What is the indication for Wegovy (semaglutide) in adults with a high body mass index (BMI) and weight-related conditions such as type 2 diabetes, high blood pressure, or high cholesterol?

Wegovy (Semaglutide 2.4 mg) Indication

Wegovy is FDA-approved 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 type 2 diabetes, hypertension, or dyslipidemia, and must be used as an adjunct to a reduced-calorie diet and increased physical activity. 1, 2, 3

Primary FDA-Approved Indications

Weight Management Criteria

• Adults with BMI ≥30 kg/m² qualify for Wegovy without any additional requirements 1, 2
• Adults with BMI ≥27 kg/m² qualify if they have at least one weight-related comorbid condition including:
  • Type 2 diabetes mellitus 1, 2, 3
  • Hypertension (high blood pressure) 1, 2, 3
  • Dyslipidemia (high cholesterol) 1, 2, 3
  • Obstructive sleep apnea 1
  • Cardiovascular disease 1

Cardiovascular Risk Reduction (2024 FDA Approval)

• Wegovy is approved to reduce the risk of cardiovascular death, heart attack, and stroke in adults with obesity or overweight AND established cardiovascular disease 4
• This indication applies to patients aged ≥45 years with BMI ≥27 kg/m² who have prior myocardial infarction, stroke, peripheral arterial disease, or history of revascularization 4
• In the SELECT trial of 17,600+ participants, major cardiovascular events occurred in 6.5% of Wegovy-treated patients versus 8% in placebo, representing a 20% risk reduction 4, 1

Required Lifestyle Interventions

Wegovy is NOT a standalone treatment—it must be combined with specific lifestyle modifications: 1, 2, 3

• Reduced-calorie diet: Minimum 500-kcal reduction below daily requirements 1
• Physical activity: Minimum 150 minutes per week of exercise 1
• Resistance training: To preserve lean body mass during weight loss 1
• Behavioral counseling: Structured lifestyle modification support 1

Dosing and Administration

• Route: Once-weekly subcutaneous injection in abdomen, thigh, or upper arm 1, 5, 3
• Maintenance dose: 2.4 mg weekly (patients unable to tolerate may use 1.7 mg) 1, 6
• Titration schedule: Start at 0.25 mg weekly and escalate over 16 weeks to reach 2.4 mg 1

Absolute Contraindications

Do NOT prescribe Wegovy if the patient has: 1, 5

• Personal or family history of medullary thyroid cancer 1, 5
• Multiple endocrine neoplasia syndrome type 2 (MEN2) 1, 5
• History of severe hypersensitivity reaction to semaglutide 1

Expected Weight Loss Outcomes

• Mean weight loss: 14.9-15.8% at 68 weeks in clinical trials 1, 6, 7
• Clinically significant response rates at 68 weeks: 7
  • ≥5% weight loss: 86.4% of patients
  • ≥10% weight loss: 69.1% of patients
  • ≥15% weight loss: 50.5% of patients
  • ≥20% weight loss: 38.5% of patients 1
• Real-world data: Mean weight loss of 20.4% at 24 months when combined with WeGoTogether support program 8

Treatment Duration and Discontinuation Criteria

• Long-term use is necessary: Weight regain of 11.6% occurs within 52 weeks after stopping 1, 9
• Evaluate response at 12-16 weeks: If weight loss is <5% after 3 months at therapeutic dose, discontinue and consider alternatives 1, 9
• Lifelong treatment is typically required to maintain weight loss and cardiovascular benefits 1, 9

Common Pitfalls to Avoid

• Do not prescribe for cosmetic weight loss alone—FDA approval requires obesity or overweight with comorbidities 1, 2
• Do not use in patients with type 1 diabetes—Wegovy is not approved for diabetes treatment 1
• Do not combine with other GLP-1 receptor agonists or DPP-4 inhibitors due to overlapping mechanisms 1
• Do not ignore peri-operative aspiration risk—discontinue 3 weeks before elective surgery due to delayed gastric emptying 1