Wegovy® – A New Treatment for Obesity

by Robert Kushner, MD

Fall 2021

Disclaimer: Consult with your healthcare provider if you are interested in starting Wegovy®.

In June 2021, the U.S. Food and Drug Administration (FDA) approved Wegovy® (the brand name for once-weekly Semaglutide 2.4 mg injection) for chronic weight management. This is the first new medication approved since 2014 as an addition to diet and physical activity indicated for adults with obesity (initial BMI ≥30 kg/m2) or overweight (initial BMI ≥27 kg/m2) with at least one weight-related medical condition.

What is Wegovy®?

Wegovy® is an injectable prescription medicine used for adults with obesity or overweight (excess weight) who also have weight-related medical problems to help them lose weight and keep the weight off.

Medically speaking, Wegovy® is a glucagon-like-peptide-1 (GLP-1) receptor agonist that is engineered in the laboratory. What this means is that Wegovy® mimics the naturally occurring GLP-1 hormone that is released by our intestines into our bloodstream within minutes after we ingest food.

This gut hormone has many important metabolic actions, including:

• Helping to regulate blood sugar
• Slowing stomach-emptying of food
• Controlling appetite

What Have the Research Studies Shown?

The effectiveness and safety of Wegovy® have been demonstrated in the Semaglutide Treatment Effect for People with Obesity (STEP) program. The four STEP studies involved 4,500 individuals from around the world that were either affected by obesity or classified as overweight with co-existing medical conditions resulting from their excess weight.

All individuals were provided lifestyle counseling and randomized (flip of a coin) to receive either Wegovy® or a matching placebo (a substance that has no therapeutic effect) for a total of 68 weeks. The outcomes of the STEP studies were impressive:

• The average weight-loss was 15 to 17% of the individual’s starting weight. For an individual who weighs 230 lbs.,this translates into a 35 to 39 lb. weight-loss. In the STEP 1 study, one-third of individuals were able to lose at least 20% of their weight.
• Significant improvements were also seen in
  • Waist circumference
  • Blood pressure
  • Blood fats
  • Inflammation
  • Physical ability

When Should Wegovy® Be Used?

Wegovy® should be used for the chronic management of obesity or overweight with an existing weight-related medical problem such as diabetes, hypertension or sleep apnea. Similar to all medications approved for weight management, it should be prescribed along with diet, exercise and counseling when needed.

How is Wegovy® Administered?

Wegovy® is a self-injectable drug administered subcutaneously (under the skin) once a week with a single-dose, pre-filled pen injector. The medication is given at a dose of 0.25 mg once a week for the first four weeks. It is then slowly increased every month to reach the maintenance dose of 2.4 mg weekly for four months. Escalating the doses slowly is a way to minimize potential side effects. Patients should work with their healthcare provider to develop a dosing schedule that works best for them.

What are the Side Effects of Wegovy®?

The most common side effects include:

• Nausea
• Diarrhea
• Vomiting
• Constipation

Wegovy® may also cause hypoglycemia (low blood sugar) when used with some other anti-diabetic drugs.

Are there any Concerns About Wegovy®?

Wegovy® should not be used in patients with a history of severe allergic reactions to Semaglutide or in patients with a personal or family history of medullary thyroid carcinoma or a rare condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Wegovy® also contains warnings for:

• Inflammation of the pancreas (pancreatitis)
• Gallbladder problems
• Increased heart rate
• Acute kidney injury
• Diabetic Retinopathy (damage to the eye’s retina)

Conclusion

Wegovy® is likely indicating a new generation of hormonal medications for chronic weight management that are more effective for weight-loss and improvement in cardiovascular risk factors. Medications are an important tool in the medical management of obesity for many individuals. We hope that in the years to come, more effective medications will come out and will assist people affected by obesity in their weight-loss or weight maintenance journey.

About the Author
Robert Kushner, MD, is a Professor of Medicine and Medical Education at Northwestern University Feinberg School of Medicine, and Director of the Center for Lifestyle Medicine at Northwestern Medicine in Chicago, IL. He is a founder of the American Board of Obesity Medicine (ABOM), past President of The Obesity Society (TOS), and past board member of the Obesity Action Coalition (OAC). Dr. Kushner has also served as the Chair and Co-Chair of the planning committee for OAC’s Your Weight Matters Annual Convention.

Dr. Kushner was an investigator in the STEP trials and serves on the Global and National Advisory Board for Novo Nordisk for which he receives compensation.

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