Wegovy

Wegovy (semaglutide) is a once-weekly injection for weight management. It copies GLP-1, a gut hormone that signals fullness to your brain and slows how quickly your stomach empties. It is authorised across the EU and is prescribed by licensed doctors when clinically appropriate.

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What it is

Wegovy contains the active ingredient semaglutide, an EU-authorised prescription medicine, authorised for use in the EU since 6 January 2022 under EMA marketing authorisation EMEA/H/C/005422. Because Wegovy is centrally authorised, one EU authorisation covers all 27 member states. It carries the same active substance as Ozempic but a different authorised indication and a different dose ladder. Wegovy is authorised for:

• Weight management in adults with a BMI of 30 kg/m² or more, alongside a reduced-calorie diet and increased physical activity
• Weight management in adults with a BMI of 27 to under 30 kg/m² who also have a weight-related health condition
• Weight management in adolescents aged 12 and over with obesity and a body weight above 60 kg

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How it works

Semaglutide is a once-weekly GLP-1 receptor agonist. It binds to GLP-1 receptors on neurons in the hypothalamic arcuate nucleus and the brainstem (nucleus tractus solitarius), the regions that integrate peripheral energy-status signals. Activation of these receptors promotes the release of pro-opiomelanocortin (POMC) and suppresses agouti-related peptide (AgRP) — the two key neuropeptide populations that respectively suppress and drive appetite. The net effect is reduced caloric intake without conscious effort. Semaglutide is a close copy of GLP-1, the hormone your gut releases after you eat, sharing about 94% of its structure — which is why it fits the same docking points on cells, though built to last much longer in the body (a single amino-acid substitution and a fatty-acid side chain extend its half-life to about one week). It also slows gastric emptying, which contributes to earlier satiety after meals, and stimulates glucose-dependent insulin secretion, which is why it carries a low risk of hypoglycaemia in people without diabetes.

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Dose schedule

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How to inject it

Wegovy is injected just under the skin (subcutaneous) — not into a vein or muscle. Do not shake the pen.

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What the studies reported

STEP 1, the peer-reviewed pivotal trial (DOI 10.1056/NEJMoa2032183, ClinicalTrials.gov NCT03548935), was a randomised, double-blind, placebo-controlled trial conducted at 129 sites in 16 countries. A total of 1,961 adults with a BMI of 30 or more (or 27 or more with at least one weight-related complication) and without diabetes were assigned in a 2:1 ratio to once-weekly subcutaneous semaglutide 2.4 mg (n=1,306) or placebo (n=655) for 68 weeks, plus lifestyle intervention in both groups. The coprimary end points were the percentage change in body weight and the proportion of participants losing at least 5% of baseline weight. The primary estimand assessed effects regardless of treatment discontinuation or rescue interventions — an intention-to-treat approach that reflects real-world persistence. Overall, 94.3% of participants completed the trial, 91.2% had a body-weight measurement at week 68, and 81.1% adhered to treatment. The trial did not follow weight after the 7-week off-drug washout, so it provides no controlled data on longer-term maintenance when semaglutide is discontinued.

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Managing side effects

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Who it is not suitable for

Semaglutide is contraindicated in people with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN 2) because GLP-1 receptor agonism can promote C-cell proliferation; preclinical studies in rodents showed an increased incidence of C-cell tumours. Although the clinical relevance in humans remains uncertain, the EMA SmPC lists this as a contraindication. It is also contraindicated during pregnancy, planned pregnancy in the next 2 months, and breastfeeding. In people with severe renal impairment (eGFR below 30 mL/min/1.73 m²) semaglutide is not recommended because elimination involves renal clearance and data in this population are absent. No dose adjustment is needed in mild to moderate hepatic impairment, but data in severe impairment (Child-Pugh C) are not available.

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What to expect

Most people notice reduced appetite within 2–4 weeks. Weight loss is assessed at 3 months — a loss of 5% or more of starting weight is considered a good response. Your doctor monitors progress and adjusts the treatment plan as needed.

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Common questions

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How Hi-Doctor handles it

An EU-licensed doctor reviews your case and, if eligible, issues an electronic prescription valid at any EU pharmacy under Directive 2011/24/EU. See the semaglutide page for the underlying mechanism and how Wegovy differs from Ozempic, how it works for the consultation process, and pricing for the consultation fee.

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