Indications for Semaglutide for Weight Reduction
Semaglutide 2.4 mg weekly is indicated for chronic weight management in adults with BMI ≥30 kg/m² (obesity) or BMI ≥27 kg/m² (overweight) with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia, and must be used as an adjunct to reduced-calorie diet and increased physical activity. 1, 2, 3
Primary Indications
BMI Criteria
- BMI ≥30 kg/m² (obesity) regardless of comorbidities qualifies for semaglutide treatment 1, 2, 4
- BMI ≥27 kg/m² (overweight) with at least one weight-related comorbidity is required for treatment 1, 2, 3
Required Weight-Related Comorbidities (for BMI 27-29.9 kg/m²)
Mandatory Lifestyle Modifications
Semaglutide must be prescribed in conjunction with lifestyle interventions—it is not a standalone therapy. 1, 4
- Reduced-calorie diet is required 1, 2, 3
- Increased physical activity is mandatory 1, 2, 3
- Resistance training should be incorporated to preserve lean body mass 1
- Patients must understand this is likely lifelong therapy, as significant weight regain (11.6% of lost weight) occurs after cessation 1
Special Populations with Enhanced Benefit
Patients with Cardiovascular Disease
- Semaglutide 2.4 mg provides additional cardiovascular benefit beyond weight loss in patients with established cardiovascular disease and BMI ≥27 kg/m² 1
- The SELECT trial demonstrated 20% reduction in composite cardiovascular death, nonfatal MI, or nonfatal stroke (HR 0.80) 1
- Prioritize semaglutide in patients with both obesity and cardiovascular disease due to proven cardiovascular risk reduction 1
Patients with Type 2 Diabetes
- Semaglutide offers dual benefits of weight loss and improved glycemic control in diabetic patients 1
- Note that weight loss is typically lower in patients with diabetes (4-6.2%) compared to non-diabetic patients (6.1-17.4%) 1
Absolute Contraindications
Do not prescribe semaglutide in the following situations: 1, 2
- Personal history of medullary thyroid cancer 1, 2
- Family history of medullary thyroid cancer 1, 2
- Multiple endocrine neoplasia syndrome type 2 (MEN2) 1, 2
Dosing and Administration Requirements
- Start at 0.25 mg weekly for 4 weeks 1
- Titrate to 0.5 mg weekly for 4 weeks 1
- Increase to 1.0 mg weekly for 4 weeks 1
- Advance to 1.7 mg weekly for 4 weeks 1
- Maintenance dose: 2.4 mg weekly after 16 weeks of titration 1
- Administered as subcutaneous injection once weekly 1, 2
- Slow titration is essential to minimize gastrointestinal side effects 1
Important Clinical Considerations
Monitoring Requirements
- Monitor for gastrointestinal side effects, particularly during dose escalation 1
- Monitor blood pressure as weight loss may necessitate antihypertensive medication adjustment 1
- Watch for signs of pancreatitis (persistent severe abdominal pain) 1
- Monitor for gallbladder disease symptoms 1
- Assess thyroid function if clinically indicated 1
Common Pitfalls to Avoid
- Do not use semaglutide with other GLP-1 receptor agonists or DPP-4 inhibitors 1
- Exercise caution when combining with insulin or insulin secretagogues due to hypoglycemia risk 1
- If 3 or more consecutive doses are missed, restart the titration schedule 1
- Counsel patients about perioperative risk: GLP-1 receptor agonists may increase pulmonary aspiration risk under anesthesia even with extended fasting 1
Expected Outcomes
- Mean weight loss of 14.9% at 68 weeks (compared to 2.4% with placebo) 1, 4
- 86.4% of patients achieve ≥5% weight loss 4
- 69.1% achieve ≥10% weight loss 4
- 50.5% achieve ≥15% weight loss 4