What is the recommended treatment plan for an adult patient with obesity using Wegovy (semaglutide)?

Patient Instructions for Wegovy (Semaglutide) for Obesity

What Wegovy Is and How It Works

Wegovy is a once-weekly injection that helps you lose weight by reducing your appetite, slowing stomach emptying, and helping you feel full longer. 1 The medication works on your brain's hunger centers and digestive system to help you eat less and maintain weight loss when combined with diet and exercise. 1

Who Should Use Wegovy

You may be prescribed Wegovy if you have: 1

• A BMI of 30 or higher (obesity), OR
• A BMI of 27 or higher with at least one weight-related health problem like high blood pressure, high cholesterol, or type 2 diabetes

How to Take Wegovy

Injection Schedule and Dose Escalation

You will start at a low dose and gradually increase over 16-20 weeks to reach the full maintenance dose of 2.4 mg weekly. 1 This slow increase helps minimize stomach side effects. 1, 2

Standard dosing schedule: 1

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

How to Inject

• Inject under the skin (subcutaneously) in your abdomen, thigh, or upper arm 1
• Inject once weekly on the same day each week 1
• You can take it with or without food 1

If You Miss Doses

• If you miss 1-2 doses: Take your next dose as soon as you remember, then continue your regular schedule 1
• If you miss 3 or more doses: Contact your doctor, as you may need to restart the gradual dose increase to avoid stomach problems 1

What to Expect

Weight Loss Results

Most people lose 14-15% of their body weight after 68 weeks (about 16 months) on Wegovy. 2, 3, 4 For example, if you weigh 200 pounds, you might lose about 30 pounds. 4

• About 86% of people lose at least 5% of their body weight 4
• About 69% lose at least 10% of their body weight 4
• About 50% lose at least 15% of their body weight 4

Weight loss continues with longer use, with people losing 15-20% of body weight after 2 years. 5, 6

Timeline for Results

• At 6 months: Average 13-14% weight loss 5
• At 12 months: Average 17-18% weight loss 5
• At 18-24 months: Average 20% weight loss 5, 6

Important: This Is Long-Term Treatment

You must continue taking Wegovy to maintain your weight loss. 1, 2 Studies show that people regain about 11-12% of their lost weight within one year after stopping the medication. 1, 2 Think of this medication like treatment for high blood pressure—it works as long as you take it. 1

Required Lifestyle Changes

Wegovy only works when combined with diet and exercise—the medication alone is not enough. 1, 2, 4

Diet Requirements

• Reduce your daily calories by 500 calories below what you normally eat 1
• Eat smaller meals (the medication will help you feel full faster) 1
• Limit alcohol and carbonated beverages, which can worsen stomach side effects 1

Exercise Requirements

• Get at least 150 minutes of physical activity per week (about 30 minutes, 5 days per week) 1, 2
• Include resistance training (weight lifting) to preserve muscle mass while losing weight 1

Common Side Effects

Stomach and Digestive Problems (Very Common)

Nausea, diarrhea, vomiting, and constipation are the most common side effects, affecting most people. 2, 3, 4 These are usually mild to moderate and improve over time, especially with the gradual dose increase. 2, 3, 4

To minimize stomach problems: 1

• Eat smaller meals
• Avoid fatty, greasy, or spicy foods
• Stay hydrated
• Limit alcohol and carbonated drinks
• Take the medication on the same day each week

These side effects typically decrease after the first few months. 3, 4

When to Call Your Doctor Immediately

Stop taking Wegovy and call your doctor right away if you have: 1, 2

• Severe abdominal pain that doesn't go away (possible pancreatitis)
• Severe nausea and vomiting that prevents you from keeping down food or liquids
• Pain in the upper right side of your stomach (possible gallbladder problems)
• Yellowing of skin or eyes
• Signs of allergic reaction: rash, itching, swelling, severe dizziness, trouble breathing

Serious Risks and Contraindications

DO NOT Use Wegovy If You Have:

Wegovy is absolutely contraindicated if you or any family member has ever had: 1, 2

• Medullary thyroid cancer
• Multiple Endocrine Neoplasia syndrome type 2 (MEN2)

Use With Caution If You Have:

• History of pancreatitis (inflammation of the pancreas) 1
• Gallbladder disease 1, 2
• Kidney problems 1
• Diabetic eye disease (retinopathy) 1
• Depression or suicidal thoughts 1

Important Warnings

Surgery and Anesthesia Risk

If you need surgery, you must stop Wegovy at least 3 weeks (21 days) before the procedure. 1 The medication slows stomach emptying, which increases the risk of food coming back up during anesthesia, even if you haven't eaten. 1 Tell your surgeon and anesthesiologist that you take Wegovy. 1

Pregnancy and Breastfeeding

Stop Wegovy at least 2 months before trying to get pregnant. 1 Do not use Wegovy if you are pregnant or breastfeeding. 1

Drug Interactions

Tell your doctor about all medications you take, especially: 1

• Insulin or diabetes medications (your doses may need to be reduced to prevent low blood sugar)
• Blood pressure medications (may need adjustment as you lose weight)
• Oral contraceptives (may be less effective; use backup contraception for 4 weeks after starting or increasing dose)

Monitoring and Follow-Up

Regular Check-Ups Required

You will need to see your doctor: 1

• Every 4 weeks during the first 4 months while increasing your dose
• Every 3 months after reaching your maintenance dose to check your progress and adjust other medications as needed

What Your Doctor Will Monitor

• Weight and BMI 1
• Blood pressure (often improves with weight loss, may need to reduce blood pressure medications) 1
• Blood sugar (if you have diabetes) 1
• Signs of gallbladder problems or pancreatitis 1

When Treatment May Be Stopped

Your doctor may recommend stopping Wegovy if: 1, 2

• You lose less than 5% of your body weight after 3-4 months at the full dose
• You have serious side effects that don't improve
• You become pregnant

Additional Health Benefits

Beyond weight loss, Wegovy may provide: 1, 3, 4

• Improved blood pressure
• Better cholesterol levels
• Reduced risk of heart attack and stroke (if you have heart disease)
• Better blood sugar control (if you have diabetes)
• Improved physical function and quality of life

Cost and Insurance

• Wegovy costs approximately $1,600 per month without insurance 1
• Many insurance plans require prior authorization 1
• Patient assistance programs may be available through the manufacturer 1
• This is a long-term medication, so plan for ongoing costs 1

Key Takeaways

✓ Start low, go slow: Gradual dose increases over 16-20 weeks minimize side effects 1, 2

✓ Expect substantial weight loss: Most people lose 14-20% of body weight over 1-2 years 2, 3, 4, 5

✓ Combine with lifestyle changes: Diet (500-calorie deficit) and exercise (150 minutes/week) are required 1, 2

✓ Plan for long-term use: Weight returns when you stop the medication 1, 2

✓ Stomach side effects are common but temporary: Nausea and diarrhea usually improve after a few months 2, 3, 4

✓ Stop 3 weeks before surgery: Critical to prevent aspiration risk during anesthesia 1

✓ Regular monitoring required: See your doctor every 3 months once on maintenance dose 1