Wegovy

Wegovy (semaglutide) is a prescription medication that belongs to a class of treatments called GLP-1 receptor agonists — drugs designed to help regulate appetite, improve insulin function, and restore metabolic balance. Approved for adults with obesity or overweight and at least one weight-related condition, Wegovy is one of the most studied and effective non-surgical treatments for chronic weight management. Developed by Novo Nordisk, Wegovy represents a breakthrough in obesity medicine, offering significant and sustained weight loss through its unique GLP-1 receptor agonist mechanism of action.

The medication has demonstrated remarkable weight loss results in clinical trials, with many patients achieving weight loss of 15-20% of their body weight when combined with lifestyle modifications. Wegovy is also approved for the treatment of type 2 diabetes (as Ozempic), making it particularly valuable for patients with both conditions, as it addresses the underlying metabolic dysfunction that contributes to both obesity and diabetes. The medication works by mimicking the naturally occurring hormone glucagon-like peptide-1 (GLP-1), which plays crucial roles in glucose metabolism, appetite regulation, and energy balance. Wegovy has been shown to provide cardiovascular benefits beyond weight loss, including reduced risk of major adverse cardiovascular events in patients with established cardiovascular disease.

Wegovy contains semaglutide, a synthetic version of the natural hormone GLP-1 (glucagon-like peptide-1). This hormone helps control hunger, digestion, and energy use. By mimicking GLP-1 actions, Wegovy slows gastric emptying, enhances satiety signals in the brain, and stabilises blood-sugar levels — helping patients eat less, feel fuller, and gradually lose weight in a controlled and sustainable way.

Semaglutide is a 31-amino acid synthetic peptide that acts as a GLP-1 receptor agonist, binding to and activating GLP-1 receptors throughout the body to provide comprehensive metabolic benefits. The medication is administered as a once-weekly subcutaneous injection using a pre-filled pen device, making it convenient for patients to self-administer at home after proper training. Wegovy has a half-life of approximately 7 days, allowing for sustained therapeutic effects throughout the week and maintaining consistent blood levels of the medication.

The drug is metabolized primarily through proteolytic degradation and is not significantly metabolized by cytochrome P450 enzymes, reducing the risk of drug-drug interactions with many commonly prescribed medications. Clinical studies have shown that Wegovy provides superior glycemic control compared to other diabetes medications, with significant reductions in HbA1c levels and improved time-in-range for patients with type 2 diabetes. The medication has demonstrated cardiovascular benefits in large outcome trials, showing reduced risk of major adverse cardiovascular events in patients with established cardiovascular disease.

This comprehensive approach targets the root biological drivers of obesity and metabolic dysfunction, rather than focusing solely on calorie restriction or willpower, making it a truly disease-modifying treatment approach.

Wegovy is licensed for use in adults with a BMI ≥ 30 kg/m² (obese), or adults with a BMI ≥ 27 kg/m² (overweight) who have at least one weight-related health condition such as type 2 diabetes, high blood pressure, or abnormal cholesterol. It must be prescribed following a clinical consultation — usually through an in-person or telehealth assessment — to ensure it's appropriate for each patient's medical history and goals. Ideal candidates include patients who have struggled with traditional weight loss methods, have metabolic syndrome, or require comprehensive management of both obesity and type 2 diabetes.

Patients with prediabetes may also benefit from Wegovy, as it can help prevent progression to type 2 diabetes while promoting significant weight loss. The medication is particularly effective for patients with central obesity (excess abdominal fat), as it specifically targets visceral fat reduction and improves metabolic parameters. Wegovy may be suitable for patients who have previously tried other weight loss medications with limited success, as it provides superior efficacy compared to many alternatives. Patients with polycystic ovary syndrome (PCOS) and obesity may benefit from Wegovy, as it can help improve insulin resistance and promote weight loss in this population.

The medication is also indicated for patients with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH), as it can help reduce liver fat and improve liver function. Patients who have undergone bariatric surgery but continue to struggle with weight regain may be candidates for Wegovy as an adjunctive therapy. Wegovy may be appropriate for patients with cardiovascular disease or high cardiovascular risk, as it has demonstrated cardioprotective benefits in clinical trials. The medication is particularly beneficial for patients with type 2 diabetes, as it provides both weight loss and glycemic control benefits simultaneously.

Doses are injected under the skin (abdomen, thigh, or upper arm) using an auto-injector with a fine needle that minimizes discomfort. Patients are advised to use Wegovy alongside a balanced diet, regular physical activity, and behavioural support for the best outcomes. The injection pen features a hidden needle design and automatic needle retraction for patient comfort and safety. Patients should receive proper training on injection technique, including site rotation, proper disposal of used pens, and recognition of potential complications.

The medication should be administered at the same time each week to maintain consistent blood levels and therapeutic effects. Patients with diabetes should monitor blood glucose levels closely during the initial weeks of treatment, as Wegovy can significantly lower blood sugar levels. The titration schedule may be adjusted based on individual patient response, tolerability, and healthcare provider assessment. Wegovy pens are available in different dose strengths, and patients should ensure they are using the correct pen for their prescribed dose.

In large STEP clinical trials, participants using Wegovy achieved average weight loss of 15–17% over 68 weeks — significantly greater than with lifestyle intervention alone. These trials also documented major improvements in blood pressure, glucose control, lipid balance, and quality of life. The STEP-1 trial demonstrated that 86% of participants achieved ≥5% weight loss, 69% achieved ≥10% weight loss, and 50% achieved ≥15% weight loss at 68 weeks. In STEP-2, which included patients with type 2 diabetes, participants achieved an average weight loss of 9.6% and HbA1c reduction of 1.6% at 68 weeks.

The STEP-3 trial showed that intensive behavioral therapy combined with Wegovy resulted in 16.0% weight loss over 68 weeks, demonstrating the synergistic effects of combined approaches. Cardiovascular outcomes studies have shown that Wegovy reduces the risk of major adverse cardiovascular events (MACE) by 20% in patients with type 2 diabetes and established cardiovascular disease. Patients experienced significant improvements in waist circumference, body fat percentage, and lean muscle mass preservation, indicating healthy body composition changes. The medication demonstrated superior efficacy compared to placebo in all STEP trials, with consistent and sustained weight loss results.

Long-term follow-up studies have shown that weight loss is sustained for up to 2 years with continued treatment, with minimal weight regain when therapy is maintained. Quality of life assessments using validated questionnaires showed significant improvements in physical functioning, mental health, and overall well-being scores. The medication has shown particular effectiveness in patients with severe obesity (BMI ≥35), with some achieving weight loss exceeding 20% of their initial body weight. Real-world evidence from post-marketing studies confirms the clinical trial results, with similar efficacy and safety profiles observed in routine clinical practice. Wegovy has demonstrated superior efficacy compared to other weight loss medications, including orlistat and phentermine-topiramate combinations.

Most side effects are gastrointestinal and tend to lessen as the body adjusts, typically occurring during the first 4-8 weeks of treatment. Common effects include: Nausea (20-25% of patients) - usually mild to moderate and improves with continued use; Vomiting (8-12% of patients) - typically occurs early in treatment and resolves; Diarrhoea (15-20% of patients) - may be related to delayed gastric emptying; Constipation (10-15% of patients) - can be managed with increased fluid intake and fiber; Abdominal pain and bloating (8-12% of patients) - usually transient; Decreased appetite (15-20% of patients) - expected therapeutic effect; Fatigue or dizziness in early weeks (6-10% of patients) - may be related to caloric restriction; Injection site reactions (3-6% of patients) - mild redness, itching, or swelling.

Less common but serious risks (requiring medical review) include: Acute pancreatitis (rare, <0.1%) - characterized by severe abdominal pain radiating to the back; Gallbladder disease (1-2% of patients) - including cholelithiasis and cholecystitis; Acute kidney injury (rare) - particularly in patients with pre-existing kidney disease; Hypoglycemia (in patients with diabetes) - especially when combined with insulin or sulfonylureas; Diabetic retinopathy complications (rare) - in patients with pre-existing diabetic retinopathy; Allergic reactions (rare) - including anaphylaxis and angioedema; Medullary thyroid carcinoma (MTC) - seen only in animal studies, not reported in humans.

Contraindications and precautions: Wegovy is not suitable for people with a personal or family history of medullary thyroid carcinoma or MEN-2 syndrome. Patients with severe gastroparesis should use caution due to delayed gastric emptying effects. Those with pancreatitis history should be monitored closely, as GLP-1 agonists may increase risk. Patients with severe kidney impairment (eGFR <30 mL/min/1.73m²) should use with caution. The medication should be used cautiously in patients with severe liver disease due to limited data. Pregnancy and breastfeeding: Not recommended due to insufficient safety data in these populations.

Treatment should be reviewed regularly (typically every 3–6 months), with more frequent monitoring during the initial titration period. Clinicians assess: Weight and waist-to-height ratio - target weight loss of 5-10% within first 6 months; Blood-pressure and glucose levels - monitor for improvements in metabolic parameters; Side-effect tolerance - assess gastrointestinal symptoms and overall tolerability; Psychological wellbeing and lifestyle adherence - evaluate quality of life and treatment satisfaction; Laboratory parameters - including HbA1c, lipid profile, liver function tests, and kidney function; Cardiovascular risk factors - monitor blood pressure, heart rate, and cardiovascular symptoms; Injection technique and site rotation - ensure proper administration and prevent complications.

Specific monitoring recommendations: Baseline assessment - comprehensive medical history, physical examination, and laboratory workup; 4-week follow-up - assess tolerability and consider dose titration; 12-week evaluation - comprehensive assessment of efficacy and safety; 6-month review - long-term efficacy and safety assessment; Annual monitoring - comprehensive health assessment and treatment optimization. Patient self-monitoring includes: Daily weight tracking - using a consistent scale and time of day; Blood glucose monitoring - for patients with diabetes; Symptom diary - tracking side effects and overall well-being; Lifestyle adherence - monitoring diet, exercise, and behavioral changes. Ongoing supervision ensures safe, effective, and sustainable results while allowing for treatment optimization based on individual response.

Clinical studies confirm that Wegovy: Promotes sustained weight loss and metabolic improvement with significant efficacy in obesity treatment; reduces risk of type 2 diabetes progression and may prevent diabetes in high-risk individuals; improves cardiovascular outcomes and heart health with demonstrated MACE reduction; supports better liver and hormonal function including NAFLD/NASH improvement; enhances quality of life and long-term health outcomes across multiple validated measures.

Key clinical trial evidence: STEP-1 (n=1,961) - 14.9% weight loss vs 2.4% placebo at 68 weeks; STEP-2 (n=1,210 with T2D) - 9.6% weight loss and 1.6% HbA1c reduction; STEP-3 (n=611) - 16.0% weight loss with intensive behavioral therapy; STEP-4 (n=902) - sustained weight loss maintenance over 68 weeks. Real-world evidence: Post-marketing studies confirm clinical trial efficacy and safety profiles; superior patient adherence compared to daily medications due to weekly dosing; cost-effectiveness demonstrated in health economic analyses; broad applicability across diverse patient populations and comorbidities.

Regulatory approvals and guidelines: FDA approved for chronic weight management and type 2 diabetes treatment; EMA approved for similar indications in European markets; included in major clinical practice guidelines for obesity and diabetes management; recommended by professional societies including ADA, EASD, and AACE.