Semaglutide for Weight Loss: Who Qualifies and How to Maximize Your Results

The search for effective and safe weight loss treatments can feel endless. Semaglutide, a groundbreaking medication in the weight-management space, has emerged as a potential solution for individuals struggling with obesity. It's important to remember that obesity is heterogenous, chronic, and complex, requiring lifelong treatment that’s not one size fits all. Semaglutide is not a miracle drug, and it’s not for everyone.

What is Semaglutide?

Semaglutide belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. These medications mimic the GLP-1 hormone, which is released in the gut in response to eating. One role of GLP-1 is to prompt the body to produce more insulin, which reduces blood sugar (glucose). For that reason, health care providers have used semaglutide for more than 15 years to treat Type 2 diabetes. Semaglutide has shown remarkable efficacy in helping individuals lose weight and maintain a healthier lifestyle.

GLP-1 in higher amounts also interacts with the parts of the brain that suppress your appetite and signal you to feel full. When used in conjunction with diet and exercise, it can cause significant weight loss - and a reduced risk of cancer, diabetes, and heart disease - in people who are obese or overweight.

Brand Names and Off-Label Use

Currently, semaglutide is only approved for weight loss under the brand name Wegovy. The typical dose for weight loss is 2.4 milligrams, administered weekly as subcutaneous (under the skin) self-injections.

But as interest in semaglutide for weight loss continues to grow, health care professionals are finding ways to manage the demand. Many prescribe other brands of semaglutide, such as Ozempic and Rybelsus, off-label (using a drug that is FDA-approved for a different reason). Many people use semaglutide off-label to help manage weight. The demand has become so high, that now there is a shortage for people who need this medication to help manage their diabetes. Ozempic is approved to lower blood sugar levels in adults with type 2 diabetes mellitus, in addition to diet and exercise.

Who is Eligible for Semaglutide for Weight Loss?

Semaglutide may not be suitable for everyone. Individuals with certain medical conditions or characteristics may not be eligible to take semaglutide. Determining whether someone is a candidate for weight loss medications begins with BMI. For each individual case, the doctor and patient should discuss the patient’s current health issues, other medications, and family medical history.

The FDA recommends Wegovy for weight loss if you meet one of the following criteria:

Have a body mass index (BMI) of 30kg/m2 or greater.
Have a BMI of 27kg/m2 or greater and at least one weight-related condition, such as high blood pressure, Type 2 diabetes, or high cholesterol.
Pediatric patients aged 12 years and older with an initial BMI at the 95th percentile or greater for age and sex.

When to Avoid Semaglutide

Avoid semaglutide if you have:

History of medullary thyroid cancer
History of gallbladder disease
History of pancreatitis
Multiple endocrine neoplasia syndrome type 2 (MEN2)

The Importance of Consulting a Healthcare Provider

If you’re considering semaglutide for weight loss, your first step should be consulting your primary care physician (PCP). They know your personal and family medical history and can guide you in the best treatment for your condition. Your doctor will also look at your full health history, including past and current medical conditions, family history, previous weight loss attempts, and medications.

Many online services now offer quick prescriptions for GLP-1s. Many direct-to-consumer brands don’t have full access to a patient’s medical history.

With prescription medications, a healthcare professional can weigh all factors affecting the patient’s lifestyle and BMI and monitor progress and side effects.

How Effective is Semaglutide for Weight Loss?

There have been several anti-obesity medications that help suppress appetite and achieve weight loss. But semaglutide performs on a new level. The average weight loss varies from 5% to 21%, with some people losing more and some people losing less.

An early study of 2,000 obese adults compared people using semaglutide plus a diet and exercise program with people who made the same lifestyle changes without semaglutide. After 68 weeks, half of the participants using semaglutide lost 15% of their body weight, and nearly a third lost 20%. Participants who incorporated only lifestyle changes lost about 2.4% of their weight. In the SURMOUNT-1 trial, adults with obesity or overweight (without diabetes) taking tirzepatide achieved up to 22.5% average body weight reduction at 72 weeks.

Since then, additional studies have shown similar results. But they’ve also revealed that participants tend to regain the weight lost when they stop taking semaglutide. Most people regain weight if AOMs are discontinued. AOMs may counter the effects of metabolic adaptation and prevent weight regain. After weight reduction, the body metabolically adapts, often causing an increase in hunger hormones and a decrease in satiety hormones and resting metabolic rate, all of which can contribute to weight regain.

Semaglutide 2.4 mg reduces the risk of major adverse cardiovascular events by 20% in adults with overweight or obesity in the SELECT trial.

Read also: Transformations with Ozempic

The Role of Lifestyle Changes

The fundamentals of obesity management will always be changes to diet and exercise. But having anti-obesity medications is another tool in the toolbox - depending on the person’s clinical history. All weight loss medications work best in the context of a healthy eating plan and exercise.

All the clinical trials that showed these medications working also included education on eating and exercise.

Potential Side Effects of Semaglutide

GLP-1s have been extensively studied and are considered safe when prescribed and monitored by a healthcare provider. The side effects of semaglutide are typically mild - especially when compared to the complications associated with overweight and obesity.

People taking semaglutide for weight loss may experience:

Dizziness
Fatigue
Gastrointestinal issues, such as diarrhea, constipation, and gassiness
Headache
Stomach issues, including nausea, vomiting, pain, or distension (bloat)

Gastrointestinal issues are the most common complaint among people just starting semaglutide. One lesser-known side effect? GLP-1s slow food moving through the intestines. It tells your brain it’s not hungry. But you may be able to reduce the side effects by beginning on a lower dose and then slowly increasing the amount you take.

How to Take Semaglutide

GLP-1 medications are typically taken as a once-weekly injection. You use a small needle to inject the medication into fatty tissue - usually in your belly, thighs, arms, or upper buttocks.

Semaglutide injections for weight loss: Currently, semaglutide is only approved for weight loss under the brand name Wegovy. The typical dose for weight loss is 2.4 milligrams, administered weekly as subcutaneous (under the skin) self-injections.

Cost and Coverage Considerations

GLP-1s are notoriously costly. The Kaiser Family Foundation estimates the annual net price of Wegovy at $13,600 and are not covered by insurance. Insurance coverage varies and will affect many patients’ choices about going on weight loss medications.

High annual costs and high demand for semaglutide have left payers struggling with how to cover the drug while minding budget consequences.

Some online healthcare providers claim to sell Ozempic, Wegovy, or Zepbound at reduced prices. However, the FDA warns against buying medications from any source other than a state-licensed pharmacy. In April 2025, they banned the sale of “counterfeit” semaglutide and tirzepatide. These medications are not made or packaged by the original manufacturers. Instead, they are compounded medications. Compounded versions of medications are made by compounding pharmacies, often to tailor a medication to specific patient needs, like an allergy to an inactive ingredient. Compounded medications are not FDA-approved due to shortages. Some patients have taken these alternatives, which are generally more affordable, without ill effects. has received 520 reports of adverse events associated with compounded semaglutide and 480 reports of adverse events associated with compounded tirzepatide (as of April 30, 2025).

The Future of Weight Loss Medications

With fervent consumer demand for weight loss medications, combined with rising obesity rates, more medications are bound for the market in the coming years. Pharmaceutical platform Ozmosi predicts one to two GLP-1 launches annually starting in 2026 specifically for obesity.

Lilly is developing at least two new options. The first, orforglipron, is an oral GLP-1 inhibitor that completed a Phase 3 clinical trial in early 2025. It could provide a welcome alternative for people who do not want injections. Phase 3 results expected soon. at 36 weeks. The other, retatrutide, targets GLP-1, GIP, and glucagon. At this writing, it is in Phase 3 clinical trials. In Phase 2, participants lost up to 24.2% of body weight at 48 weeks.

Amgen is developing MariTide, a monoclonal antibody designed to increase GLP-1 receptor activity while reducing GIP receptor activity. The once-monthly injection entered Phase 3 clinical trials in March 2025. Researchers continue to study hormones that play a role in appetite for other ways to target obesity with medication. Those of interest include not only GLP-1, but also peptide tyrosine-tyrosine (PYY) and cholecystokinin (CCK). With more options available, doctors will be increasingly able to personalize treatments.

Other Weight Loss Medications

Some weight loss medications have been on the market for many years, and new ones emerge frequently. It can be easy to overlook first-generation AOMs, but these may be appropriate for some patients, especially when cost is a factor.

Zepbound is approved to treat obesity in adults with a BMI of 30 or greater. It is both a GLP-1 and a GIP receptor agonist. Like semaglutide, it works by reducing appetite and is meant to be used in combination with diet and exercise to lose weight.
Liraglutide is a daily injectable medication that acts on hormones that send signals from the gut to the brain to make the patient feel full quicker and decrease hunger signals. Doses start at 0.6 mg to 3 mg a day. Some patients may lose 5-10% of body weight, especially with the higher dose of liraglutide. Liraglutide is also approved for Type 2 Diabetes, under the brand name Victoza. Side effects include nausea, diarrhea, constipation, vomiting, headache, decreased appetite, dyspepsia, fatigue, dizziness, abdominal pain, increased lipase, and renal insufficiency.
Phentermine is the oldest and most widely used weight loss medication. It was originally used as a short-term medication to jump-start weight loss, but now newer medical guidelines have added it to long-term therapy. Side effects include headache, overstimulation, high blood pressure, insomnia, rapid or irregular heart rate, and tremor.
Topiramate can be combined with phentermine to decrease appetite and cravings. Adults with migraines and obesity are good candidates for this weight-loss medication. Some patients may lose an average of 5-10% of body weight. Daily doses with four strengths start at 3.75 mg/23 mg to 15 mg/92 mg. Side effects include abnormal sensations, dizziness, altered taste, insomnia, constipation, and dry mouth.
Naltrexone-bupropion combines an opioid receptor antagonist with an antidepressant to affect the pleasure-reward areas of the brain and thereby decrease cravings and appetite. Start with a daily dose of one 8/90 mg tablet and gradually increase to four tablets a day. The most common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea.
Orlistat is a lipase inhibitor that comes in a capsule. Undigested fat is then passed through the body. Some patients may lose about 5% of their body weight. An over-the-counter formulation is available at 60 mg capsules with each fat-containing meal. The only over-the-counter medicine for weight loss currently approved by the FDA is Alli (orlistat). Other over-the-counter products are considered supplements.
Setmelanotide is a melanocortin-4 receptor agonist indicated for chronic weight management in adult and pediatric patients six years and older, with obesity due to certain rare genetic disorders.
Plenity is a medical device rather than a medication, Plenity was FDA-cleared in 2019 for people with a BMI of 25 to 40. It consists of a capsule that releases a biodegradable, super-absorbent hydrogel into the stomach. The gel helps to increase satiety, enabling the person to eat less.

The Importance of a Comprehensive Approach

Semaglutide can help you lose weight, but they aren’t a magic fix. There is a potential to regain the lost weight, but those chances decrease when you work with a healthcare provider to transition off the medication safely. It is intended to be used indefinitely, in combination with a healthy diet and exercise.

A treatment plan for obesity can comprise multiple forms of treatment, including medications, diet, exercise, and/or surgery. The pharmacological treatment of obesity is a fast-changing landscape, and care providers must strive continuously to stay current. Before 2012, there were few weight loss medications approved by the FDA. In the 2020s, glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) exploded in popularity and media attention. Next came a dual receptor agonist, Mounjaro, which is indicated for type 2 diabetes, and Zepbound, which is indicated for obesity. adults took a GLP-1 for weight loss in 2024. With a growing selection of weight loss medications available, patients may ask what the strongest or most effective weight loss prescription medication is, and which one is best for them. The answer is complicated, and newer is not always better.

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