Wegovy is a prescription weight loss medication that also reduces the risk of heart attacks, strokes, and cardiovascular death in people with heart disease. The active ingredient, semaglutide, is a once-weekly injection that works by mimicking a natural gut hormone to reduce appetite. It’s FDA-approved for three distinct purposes: long-term weight management, cardiovascular risk reduction, and treatment of a specific form of liver disease.
Weight Management in Adults and Adolescents
Wegovy’s primary use is chronic weight management. It’s approved for adults with a BMI of 30 or higher (obesity) or a BMI of 27 or higher (overweight) when they also have at least one weight-related health condition such as high blood pressure, type 2 diabetes, or high cholesterol. It’s also approved for adolescents aged 12 and older with obesity.
In all cases, Wegovy is meant to be used alongside a reduced-calorie diet and increased physical activity. It’s not a standalone fix. In clinical trials, adults taking the 2.4 mg dose lost an average of 15.6% of their body weight over about 72 weeks, compared to roughly 4% in the placebo group. A newer, higher dose (7.2 mg) showed even greater results at 18.7% average body weight loss over the same period, though this higher dose is not yet widely available.
The weight loss is intended to be long-term. Wegovy is classified as a chronic weight management therapy, meaning it’s designed for ongoing use rather than a short course of treatment. Stopping the medication typically leads to weight regain, which is consistent with how obesity is treated as a chronic condition.
Cardiovascular Risk Reduction
In 2024, Wegovy became the first weight management drug approved to reduce the risk of major cardiovascular events. This approval applies specifically to adults who already have established cardiovascular disease (such as a history of heart attack or stroke) and who also have obesity or overweight.
The landmark SELECT trial tested Wegovy in over 17,000 patients with heart disease and a BMI of 27 or higher who did not have diabetes. Patients taking semaglutide had a 20% lower rate of cardiovascular death, non-fatal heart attack, and non-fatal stroke compared to those on placebo. That’s a meaningful reduction, and it was the first time a weight loss medication demonstrated this kind of heart protection in a large-scale trial.
This indication matters because it shifts how doctors can think about prescribing Wegovy. For patients with both heart disease and excess weight, the medication serves a dual purpose: managing weight while independently lowering the chance of a life-threatening cardiac event.
Treatment of Liver Disease (MASH)
Wegovy’s newest approved use is for a form of fatty liver disease called metabolic dysfunction-associated steatohepatitis, or MASH (previously known as NASH). This applies to adults with moderate to advanced liver scarring (stages F2 to F3 fibrosis) who do not yet have cirrhosis. MASH is a progressive condition where fat buildup in the liver causes inflammation and scarring, and it can eventually lead to liver failure if untreated. Wegovy is one of the first medications approved to treat it directly.
How Wegovy Works in the Body
Semaglutide mimics a hormone called GLP-1 that your gut naturally releases after eating. This hormone signals your brain that you’ve had enough food. Wegovy takes advantage of that system by activating GLP-1 receptors in the brain, particularly in a region called the dorsomedial hypothalamus that helps regulate appetite.
Research from UT Southwestern Medical Center has identified that the drug appears to act on two separate groups of neurons: one that activates when you’re exposed to food (seeing or smelling it) and another that kicks in once you start eating. By dialing down both signals, the medication reduces how much food feels appealing and how much you eat before feeling full. The result is that people on Wegovy naturally consume fewer calories without the constant feeling of fighting hunger.
Dosing and What to Expect
Wegovy is injected once a week under the skin, typically in the abdomen, thigh, or upper arm. The dose ramps up gradually over about four months to give your body time to adjust and minimize side effects, especially nausea. The schedule starts at 0.25 mg weekly for the first four weeks, then increases to 0.5 mg, then 1 mg, then 1.7 mg, before reaching the maintenance dose of 2.4 mg at week 17 or later. Most people experience the strongest side effects (nausea, diarrhea, constipation) during the dose increases, and these tend to ease as the body adapts.
How Wegovy Differs From Ozempic
Wegovy and Ozempic contain the same active ingredient, semaglutide, but they’re approved for different purposes and come in different doses. Ozempic is approved for managing type 2 diabetes and reducing cardiovascular risk in people with type 2 diabetes. Wegovy is approved for weight management, cardiovascular risk reduction in people with obesity or overweight (regardless of diabetes status), and MASH. Ozempic’s maximum dose is 2 mg per week, while Wegovy goes up to 2.4 mg. That higher ceiling is part of why Wegovy tends to produce greater weight loss. Using Ozempic off-label for weight loss is common but not the same as using the FDA-approved product at the approved dose.
Who Should Not Take Wegovy
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 (MEN 2). In animal studies, semaglutide caused thyroid tumors, and while it’s unclear whether the same risk applies to humans, the FDA requires a boxed warning on the label. Anyone who has had a serious allergic reaction to semaglutide should also avoid Wegovy.
Beyond these hard contraindications, doctors typically evaluate patients individually for conditions like a history of pancreatitis, gallbladder disease, or kidney problems before prescribing. The medication is not approved for use in children under 12 or for cosmetic weight loss in people who don’t meet the BMI thresholds.