Wegovy (semaglutide) is FDA-approved for three distinct uses: chronic weight management, cardiovascular risk reduction in adults with heart disease, and treatment of a specific liver condition called metabolic dysfunction-associated steatohepatitis (MASH) with moderate or advanced liver fibrosis. Each approval comes with its own eligibility criteria, and the drug is not approved for treating type 2 diabetes, even though it contains the same active ingredient as Ozempic.
Chronic Weight Management
Wegovy’s original and most well-known approval is for long-term weight management. For adults, the FDA requires an initial BMI of 30 or greater (which meets the clinical definition of obesity) or a BMI of 27 or greater if at least one weight-related health condition is also present, such as high blood pressure, type 2 diabetes, or high cholesterol. In both cases, the medication is meant to be used alongside a reduced-calorie diet and increased physical activity, not as a standalone treatment.
In 2022, the FDA expanded this approval to include adolescents aged 12 and older who have obesity, defined as a BMI at or above the 95th percentile for their age and sex. This made Wegovy one of the few medications specifically authorized for weight management in younger patients.
Clinical trials back up the approval with substantial results. In the STEP UP trial, adults taking the standard 2.4 mg weekly dose lost an average of about 15.6% of their body weight, compared to roughly 3.9% in the placebo group. A higher 7.2 mg dose (not yet standard) pushed average weight loss to 18.7%.
Cardiovascular Risk Reduction
In March 2024, the FDA approved Wegovy for a second major use: reducing the risk of heart attack, stroke, and cardiovascular death in adults who have established cardiovascular disease along with either obesity or overweight. This made it the first medication approved specifically to lower serious heart risks in this population, independent of its weight loss effects.
The cardiovascular approval was based on the SELECT trial, a large study of adults with existing heart disease and a BMI of 27 or higher. Participants taking semaglutide experienced significantly fewer major cardiac events than those on placebo. This indication is separate from the weight management approval. A patient could qualify for cardiovascular risk reduction even if weight loss itself isn’t their primary treatment goal.
Liver Disease (MASH)
More recently, the FDA approved Wegovy for treating metabolic dysfunction-associated steatohepatitis, commonly called MASH, in adults who have moderate or advanced liver scarring (fibrosis). MASH is a progressive form of fatty liver disease that can lead to cirrhosis if untreated. This approval reflects growing evidence that semaglutide can reduce liver inflammation and fibrosis in addition to its metabolic effects.
How Wegovy Differs From Ozempic
Wegovy and Ozempic both contain semaglutide and are made by the same manufacturer, but their FDA-approved uses don’t overlap. Ozempic is approved for managing type 2 diabetes, improving kidney and cardiovascular health in adults with type 2 diabetes and chronic kidney disease, and reducing cardiovascular risk in adults with type 2 diabetes and heart disease. Wegovy is the only semaglutide product approved for weight loss. While some people taking Ozempic lose weight as a side effect, that’s an off-label outcome, not an approved use.
How the Medication Works in Practice
Wegovy is a once-weekly injection you give yourself under the skin, typically in the stomach, thigh, or upper arm. It works by mimicking a natural hormone called GLP-1 that regulates appetite. The medication slows stomach emptying and signals fullness to the brain, which reduces hunger and calorie intake over time.
You don’t start at the full dose. The standard schedule begins at 0.25 mg per week for the first four weeks, then increases every four weeks through doses of 0.5 mg, 1 mg, and 1.7 mg before reaching the maintenance dose at week 17. For adults, the maintenance dose is either 1.7 mg or 2.4 mg per week depending on tolerability. For adolescents, the target is 2.4 mg. This gradual ramp-up exists specifically to reduce gastrointestinal side effects like nausea and vomiting, which are most common early in treatment.
Who Should Not Take Wegovy
The FDA label carries a boxed warning, the most serious type, related to thyroid cancer risk. Wegovy is contraindicated for anyone with a personal or family history of medullary thyroid carcinoma (a rare type of thyroid cancer) or a condition called Multiple Endocrine Neoplasia syndrome type 2. These contraindications are based on animal studies showing thyroid tumors in rodents given semaglutide, though whether this risk translates to humans isn’t fully established. If you have a history of either condition in your family, this medication is not an option.