What tests are needed for a patient with hypertension (High Blood Pressure), hyperlipidemia (High Lipid Levels) and gastroesophageal reflux disease (GERD) on Wegovy (Semaglutide) for weight loss after 6 months?

Follow-Up Testing for Patient on Wegovy at 6 Months

At 6 months of Wegovy therapy, you should obtain fasting lipid panel, fasting glucose or hemoglobin A1c, blood pressure measurement, liver function tests, and body weight/BMI to assess treatment efficacy and monitor for improvement in obesity-related comorbidities. 1

Core Metabolic Monitoring

Weight Loss Assessment

• Measure body weight and calculate BMI to determine if patient has achieved ≥5% weight loss, which produces clinically meaningful improvements in cardiometabolic risk factors 1, 2
• Evaluate treatment efficacy at this 6-month timepoint, as guidelines recommend assessment at 12-16 weeks on maximum tolerated dose, and you are now well past that threshold 3
• If weight loss is less than 4-5% at 16 weeks on maximum tolerated dose, consider discontinuing therapy per GLP-1 receptor agonist guidelines 3

Cardiovascular Risk Factor Monitoring

• Fasting lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides) to assess for improvement in dyslipidemia, as GLP-1 receptor agonists demonstrate cardioprotective effects through improved lipid profiles 1, 3
• Blood pressure measurement to evaluate hypertension control, as even modest weight loss of 3-5% produces clinically meaningful reductions in blood pressure 1
• Fasting plasma glucose and/or hemoglobin A1c to screen for prediabetes (fasting glucose 100-125 mg/dL, A1c 5.7-6.4%) and assess for improvement in glucose metabolism 1

Hepatic Assessment

• Liver function tests (ALT, AST) to monitor for improvement in nonalcoholic fatty liver disease, which commonly improves with weight loss 1
• Weight loss has been shown to decrease ALT by 9 U/L and AST by 3 U/L in patients using weight loss interventions 1

Additional Monitoring Considerations

Waist Circumference

• Measure waist circumference as central obesity is an independent risk factor for mortality, and weight loss interventions reduce waist circumference by an average of 4.1 cm 1
• This is particularly important given your patient's metabolic syndrome components (hypertension, hyperlipidemia) 1

Metabolic Syndrome Screening

• Assess for metabolic syndrome criteria: waist circumference ≥88 cm (women) or ≥102 cm (men), triglycerides ≥150 mg/dL, fasting glucose ≥100 mg/dL, blood pressure ≥130/85 mm Hg, HDL-C <40 mg/dL (men) or <50 mg/dL (women) 1
• Your patient already has 2 components (hypertension, hyperlipidemia), making this assessment critical 1

Clinical Decision Points

Treatment Continuation

• Continue Wegovy if patient has achieved ≥5% weight loss, as this threshold produces significant cardiometabolic benefits 2
• Expected weight loss with semaglutide at 6 months is approximately 13-15% in real-world settings 4, 5
• Consider discontinuation if <4-5% weight loss at 16 weeks on maximum tolerated dose, extrapolating from liraglutide guidelines for GLP-1 receptor agonists 3

Long-Term Planning

• Emphasize that long-term use is necessary to maintain weight loss benefits, as discontinuation leads to rapid weight regain 3, 2
• Continue monitoring for gastrointestinal adverse events (nausea, diarrhea, vomiting, constipation), which are the most common side effects 3, 6

GERD-Specific Consideration

• Reassess GERD symptoms, as gastroesophageal reflux disease improves with weight loss 1
• Note that semaglutide causes delayed gastric emptying, which could theoretically affect GERD, though weight loss benefits typically outweigh this concern 7