Semaglutide for Weight Loss: What You Should Know
Medically reviewed by Lindsay Cook, PharmD
Semaglutide is a drug that’s available in several different products, including Ozempic and Wegovy, both injectable medications. It belongs to the drug class known as glucagon-like peptide-1 (GLP-1) agonists, which work by telling your body to produce insulin after you eat. This helps keep your blood sugar levels stable.
Wegovy is approved for weight loss use alongside a reduced-calorie diet and increased exercise in adults with a body mass index (BMI) greater than 27–30, or children 12 and older with a higher-than-average BMI for their age and sex. Wegovy is also approved to reduce the risk of serious heart problems in adults with obesity or who are overweight.
This article will discuss the uses of semaglutide for weight loss, how it works, the differences between semaglutide products, dosing, and more.
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Semaglutide for Weight Loss
Semaglutide is a GLP-1 agonist, which mimics GLP-1, a hormone your body produces naturally. GLP-1 causes your body to release insulin, suppresses your appetite, and makes you feel full for longer. These actions together can help lead to weight loss.
Wegovy is approved for the following indications:
Adults with a BMI of 30 or greater
Adults with a BMI of 27 or greater if the individual also has a weight-related condition like high blood pressure, type 2 diabetes, or a lipid disorder
Children 12 years or older with a BMI in the 95th percentile or greater for their age and sex
Off-Label Use of Ozempic for Weight Loss
Because Ozempic and Wegovy both contain the drug semaglutide, Ozempic may also help with weight loss, but this use would be considered off-label. Ozempic is primarily meant to treat high blood sugar levels associated with type 2 diabetes.
Off-label means a drug is prescribed for a purpose other than those it is approved to treat. Ozempic does not have U.S. Food and Drug Administration (FDA) approval for weight loss, but it may still contribute to weight loss for many people.
Ozempic would most likely be a preferred drug in people who have type 2 diabetes and are overweight but not yet obese, with a BMI between 25 and 29.9.
About BMI
Body mass index (BMI) is a dated, flawed metric. It does not take into account factors such as body composition, ethnicity, sex, race, and age. Even though BMI is a biased measure, the medical community still uses it widely because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.
How Effective Is Semaglutide?
Average weight loss at 68 weeks after starting Wegovy was 15.8%. These results came not only from the administration of the medication but from adding exercise and diet improvements as well.
The results of this study align with the results of clinical trials that these drugs underwent before approval as well.
In the study, people with obesity or those who were overweight and also had at least one comorbidity (such as high blood pressure, type 2 diabetes, or lipid disorders) took Wegovy for 68 weeks. Wegovy decreased weight in these individuals by an average of 14.9%.
What to Know About the Side Effects
Some mild and common side effects of semaglutide include nausea, vomiting, diarrhea, constipation, or abdominal pain.
Potential serious side effects include:
Acute pancreatitis, or inflammation of the pancreas
Hypoglycemia, or blood sugar levels that are too low
Acute kidney injury
Complications of diabetic retinopathy in people with type 2 diabetes
Increased heart rate
Thoughts of suicide
Pancreatitis and gallbladder problems may feel similar to more common, less serious stomach-related side effects of these medications, such as the abdominal pain listed above. If your symptoms do not lessen or they seem severe, let your healthcare provider know right away.
Safety Warnings
All semaglutide products, including Wegovy and Ozempic, come with a boxed warning (the FDA’s strictest warning label) regarding thyroid C-cell tumors.
This is because GLP-1 agonists have been found to cause these tumors in rats and mice. The risk in humans is unknown, but you shouldn’t take semaglutide if you have a personal or family history of thyroid cancer.
Semaglutide Dosing for Weight Loss
This table summarizes the differences and similarities in how exactly Ozempic and Wegovy are taken.
Ozempic | Wegovy | |
Available strengths and pen sizes | Single-dose pens containing doses of 0.25 mg, 0.5 mg, 1 mg, and 2 mg. A new pen will be used for each dose each week. | Single-dose pens containing doses of 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, and 2.4 mg. A new pen will be used for each dose each week. |
Recommended dosing | Week 1-4: 0.25 mg weekly | Week 1-4: 0.25 mg weekly Week 5 8: 0.5 mg weekly Week 9-12: 1 mg weekly Week 13-16: 1.7 mg weekly Week 17 on: 2.4 mg weekly |
Available generically | No | No |
Dosing for children and adolescents | Not approved for children or adolescents younger than 18 years. | Approved for 12 years and older, with the same goal maintenance dose of 2.4 mg weekly. May reduce to 1.7 mg weekly if 2.4 mg is not tolerated. |
Wegovy vs. Ozempic: Dosing for Ozempic's Off-Label Use
As the above table notes, Wegovy and Ozempic have similar dosing, but they are not the same. They are not interchangeable products. If you're prescribed Ozempic off-label for weight loss, your healthcare provider may slightly alter the approved dosing to fit your situation based on their experience and expertise.
Who Would Benefit From Semaglutide?
The following are the FDA-approved criteria for using Wegovy. People who fit these criteria are considered to be the most likely to benefit from the medication:
Adults with a BMI of 30 or greater
Adults with a BMI of 27 or greater if the individual also has a weight-related condition like high blood pressure, type 2 diabetes, or a lipid disorder
Children 12 years and older with an initial BMI at the 95th percentile or greater for age and sex (obesity)
That said, additional positive outcomes are possible beyond weight loss.
One clinical trial called the STEP 5 trial compared weight loss with other measurements after 104 weeks of either 2.4 milligrams of semaglutide or a placebo once weekly, plus behavioral modifications, including diet and exercise improvements. The study population included adults who met the above criteria.
Outcomes included:
Waist circumference decreased by 14.4 centimeters (cm) in the semaglutide group compared to 5.2 cm in the placebo group.
Systolic blood pressure decreased by 5.7 millimeters of mercury (mmHg) in the semaglutide group compared to 1.6 mmHg in the placebo group.
Lipid levels also saw stronger positive adjustments in the semaglutide group compared to those in the placebo group.
This study demonstrates that adults who meet the FDA-approved indications for semaglutide treatment will likely benefit from the medication in multiple ways, especially if they incorporate diet and exercise improvements into their treatment regimen.
Takeaway
In 2024, the FDA approved Wegovy to reduce the risk of serious heart problems in adults with obesity or who are overweight. Wegovy should be used in addition to a reduced-calorie diet and increased physical activity.
Other Ways to Manage Weight
Drug administration is not the sole way you should go about maintaining healthy body composition. As shown in the clinical trials for these drugs, results are much better if exercise and an improved diet are added.
The STEP 5 trial included dietitian counseling on adherence to a reduced-calorie diet (a 500-calorie-per-day decrease from baseline at the beginning of the trial) plus 150 minutes per week of increased physical activity such as walking.
The National Diabetes Prevention Program, or National DPP, is a national effort spanning public and private organizations that offers programs and education to help prevent type 2 diabetes as well as obesity across the United States.
Many habits and lifestyle choices promote a healthy overall body composition and blood sugar levels. Making these changes is what the DPP aims to help you accomplish by teaching you how to:
Eat healthy without giving up all the foods you love
Add physical activity to your life in convenient ways that you enjoy
Deal with stress in healthy ways
Cope with challenges that can derail your hard work—like how to choose healthy food when eating out
Get back on track if you start to stray from your plan
The world of nutrition can feel complicated, especially if you’re trying to make many lifestyle changes at once. As part of a care plan with your primary healthcare provider, it can help to consult a registered dietitian (RD), nutritionist, or even a certified diabetes care and education specialist (CDCES). They can help make it easier to eat healthy and understand different interventions that aid in weight loss.
Summary
GLP-1 agonists like semaglutide and available products such as Ozempic and Wegovy have become extremely popular in recent years.
These medications can have a significant impact on weight management, especially for individuals with co-occurring conditions like high blood pressure, type 2 diabetes, and lipid disorders. However, GLP-1 agonists are most effective when combined with diet improvements and increased physical activity.
Read the original article on Verywell Health.
