Wegovy (Semaglutide) Prescription BMI Criteria
Wegovy (semaglutide) can be prescribed for adults with a BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity.
BMI Thresholds for Wegovy Prescription
Wegovy (semaglutide 2.4 mg) is FDA-approved for chronic weight management in:
- Adults with BMI ≥30 kg/m² (obesity)
- Adults with BMI ≥27 kg/m² who have at least one weight-related comorbid condition 1, 2
Weight-Related Comorbidities That Qualify
When prescribing Wegovy for patients with BMI ≥27 kg/m², at least one of these conditions should be present:
- Hypertension
- Type 2 diabetes
- Dyslipidemia
- Cardiovascular disease
- Sleep apnea
- Nonalcoholic fatty liver disease
Treatment Expectations and Monitoring
Efficacy
Semaglutide 2.4 mg has demonstrated superior weight loss compared to other anti-obesity medications:
- Mean weight loss of 14.9% from baseline at 68 weeks (vs. 2.4% with placebo) 3
- 86.4% of patients achieve ≥5% weight loss 3
- 69.1% achieve ≥10% weight loss 3
- 50.5% achieve ≥15% weight loss 3
Monitoring Requirements
- Evaluate response after 12 weeks on the maintenance dose
- If a patient has not lost at least 5% of baseline body weight, discontinue Wegovy as it is unlikely to achieve clinically meaningful weight loss 1
- Continued use requires ongoing evaluation of benefit vs. risk
Special Considerations
Comparison to Other GLP-1 Receptor Agonists
Semaglutide 2.4 mg demonstrates greater efficacy than liraglutide 3.0 mg:
- 15.8% vs. 6.4% mean weight reduction in direct comparison studies 4
- Higher proportion of patients achieving ≥10% weight loss (70.9% vs. 25.6%) 4
Ethnic Considerations
In East Asian populations, semaglutide 2.4 mg weekly showed:
- 13.2% mean weight reduction (vs. 2.1% with placebo) 5
- 83% of patients achieved ≥5% weight loss 5
- 40% reduction in abdominal visceral fat area 5
Common Pitfalls and Caveats
Discontinuation Criteria: Failure to discontinue therapy when patients don't achieve ≥5% weight loss after 12 weeks on the maintenance dose wastes resources and exposes patients to unnecessary side effects 1.
Long-Term Therapy: Weight regain is common when medication is withdrawn. Patients should understand that Wegovy may require long-term use to maintain weight loss 1.
Gastrointestinal Side Effects: Nausea and diarrhea are common but typically transient. Gradual dose titration helps mitigate these effects 3, 1.
Concurrent Lifestyle Modifications: Wegovy should always be prescribed as an adjunct to diet and physical activity interventions, not as a standalone treatment 1.
Pregnancy Considerations: Wegovy is contraindicated in pregnancy and women of reproductive potential should use effective contraception 1.