Ozempic Dosing for Weight Loss
For weight loss specifically, Ozempic (semaglutide) is not FDA-approved at the doses used for diabetes management; the FDA-approved formulation for weight loss is Wegovy (semaglutide 2.4 mg weekly), which requires a specific titration schedule reaching 2.4 mg weekly as the maintenance dose. 1
FDA-Approved Dosing for Weight Loss
The recommended dosing schedule for semaglutide when used for weight loss is:
- Week 1-4: 0.25 mg subcutaneously once weekly 1, 2
- Week 5-8: 0.5 mg once weekly 1, 2
- Week 9-12: 1.0 mg once weekly 1, 2
- Week 13-16: 1.7 mg once weekly 1, 2
- Week 17 onwards: 2.4 mg once weekly (maintenance dose) 1, 2
The medication should be administered subcutaneously at any time of day, without regard to meals. 2
Critical Distinction: Ozempic vs. Wegovy
Ozempic is FDA-approved only for type 2 diabetes management at maximum doses of 1.0 mg weekly, while Wegovy (semaglutide 2.4 mg) is the FDA-approved formulation specifically for chronic weight management. 1 When prescribing for weight loss in non-diabetic patients, Wegovy at 2.4 mg weekly is the appropriate choice, not Ozempic. 1
Expected Weight Loss Outcomes
With the full 2.4 mg weekly dose:
- Mean weight loss of 14.9-16.0% at 68 weeks 3, 1, 4, 5
- 86.4% of patients achieve ≥5% weight loss 5
- 69.1% achieve ≥10% weight loss 5
- 50.5% achieve ≥15% weight loss 5
Mandatory Lifestyle Interventions
Semaglutide must be combined with:
- Caloric deficit of at least 500 kcal/day below total requirements 1, 2
- Minimum 150 minutes weekly of physical activity 1, 2
- Resistance training to preserve lean body mass 1
- Behavioral counseling and lifestyle modification support 1
Eligibility Criteria
Semaglutide 2.4 mg is indicated for:
- Adults with BMI ≥30 kg/m² (obesity) without additional requirements 1, 2
- Adults with BMI ≥27 kg/m² (overweight) with at least one weight-related comorbidity (hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea, cardiovascular disease) 1, 2
Absolute Contraindications
Do not prescribe semaglutide in patients with:
- Personal or family history of medullary thyroid cancer 3, 1
- Multiple endocrine neoplasia syndrome type 2 (MEN2) 3, 1
- History of severe hypersensitivity reaction to semaglutide 1
Monitoring and Treatment Response
- Assess every 4 weeks during titration for gastrointestinal tolerance, weight loss progress, and blood pressure 1, 2
- Evaluate treatment response at 12-16 weeks on maximum tolerated dose 3, 1
- Discontinue if <5% weight loss after 3 months at therapeutic dose, as early non-responders are unlikely to benefit from continued therapy 3, 1
- After reaching maintenance dose, monitor at least every 3 months for weight stability, cardiovascular risk factors, and medication adherence 1
Common Adverse Effects and Management
Gastrointestinal effects are most common:
- Nausea (44%), diarrhea (32%), vomiting (25%), constipation (23%) 2, 6
- These are typically mild-to-moderate, transient, and decrease over time 6, 5
- Slow titration is the most effective strategy to minimize these symptoms 1, 2
Serious but rare risks include:
- Pancreatitis (causality not definitively established) 3, 1
- Gallbladder disease (cholelithiasis, cholecystitis) 1
Treatment Duration
Semaglutide should be considered lifelong therapy to maintain weight loss. 1, 2 After discontinuation, patients regain significant weight—approximately 11.6% of lost weight within 52 weeks. 1 This highlights that obesity is a chronic disease requiring long-term pharmacological management. 1
Cost Considerations
The average wholesale price is approximately $1,619 per 30-day supply, requiring long-term financial planning and insurance authorization. 3, 1
Additional Cardiovascular Benefits
Beyond weight loss, semaglutide 2.4 mg provides:
- 20% reduction in cardiovascular death, nonfatal MI, or nonfatal stroke (HR 0.80) in patients with obesity and established cardiovascular disease 1
- Improvements in blood pressure, lipid profiles, and inflammatory markers 1, 6
Common Pitfall to Avoid
Do not use Ozempic 1.0 mg (the diabetes formulation) when prescribing for weight loss in non-diabetic patients. The FDA-approved dose for weight management is 2.4 mg weekly (Wegovy), which demonstrates superior efficacy. 1 Using lower doses will result in suboptimal weight loss outcomes.