. Kommu S et al. Semaglutide. StatPearls. February 11, 2024.
  7. Eldor R et al. Gradual Titration of Semaglutide Results in Better Treatment Adherence and Fewer Adverse Events: A Randomized Controlled Open-Label Pilot Study Examining a 16-Week Flexible Titration Regimen Versus Label-Recommended 8-Week Semaglutide Titration Regimen. Diabetes Care. July 17, 2025.
  8. How Fast Does Semaglutide Kick In? Mayo Clinic. January 7, 2024.
  9. Smits M et al. Safety of Semaglutide. Frontiers in Endocrinology. July 6, 2021.
  10. Gorgojo-Martinez J et al. Clinical Recommendations to Manage Gastrointestinal Adverse Events in Patients Treated with Glp-1 Receptor Agonists: A Multidisciplinary Expert Consensus. Journal of Clinical Medicine. December 24, 2022.
  11. Berg S et al. Discontinuing glucagon-like peptide-1 receptor agonists and body habitus: A systematic review and meta-analysis. Obesity Reviews. April 4, 2025.
  12. Mehrtash F et al. I Am Taking a GLP-1 Weight-Loss Medication — What Should I Know? JAMA Internal Medicine. July 14, 2025.
  13. GLP-1 Diabetes and Weight-Loss Drug Side Effects: "Ozempic Face" and More. Harvard Health Publishing. February 5, 2024.
  14. ‘Ozempic Face’: What It Is and How To Avoid It. Cleveland Clinic. March 5, 2025.
  15. Kapan A et al. Real-World Insights Into Incretin-Based Therapy: Associations Between Changes In Taste Perception And Appetite Regulation In Individuals With Obesity And Overweight: A Cross-Sectional Study. Diabetes, Obesity and Metabolism. June 24, 2025.
  16. O’Keefe J et al. Anti-consumption agents: Tirzepatide and semaglutide for treating obesity-related diseases and addictions, and improving life expectancy. Progress in Cardiovascular Diseases. March-April 2025.
  17. Hendershot C et al. Once Weekly Semaglutide in Adults With Alcohol Use Disorder A Randomized Clinical Trial. JAMA Psychiatry. February 12, 2025.
  18. Zeng J et al. Therapeutic management of metabolic dysfunction associated steatotic liver disease. United European Gastroenterology Journal. January 9, 2024.
  19. Berg S et al. Discontinuing glucagon-like peptide-1 receptor agonists and body habitus: A systematic review and meta-analysis. Obesity Reviews. April 4, 2025.
Meet Our Experts
See Our Editorial PolicyMeet Our Health Expert Network

Diala Alatassi, MD, FACP

Medical Reviewer

Diala Alatassi, MD, is a board-certified obesity medicine specialist who is committed to providing comprehensive, compassionate, and personalized care. By integrating medical expertise with a supportive and motivational approach, Dr. Alatassi fosters a partnership with each patient, guiding them with empathy and respect, to ensure they feel confident and capable of making lasting changes for their overall well-being.

In her free time, she enjoys spending time outdoors with family and friends and traveling.

See full bio
Marygrace Taylor

Marygrace Taylor

Author

Marygrace Taylor is an award-winning freelance health and wellness writer with more than 15 years of experience covering topics including women’s health, nutrition, chronic conditions, and preventive medicine. Her work has appeared in top national outlets like Prevention, Parade, Women’s Health, and O, The Oprah Magazine.

She's also the coauthor of three books: Eat Clean, Stay Lean: The Diet, Prevention Mediterranean Table, and Allergy-Friendly Food for Families. She lives in Philadelphia.

See full bio
See Our Editorial PolicyMeet Our Health Expert Network