Weight loss medications, including injectable options, can be a valuable tool for individuals who have found it challenging to achieve a healthier weight through traditional methods like diet and exercise alone. However, these medications are not a one-size-fits-all solution, and specific qualifications must be met to ensure their safe and effective use. This article explores the criteria for weight loss injections, including factors like BMI, health conditions, and commitment to lifestyle changes. It also discusses the different types of weight loss injections available, their effectiveness, potential side effects, and other considerations.
Who Is Eligible for Weight Loss Injections?
Several key factors determine whether an individual is a suitable candidate for weight loss injections. These factors generally include body mass index (BMI), the presence of weight-related health conditions, and a willingness to commit to long-term lifestyle changes.
BMI and Weight-Related Health Conditions
Typically, adults with a body mass index (BMI) of 30 or higher, classifying them as obese, may qualify for weight loss medications. Individuals with a BMI of 27 or higher who also have weight-related health conditions - such as type 2 diabetes, high blood pressure, or sleep apnea - may also be eligible.
Commitment to Lifestyle Changes
In addition to meeting BMI and health criteria, candidates should be committed to making long-term lifestyle changes that include healthy eating, physical activity, and behavior modification. Weight loss medications are most effective when combined with a comprehensive approach to weight management. All weight loss medications work best in the context of a healthy eating plan and exercise.
Contraindications
Certain groups of people are generally not eligible for weight loss medications. These include individuals who are pregnant, planning to become pregnant, or breastfeeding. Additionally, individuals with specific health conditions, such as uncontrolled thyroid disorders, a history of medullary thyroid cancer, gallbladder disease, pancreatitis, multiple endocrine neoplasia syndrome type 2 (MEN2), or certain types of heart disease, may not be suitable candidates.
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Types of Weight Loss Injections
The pharmacological treatment of obesity is a fast-changing landscape, and care providers must strive continuously to stay current. 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. Several weight loss injections are currently available, each with its mechanism of action, dosage, and potential side effects.
Semaglutide (Wegovy, Ozempic)
Semaglutide belongs to a class of medications known as glucagon-like peptide-1 receptor agonists, or GLP-1 RAs. It mimics the GLP-1 hormone, 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.
But 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.
Wegovy is a brand name for semaglutide, a GLP-1 receptor agonist. It was FDA-approved in 2021. It is administered as an injection and approved for use in adults and children aged 12 years or more with obesity (BMI ≥30 for adults, BMI ≥ 95th percentile for age and sex for children) or some adults with excess weight (BMI ≥27) who also have weight-related medical problems.
The dose must be increased gradually over 16 to 20 weeks to arrive at the 2.4 mg dosage. This progression can help to alleviate side effects, which include gastrointestinal symptoms, headache, dizziness, and fatigue. It is intended to be used indefinitely, in combination with a healthy diet and exercise.
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Ozempic may be a more familiar name to some patients. Semaglutide is also approved to lower blood sugar levels in adults with type 2 diabetes mellitus, in addition to diet and exercise.
Effectiveness of Semaglutide
There have been several anti-obesity medications that help suppress appetite and achieve weight loss. But semaglutide performs on a new level. 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. 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.
Side Effects of Semaglutide
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, and stomach issues (including nausea, vomiting, pain, or distension). Gastrointestinal issues are the most common complaint among people just starting semaglutide. But you may be able to reduce the side effects by beginning on a lower dose and then slowly increasing the amount you take.
Liraglutide (Saxenda, Victoza)
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.
Tirzepatide (Zepbound, Mounjaro)
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.
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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. Tirzepatide is a dual GIP and GLP-1 receptor agonist that suppresses appetite, improves satiety, and supports metabolic health. In addition to impressive weight loss, studies show improvements in cardiovascular risk factors and metabolic markers.
Mounjaro is indicated for type 2 diabetes. The guidelines for tirzepatide (Zepbound) and semaglutide (Wegovy) state that a patient should have a BMI of 30 or a BMI of 27 with weight-related health problems.
Other Weight Loss Medications
While the focus here is on weight loss injections, it's worth noting other available options, including oral medications.
Phentermine
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.
Phentermine-Topiramate (Qsymia)
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. Those approved by the FDA for long-term use include phentermine-topiramate (Qsymia)
Naltrexone-Bupropion (Contrave)
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. Those approved by the FDA for long-term use include naltrexone-bupropion (Contrave)
Orlistat (Xenical, Alli)
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. Those approved by the FDA for long-term use include orlistat (Xenical, Alli), The only over-the-counter medicine for weight loss currently approved by the FDA is Alli (orlistat).
Setmelanotide
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
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 Treatment Plan
FDA-approved anti-obesity medications (AOMs) are safe, evidence-based therapies that target specific physiology to improve the disease and are most effective when used as part of a comprehensive treatment plan. A treatment plan for obesity can comprise multiple forms of treatment, including medications, diet, exercise, and/or surgery.
Lifestyle Modifications
All weight loss medications work best in the context of a healthy eating plan and exercise. The fundamentals of obesity management will always be changes to diet and exercise.
Addressing Metabolic Adaptation
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.
Cost and Insurance Coverage
While the availability of weight loss medications has expanded in recent years, insurance coverage can vary widely. More employers are beginning to recognize the benefits of supporting employees’ weight management efforts, particularly as it can lead to improved overall health and reduced healthcare costs. Insurance coverage varies and will affect many patients’ choices about going on weight loss medications. 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.
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.
Risks of Compounded Medications and Online Pharmacies
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).
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