What is the suitability and usage of Wegovy (semaglutide) for weight management in adults with a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher with at least one weight-related condition?

Wegovy (Semaglutide 2.4 mg) for Weight Management

Wegovy is highly suitable and FDA-approved for adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related condition, delivering superior weight loss of 14.9-16.0% at 68 weeks when combined with lifestyle modifications. 1, 2, 3

Patient Eligibility Criteria

You should prescribe Wegovy if your patient meets either of these criteria:

• BMI ≥30 kg/m² without any additional requirements 4, 5
• BMI ≥27 kg/m² with at least one weight-related comorbidity including type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease 1, 4

Absolute contraindications that prohibit use:

• Personal or family history of medullary thyroid cancer 1, 4
• Multiple endocrine neoplasia syndrome type 2 (MEN2) 1, 4
• Pregnancy or breastfeeding 6

Dosing and Administration

Follow this exact titration schedule to minimize gastrointestinal side effects:

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

Administer as a subcutaneous injection once weekly on the same day each week, regardless of meals. 1, 4

Expected Weight Loss Outcomes

Wegovy delivers clinically significant weight loss that exceeds all other approved anti-obesity medications except tirzepatide:

• Mean weight loss of 14.9-16.0% at 68 weeks compared to 2.4-5.7% with placebo 1, 2, 3
• 86.4% of patients achieve ≥5% weight loss 2
• 69.1% achieve ≥10% weight loss 2
• 50.5% achieve ≥15% weight loss 2
• Long-term data shows sustained weight loss of 20.4% at 24 months in real-world settings with patient support programs 7

Weight loss is consistently greater in non-diabetic patients (14.9-17.4%) compared to those with diabetes (4-6.2%). 4

Required Lifestyle Modifications

Wegovy must be combined with these specific interventions—medication alone is insufficient:

• Reduced-calorie diet: 500-kcal deficit below daily requirements 4
• Physical activity: Minimum 150 minutes per week 1, 2
• Resistance training: Essential to preserve lean body mass during weight loss 4
• Behavioral counseling: 30 counseling visits over 68 weeks in clinical trials 3

Cardiovascular Benefits Beyond Weight Loss

Wegovy provides proven cardiovascular protection in patients with established cardiovascular disease:

• 20% reduction in cardiovascular death, nonfatal MI, or nonfatal stroke (HR 0.80,95% CI 0.72-0.90) in patients with BMI ≥27 and cardiovascular disease 4
• Approved by FDA to reduce cardiovascular events in adults with obesity or overweight AND established cardiovascular disease 4
• Cardioprotective mechanisms include improved myocardial substrate utilization, anti-inflammatory effects, reduced ischemia injury, and improved lipid profiles 4

Common Side Effects and Management

Gastrointestinal effects occur in 84.1% of patients but are typically mild-to-moderate and transient:

• Nausea: Most common, occurs in 18-40% of patients 4
• Diarrhea: Occurs in 12% of patients 4
• Vomiting: Occurs in 8-16% of patients 4
• Constipation and abdominal pain: Also common 4

Mitigation strategies that reduce side effects:

• Slow titration over 16 weeks minimizes gastrointestinal symptoms 1, 4
• Reduce meal size and avoid large portions 4
• Limit alcohol and carbonated beverages 4
• Side effects typically decrease over time with continued exposure 4

Treatment discontinuation due to gastrointestinal events occurs in only 4.5% of patients. 2

Serious but Rare Risks Requiring Monitoring

Monitor for these serious adverse events at every visit:

• Pancreatitis: Reported in clinical trials, though causality not definitively established 4
• Gallbladder disease: Including cholelithiasis and cholecystitis 1, 4
• Acute kidney injury: Requires monitoring in patients with renal disease 4

Discontinue immediately if persistent severe abdominal pain occurs. 4

Treatment Duration and Weight Maintenance

Wegovy requires lifelong use to maintain weight loss—this is critical for patient counseling:

• After cessation, patients regain 11.6% of lost weight within 52 weeks 1
• Sudden discontinuation results in regain of one-half to two-thirds of weight loss within 1 year 4
• Weight loss plateaus around 68 weeks but is sustained with continued treatment 2, 3

Monitoring Schedule

Follow this exact monitoring protocol:

During titration (first 16 weeks):

• Assess every 4 weeks for gastrointestinal tolerance, weight loss progress, and blood pressure 4

After reaching maintenance dose:

• Monitor at least every 3 months for weight stability, cardiovascular risk factors, blood pressure, and medication adherence 4

Treatment response evaluation at 12-16 weeks:

• If weight loss <5% after 3 months at therapeutic dose, discontinue and consider alternatives 4
• Early responders (≥5% weight loss after 3 months) should continue long-term 4

Concomitant Medication Adjustments

Make these specific medication changes when initiating Wegovy:

• Reduce insulin by 20% to prevent hypoglycemia 4
• Discontinue or reduce sulfonylureas by 50% due to hypoglycemia risk 4
• Do not combine with other GLP-1 receptor agonists or DPP-4 inhibitors 4
• Monitor blood pressure closely as antihypertensive requirements may decrease with weight loss 4

Special Populations and Considerations

No dose adjustment required for renal impairment across all CKD stages, including eGFR <30 mL/min/1.73 m². 4, 6

For patients with type 2 diabetes, Wegovy offers dual benefits of weight loss and improved glycemic control with HbA1c reductions of approximately 1.4-1.48%. 1, 4

For patients with NAFLD/NASH, semaglutide shows robust evidence with 59% achieving NASH resolution at lower doses. 4

Perioperative Management

Discontinue Wegovy at least 3 weeks (three half-lives) before elective surgery requiring anesthesia due to delayed gastric emptying and aspiration risk. 4

Retained gastric contents persist even after extended fasting, with 24.2% of semaglutide users showing increased residual gastric content versus 5.1% of controls. 4

Cost Considerations

Average wholesale price is approximately $1,557-$1,619 per 30-day supply, requiring long-term financial planning and insurance authorization. 4

Payors should cover evidence-based obesity treatments to reduce barriers to treatment access. 4

Comparative Efficacy

Wegovy demonstrates superior weight loss compared to liraglutide 3.0 mg:

• Semaglutide 2.4 mg: 15.8% weight loss 8
• Liraglutide 3.0 mg: 6.4% weight loss 8
• Treatment difference: 9.4 percentage points (95% CI -12.0 to -6.8, P<0.001) 8

Tirzepatide 15 mg weekly achieves superior weight loss of 20.9% at 72 weeks, but Wegovy remains preferred for patients with established cardiovascular disease due to proven cardiovascular outcome benefits. 4