Is Wegovy (semaglutide) a viable option for weight loss in a patient with a BMI of 47.2 and a history of gastric sleeve removal due to complications?

From the Guidelines

Wegovy (semaglutide) is a viable option for weight loss in a patient with a BMI of 47.2 and a history of gastric sleeve removal due to complications, as it has been shown to be effective in promoting significant weight loss in adults with obesity. This medication, administered as a once-weekly subcutaneous injection, is FDA-approved for chronic weight management in adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related comorbidity 1. The recommended dosing schedule starts at 0.25 mg weekly for the first month, then increases monthly (0.5 mg, 1 mg, 1.7 mg) until reaching the maintenance dose of 2.4 mg weekly.

For this specific patient, Wegovy may be particularly beneficial since surgical options have been exhausted due to previous complications. Semaglutide works by mimicking GLP-1, a hormone that regulates appetite and food intake, helping patients feel fuller longer and consume fewer calories. The medication's mechanism doesn't rely on the altered gastrointestinal anatomy that would have been present with the gastric sleeve, making it pharmacologically appropriate for this patient. However, thorough evaluation of the patient's current gastrointestinal function, reason for sleeve removal, and other medical conditions is essential before initiating therapy to ensure there are no contraindications to GLP-1 receptor agonist treatment.

Some key points to consider when using Wegovy for weight loss in this patient include:

• Monitoring for potential side effects such as nausea, vomiting, and pancreatitis 1
• Gradual dose titration to mitigate adverse effects 1
• Evaluation of the patient's current gastrointestinal function and medical conditions to ensure no contraindications to GLP-1 receptor agonist treatment
• Combination with lifestyle modifications, including dietary changes and physical activity, to enhance weight loss and improve overall health 1

Overall, Wegovy (semaglutide) is a suitable option for weight loss in this patient, and its use should be considered in conjunction with lifestyle modifications and careful monitoring for potential side effects 1.

From the FDA Drug Label

Semaglutide lowers fasting and postprandial blood glucose and reduces body weight. All pharmacodynamic evaluations were performed after 12 weeks of treatment (including dose escalation) at steady state with semaglutide 1 mg.

Wegovy (semaglutide) may be a viable option for weight loss in a patient with a BMI of 47.2 and a history of gastric sleeve removal due to complications.

• The patient has already been tried on Ozempic with limited weight loss and is now on Wegovy.
• Key considerations for the use of Wegovy in this patient include:
  • The patient's history of gastric sleeve removal and potential impact on absorption or efficacy of semaglutide.
  • The patient's current weight and BMI, and potential for semaglutide to reduce body weight.
  • The patient's previous experience with Ozempic and potential for similar or improved efficacy with Wegovy.

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From the Research

Patient's Situation

The patient has a BMI of 47.2 and weighs 348 lbs, with a history of gastric sleeve removal due to complications. The patient was previously tried on Ozempic with limited weight loss and is now on Wegovy.

Effectiveness of Wegovy

• Wegovy (semaglutide) has been shown to be effective in promoting weight loss in patients with obesity, including those without type 2 diabetes 3, 4.
• A study found that semaglutide resulted in a mean weight loss of 10.3% at 6 months in patients with weight recurrence after sleeve gastrectomy 5.
• Another study demonstrated that semaglutide was effective in achieving weight loss in post-bariatric patients with weight regain or insufficient weight loss, with a total weight loss of -6.0% at 3 months and -10.3% at 6 months 6.

Options to Help BMI

• Semaglutide (Wegovy) is a viable option for weight loss in patients with a high BMI, including those with a history of bariatric surgery 6, 5.
• Lifestyle intervention, including diet and exercise, is also essential for achieving and maintaining weight loss 4.
• Other treatment options, such as tirzepatide, may also be effective in managing weight recurrence after sleeve gastrectomy, with a mean weight loss of 15.5% at 6 months 5.

Considerations

• The patient's history of gastric sleeve removal and limited weight loss with Ozempic should be taken into account when considering treatment options 7.
• The potential benefits and risks of semaglutide, including gastrointestinal adverse events, should be carefully evaluated 4.
• Regular monitoring and follow-up are necessary to assess the effectiveness of treatment and make adjustments as needed 6, 5.