Semaglutide For Weight Loss

Semaglutide is the active ingredient found in the weight loss injection Wegovy. It is also used as a type 2 diabetes treatment for managing blood sugar levels under the brand name Ozempic. Semaglutide is effective for weight loss as it can improve feelings of fullness and decrease hunger levels. Wegovy (semaglutide) has been proven to help people lose up to 15% of their starting body weight at the maintenance dose of 2.4mg for 68 weeks.

Semaglutide is a type of medication called a glucagon-like peptide-1 (GLP-1) agonist. It works for weight loss by decreasing your appetite levels after eating and makes you feel full. It also delays the process of food leaving your stomach, further improving feelings of fullness. Semaglutide is used for long-term weight management in some people in the form of the weight loss injection Wegovy.

Semaglutide can also be used to control blood sugar levels in patients with type 2 diabetes and is found under the brand name Ozempic. Wegovy and Ozempic may contain the same active ingredient, but their dosage schedules are different as they’re used for different purposes.

What is semaglutide used for?

Semaglutide is used for 2 medical conditions:

• overweight or obesity to improve weight loss results when taken alongside diet and exercise changes
• type 2 diabetes to control blood sugar levels in patients who cannot take metformin or cannot control their blood sugar levels with other medications

How does semaglutide work?

Semaglutide belongs to a group of medications called GLP-1 receptor agonists which work by binding to GLP-1 receptors. GLP-1 is a natural hormone that our body uses to manage appetite levels and blood sugar. It causes the stomach to empty more slowly, making you feel less hungry. It also sends signals to the brain to reduce your appetite.

Taking semaglutide also causes insulin to be released from your pancreas and stops glucagon from being released, causing blood sugar levels to fall.

What forms of semaglutide are there?

Semaglutide comes in 3 brands:

• Ozempic: A weekly injection used for type 2 diabetes management
• Rybelsus: An oral tablet used for managing type 2 diabetes
• Wegovy: A weekly injection, prescribed for weight management

Semaglutide, under the brand name Wegovy, can be used for weight loss. You’ll need to meet the criteria to take it, such as having a BMI of overweight (27 to 30) and a weight-related medical condition like prediabetes, or a BMI of obese (30 or more).

Wegovy comes as an injection. Research has shown that people lose up to 15% of their starting weight after taking 2.4mg a week for 68 weeks.

How does semaglutide work for weight loss?

Semaglutide works by binding to GLP-1 receptors and mimicking the actions of the natural hormone GLP-1. This means it sends signals to your brain, reducing your appetite and causing the stomach to empty more slowly, making you feel less hungry and fuller for longer.

Naturally, GLP-1 only does this after eating, but semaglutide taken once a week will continuously reduce your appetite, so you’ll feel less hungry all the time, not just after eating. It works effectively alongside a diet and exercise plan.

How do you take semaglutide for weight loss?

Wegovy is an injection that comes in a pre-filled injection pen containing 4 doses. A doctor or nurse can show you how to use it, and you can find more information on injecting Wegovy safely in the patient information leaflet.

You should inject Wegovy once a week, ideally on the same day and around the same time, under the skin. The preferred places for injection are in the tummy (abdomen) or thigh. The upper arm can be used with the help of somebody else. You should use a different injection site each time, even if this is just a different part of the skin in the same area, or the opposite side of your body.

What is the dose of semaglutide for weight loss?

When you start taking semaglutide for weight loss, the starting dose will be 0.25mg once a week for at least 4 weeks. Your dose will then be slowly increased by your doctor following the Wegovy dosage schedule. Your dose can be increased up to a maximum of 2.4mg once a week, which is the maintenance dose.

Who can take semaglutide for weight loss?

You can take semaglutide for weight loss if you have a body mass index (BMI):

• between 27 and 30, which is classed as overweight, and have been diagnosed with a medical condition that is affected by your weight, such as prediabetes or high blood pressure.
• of 30 or above, which is classed as obese, regardless of whether you have a medical condition that is affected by weight

You don’t need to have diabetes to take semaglutide for weight loss, as Wegovy is specifically made for weight loss. You’ll also need to have no conditions that could interact with the active ingredient or make it unsafe to take.

Who should not take semaglutide?

You should not take semaglutide for weight loss if you are:

• allergic to semaglutide, or any other ingredients in the Wegovy pen
• pregnant
• breastfeeding
• already taking a GLP-1 receptor agonist (taking 2 medications with the same active ingredient type would be the same as taking an overdose and could lead to severe side effects)

You should only take semaglutide if you have been prescribed it by a doctor.

What are the different doses available?

Wegovy comes in 5 different doses. These are:

• 0.25mg
• 0.5mg
• 1mg
• 1.7mg
• 2.4mg

You take each dose following the schedule below:

One study found that people can lose up to 15% of their starting weight when taking 2.4mg of Wegovy (semaglutide) once a week for 68 weeks.

In the same study, 83.5% of people who took Wegovy lost at least 5% of their starting weight. Participants in the study also followed a diet and exercise program, including a reduced calorie intake and a healthy, balanced diet.

Is semaglutide available on the NHS for weight loss?

Wegovy is available on the NHS for weight loss but it can only be prescribed by a doctor at a tier 3 specialist weight management service. You can be referred by your GP but waiting times can vary from a few months to a few years.

Some GPs are receiving specialist training to be able to prescribe Wegovy. Ask your GP if they can prescribe Wegovy.

Semaglutide is also effective in treating type 2 diabetes by managing blood sugar levels. It comes as a tablet (Rybelsus) or an injection (Ozempic) and is available on the NHS.

How does semaglutide work for people with type 2 diabetes?

Semaglutide works by binding to GLP-1 receptors. This causes insulin to be released from your pancreas and stops glucagon from being released which both cause blood sugar levels to fall.

It is possible to lose weight if you take semaglutide for type 2 diabetes. This is because semaglutide also slows the emptying of your stomach and suppresses your appetite but is less likely to cause the same results as Wegovy as it comes in a lower dose for blood sugar management.

How do you take semaglutide for diabetes?

Semaglutide for type 2 diabetes comes as a tablet (Rybelsus) or as an injection (Ozempic).

You should take Rybelsus once a day on an empty stomach. Do not crush, split or chew your tablet. After taking Rybelsus, wait at least half an hour before eating, drinking or swallowing other medications.

Ozempic is an injectable form of semaglutide. It comes in a pre-filled injection pen which has 4 doses. A doctor or nurse can show you how to use it. You should inject Ozempic once a week, ideally on the same day, under the skin. The preferred places for injection are in the tummy (abdomen) or thigh. You should use a different injection site each time.

What is the dosage of semaglutide for diabetes?

If you take oral semaglutide (Rybelsus), you will start by taking 3mg once a day for 1 month. Next, your daily dose will increase to 7mg. Your dose will then be reviewed by your doctor, and your blood sugar levels will be checked. If you still need help managing your blood sugar levels your dose will increase to 14mg once a day. If your blood sugars are well managed at a dose of 7mg, your doctor will recommend staying on this dose and continuing to monitor your blood sugar.

If you take injectable semaglutide (Ozempic), you will start by injecting 0.25mg once a week for 4 weeks. Your dose will then increase to 0.5mg once a week for 4 weeks. At this point, your dose will be reviewed and your blood sugar levels checked by a doctor. You will either stay on the same dose or your dose will increase to 1mg once a week if your blood sugar levels aren’t being managed well enough at 0.5mg.

Who can take semaglutide for diabetes?

You should only take semaglutide for diabetes if you have been prescribed it by a doctor.

Semaglutide can be taken if you have been diagnosed with type 2 diabetes and you cannot take metformin, or your current diabetes medications do not lower your blood sugar well enough.

Who should not take semaglutide for diabetes?

You should not take semaglutide if you are:

• allergic to semaglutide or any ingredient in the tablet or injectable pen (depending on which type you’re prescribed)
• pregnant
• breastfeeding

How effective is semaglutide for managing type 2 diabetes?

Studies measuring the effectiveness of semaglutide for type 2 diabetes use HbA1c (a marker of long-term blood sugar level control). HbA1c is measured in percentages. If you have type 2 diabetes, your HbA1c will be 6.5% or over.

Clinical trials have shown that 1mg of injected semaglutide once per week for at least 30 weeks lowers HbA1c by 1.4 to 2.2%. They also show that taking a 14mg tablet of semaglutide once a day for 26 weeks lowers your HbA1c by 1.5%.

Lowering your HbA1c by 1% reduces your risk of diabetic kidney, nerve and eye complications by 25%.

Is semaglutide available on the NHS for managing type 2 diabetes?

Semaglutide is available on the NHS to treat type 2 diabetes and can be found as Rybelsus or Ozempic. You’ll need to be diagnosed with type 2 diabetes by your doctor and have tried other medications and diet and lifestyle changes to improve your blood sugar levels before trying it.

Like all medications, semaglutide can cause side effects, however not everybody gets them.

Very common or common side effects of semaglutide

• feeling sick
• being sick
• stomach pain
• bloating
• constipation
• diarrhoea
• heartburn
• tiredness
• burping
• passing gas
• gallstones

Very common or common side effects in people with type 2 diabetes:

• decreased appetite
• weight loss
• low blood sugar (hypoglycaemia)

Very common or common side effects in people taking semaglutide as an injection:

• hair loss
• feeling dizzy
• headache
• eye problems (diabetic retinopathy – in people with type 2 diabetes)
• injection site reactions

Uncommon, rare and very rare side effects of semaglutide

• inflamed pancreas (pancreatitis)
• change of taste
• fast heartbeat
• rash, itching or hives
• allergic reaction

An uncommon side effect of Wegovy is paralysis of the stomach (gastroparesis).

A rare side effect of semaglutide by injection is swelling of the skin, especially around the eyes and mouth (angioedema). You should contact a doctor or go to A&E straight away if you get this side effect.

How long do side effects last?

Most side effects will go away within a few weeks but may come back with a dose increase. Side effects normally go away within 1 month of stopping semaglutide.

When should I talk to my doctor about my side effects?

You should talk to your doctor if you’re getting side effects that last a long time, are severe, or are affecting your day-to-day activities.

If you get any serious side effects, you should get emergency medical help by calling 999. Serious side effects are:

• low blood sugar (feeling dizzy, irritable, confused, fast heartbeat, sweating)
• inflamed pancreas (severe stomach or back pain)
• paralysis of the stomach (bloating, constipation, feeling sick, being sick)
• gallstones (pain in the top of your tummy – especially after eating)
• eye problems (change in your vision)
• allergic reaction (swelling of the skin or throat, difficulty swallowing or breathing, rash, feeling dizzy, fast heartbeat)

What can I do to manage side effects?

You can manage some mild side effects at home.

If you are feeling sick, you could try:

• eating smaller, more frequent meals
• avoiding fatty foods
• eating bland foods like toast, rice or crackers
• taking regular sips of a cold drink
• drinking ginger or peppermint tea
• getting some fresh air

If you are constipated, you could try:

• making changes to your diet (eating fruit and fibre)
• drinking plenty of water
• increasing your physical activity

If diet and lifestyle changes have not helped, speak to a pharmacist. They may be able to suggest a laxative (a medication to help you pass stools).

If your stool is loose or watery, drink plenty of water and avoid food that is spicy or fatty.

Other medications can help with weight loss. These include:

• Mounjaro (tirzepatide)
• Orlistat (Xenical, alli)
• Saxenda (liraglutide)

Mounjaro

This contains the active ingredient tirzepatide, which is also a GLP-1 receptor agonist like semaglutide. Mounjaro is used for weight loss and is found under the same name to treat type 2 diabetes. It also mimics a second hormone called glucose-dependent insulinotropic polypeptide (GIP). Doctors aren’t entirely sure how it works, but it's thought to further enhance the effects of GLP-1, so your appetite will be reduced and you’ll feel fuller for longer.

On the highest maintenance dose (15mg), Mounjaro was found to help people lose up to 22.5% of their starting weight after taking the dose for 72 weeks. It’s an injection taken under the skin, at the same time and day each week, once a week.

Orlistat

Orlistat is found as a generic medicine, or under the branded names Xenical (120mg tablets) and alli (60mg tablets which can be bought over the counter). In either form, orlistat works by reducing the absorption of fat from your food. 37% of people taking 120mg of orlistat 3 times per day lose 5% or more of their starting weight after 12 weeks.

Orlistat in all forms is a tablet taken orally, and should only be taken with a meal containing some dietary fat, up to 3 times a day. It’s recommended to consume no more than 10% of your dietary fat with each meal alongside your orlistat tablet.

Saxenda

Saxenda contains liraglutide and works in the same way as semaglutide (Wegovy), as it’s also a GLP-1 agonist. Although Wegovy and Saxenda work similarly, there are also many differences between the treatments, such as Saxenda being taken once per day rather than once per week. A study on Saxenda (liraglutide) showed that people can lose 8% of their starting weight after taking 3mg per day for 68 weeks.

It is an injection that comes in a pre-filled injection pen. It comes in doses of 0.6mg, 1.2mg, 1.8mg, 2.4mg and 3mg but is currently long-term out of stock. There should be a generic form of liraglutide released in the UK later this year.

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• Semaglutide for the Treatment of Type 2 Diabetes Mellitus NCBI [accessed 19/05/2024]
• Wegovy 2.4mg EMC [accessed 19/05/2024]