Can I start injecting Wegovy (semaglutide) for weight loss in an adult patient with a body mass index (BMI) of 30 or higher, or 27 or higher with at least one weight-related condition?

Can You Start Wegovy (Semaglutide 2.4mg)?

Yes, you can start Wegovy if you have a BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity (such as hypertension, type 2 diabetes, or dyslipidemia), provided you have no contraindications. 1, 2

Eligibility Criteria

You must meet these BMI thresholds: 1

• BMI ≥30 kg/m² (obesity) without additional conditions, OR
• BMI ≥27 kg/m² (overweight) with at least one weight-related comorbidity including:
  • Type 2 diabetes
  • Hypertension
  • Dyslipidemia
  • Obstructive sleep apnea
  • Cardiovascular disease 1, 2

Absolute Contraindications - Do NOT Start If:

You have any of the following: 1, 2, 3

• Personal or family history of medullary thyroid cancer 1, 2, 3
• Multiple endocrine neoplasia syndrome type 2 (MEN2) 1, 2, 3
• Pregnancy or breastfeeding 1
• Known hypersensitivity to semaglutide 3

Pre-Treatment Screening Required

Before starting, evaluate for: 1, 2

• History of pancreatitis (use with caution if present) 1, 2
• History of cholelithiasis/gallbladder disease (use with caution) 1, 2
• Severe gastroparesis or GI motility disorders 1, 2
• Current medications that promote weight gain (consider alternatives) 2
• Renal function (no dose adjustment needed, but monitor for dehydration risk) 3

Dosing Schedule - Follow This Exact Titration

Start low and titrate slowly over 16 weeks to minimize gastrointestinal side effects: 1, 2, 4

• Weeks 1-4: 0.25 mg subcutaneously once weekly 1, 2, 4
• Weeks 5-8: 0.5 mg once weekly 1, 2, 4
• Weeks 9-12: 1.0 mg once weekly 1, 2, 4
• Weeks 13-16: 1.7 mg once weekly 1, 2, 4
• Week 17 onward: 2.4 mg once weekly (maintenance dose) 1, 2, 4

Inject subcutaneously in abdomen, thigh, or upper arm at any time of day, without regard to meals. 3

Mandatory Lifestyle Interventions

Wegovy MUST be combined with: 1, 2, 4

• Caloric deficit of 500 kcal/day below daily requirements 1, 2, 4
• Minimum 150 minutes/week of physical activity 1, 2
• Resistance training to preserve lean body mass 2
• Behavioral counseling for sustained lifestyle changes 1, 2

Expected Weight Loss Outcomes

At 68 weeks, expect: 2, 5, 6

• Mean weight loss of 14.9-16.0% of initial body weight (vs. 2.4-5.7% with placebo) 2, 5, 6
• 86.4% of patients achieve ≥5% weight loss 5
• 69.1% achieve ≥10% weight loss 5
• 50.5% achieve ≥15% weight loss 5

Common Side Effects and Management

Gastrointestinal effects are most common (typically mild-to-moderate and transient): 1, 2, 5

• Nausea (44%) - reduce meal size, avoid high-fat foods 1, 2
• Diarrhea (32%) - limit alcohol and carbonated drinks 1
• Vomiting (25%) - slow titration helps 1, 2
• Constipation (23%) - increase fiber and hydration 1

Serious but rare risks requiring monitoring: 1, 2

• Pancreatitis (monitor for persistent severe abdominal pain) 1, 2
• Gallbladder disease (cholelithiasis, cholecystitis) 1, 2
• Acute kidney injury from dehydration (monitor hydration status) 2

Monitoring Schedule

During titration (first 16 weeks): 2, 4

• Every 4 weeks: Assess weight, gastrointestinal tolerance, blood pressure 2, 4
• If diabetic: Monitor blood glucose more closely to prevent hypoglycemia 4

After reaching maintenance dose: 2

• Every 3 months minimum: Weight, blood pressure, cardiovascular risk factors 2
• Evaluate treatment response at 12-16 weeks on maximum tolerated dose 2

When to Discontinue

Stop Wegovy if: 1, 2

• Weight loss <5% after 12 weeks at maximum tolerated dose 1
• Significant safety or tolerability issues emerge 2
• Development of contraindications (e.g., pregnancy, medullary thyroid cancer diagnosis) 1, 2

Critical Long-Term Considerations

This is lifelong therapy: 2

• Weight regain occurs after stopping - patients regain 50-67% of lost weight within 1 year of discontinuation 2
• Plan for indefinite treatment to maintain weight loss and health benefits 2
• Cost is approximately $1,600 per month - verify insurance coverage before starting 2

Additional Cardiovascular Benefits

Beyond weight loss, Wegovy provides: 2

• 20% reduction in cardiovascular death, nonfatal MI, or nonfatal stroke (HR 0.80) in patients with obesity and established cardiovascular disease 2
• Improvements in blood pressure, lipid profiles, and inflammation markers 2, 5

Special Surgical Considerations

If surgery is planned: 2

• Discontinue Wegovy at least 3 weeks before elective surgery requiring anesthesia due to delayed gastric emptying and aspiration risk 2
• Gastric ultrasound may be considered pre-operatively to assess residual gastric contents 2