Can Ozempic (semaglutide) be used for weight loss?

Ozempic (Semaglutide) for Weight Loss

Yes, semaglutide (Ozempic) is effective for weight loss and was FDA approved for obesity treatment in 2021 at a dose of 2.4 mg weekly under the brand name Wegovy, though Ozempic (approved for diabetes) is commonly used off-label for weight loss. 1

Efficacy of Semaglutide for Weight Loss

• Semaglutide works by mimicking GLP-1, acting on the hypothalamus to suppress appetite, delay gastric emptying, increase insulin release, decrease glucagon secretion, and increase pancreatic β-cell growth 1
• In the STEP 1 trial, participants without diabetes achieved mean weight loss of 14.9% at 68 weeks compared to 2.4% with placebo 1, 2
• In the STEP 3 trial, when combined with intensive behavioral therapy and initial low-calorie diet, semaglutide produced 16.0% mean weight loss versus 5.7% with placebo 1, 3
• Long-term data from the STEP 5 trial showed sustained weight loss of 15.2% over 104 weeks (2 years) with semaglutide versus 2.6% with placebo 4
• Semaglutide has demonstrated the largest weight loss of any FDA-approved obesity medication to date 5

Clinical Benefits Beyond Weight Loss

• Semaglutide treatment is associated with improvements in:
  • Cardiovascular risk factors 2
  • Physical functioning 2
  • Heart failure-related symptoms in patients with preserved ejection fraction 1
• The SELECT study showed that in participants with cardiovascular disease and BMI ≥27 without diabetes, semaglutide reduced the composite incidence of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke (hazard ratio 0.80) 1
• Meta-analyses show GLP-1 receptor agonists decrease risk of cardiovascular events in adults with overweight or obesity without diabetes 1

Important Considerations for Use

• Semaglutide must be used in conjunction with lifestyle changes (reduced-calorie diet and physical activity) for optimal results 1
• Weight regain occurs after discontinuation, suggesting long-term use is necessary:
  • In follow-up studies, participants regained 11.6% of lost weight within 52 weeks after stopping treatment 1
  • In the STEP 4 trial, participants who switched to placebo after 20 weeks regained 6.9% of lost weight 1
• Gastrointestinal adverse events are common (nausea, vomiting, diarrhea, constipation):
  • Reported in 82.8% of semaglutide users versus 63.2% with placebo in STEP 3 3
  • Generally mild-to-moderate and transient 2
  • Treatment discontinuation due to GI events occurs in approximately 3.4-4.5% of patients 3
• Semaglutide is contraindicated in patients with personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 1

Dosing and Administration

• For obesity treatment, semaglutide is dosed at 2.4 mg subcutaneously once weekly (under brand name Wegovy) 1, 6
• Ozempic (semaglutide for diabetes) is commonly used off-label for weight loss but at lower doses than approved for obesity 1
• Gradual dose titration is recommended to mitigate gastrointestinal side effects 1

Insurance and Access Considerations

• Medicare currently excludes coverage of FDA-approved antiobesity medications for obesity alone 1
• Medications for weight loss can be costly and global shortages currently exist, especially for GLP-1 receptor agonists 1
• When prescribed off-label (using Ozempic for weight loss rather than Wegovy), insurance coverage may be restricted to FDA-approved indications 1

Comparison to Other Weight Loss Options

• Semaglutide produces greater weight loss than liraglutide (another GLP-1 receptor agonist) with lower rates of gastrointestinal adverse events 1
• Tirzepatide (a dual GIP/GLP-1 receptor agonist) shows even greater weight loss than semaglutide (20.9% at highest dose versus 15% with semaglutide) 1
• For patients who cannot access or tolerate GLP-1 receptor agonists, alternatives include phentermine (short-term use only), metformin (modest 3% weight loss), or other FDA-approved options 1