INTRODUCTION

Obesity constitutes an epidemic and a critical public health issue. The global incidence of obesity is on the rise, showing a notable increase in obesity rates among both adults and children. With estimates indicating that over 1 billion people globally will face obesity by 2030, the growing number of overweight and obese individuals in India is a significant issue. Medical weight management stands out among the various treatment options for excess weight. Recent developments have significantly altered our treatment approaches, paving the way for future advancements in obesity care.

Semaglutide, marketed under the Ozempic and Wegovy brand name, has surged in popularity, driven by social media buzz and celebrity endorsements. Between early 2020 and the conclusion of 2022, the number of prescriptions for Ozempic, Wegovy, and other medications with comparable mechanisms of action experienced a remarkable 300% rise, culminating in more than 9 million prescriptions issued in the last quarter of 2022.

According to reports, individuals are resorting to these medications as a “quick solution” for shedding a few kilograms; however, the potential side effects can be hazardous, necessitating their use under medical supervision. Therefore, several questions need to be explored.

SEMAGLUTIDE (Ozempic, Wegovy) : FAQs

1. What is Semaglutide?

• Semaglutide is a glucagon-like peptide 1 (GLP-1) agonist, i.e. it increases the activity of GLP-1.
• GLP-1 is a hormone produced in the small intestine that regulates blood glucose levels and modulates appetite.

2. What are the brands of Semaglutide currently available?

• The US FDA has approved Novo Nordisk Semaglutide under three distinct brand names:
  • Injection – Ozempic®, Wegovy®
  • Tablets – Rybelsus®

3. Are Ozempic or Wegovy currently available in India?

• Ozempic and Wegovy are neither officially approved nor currently available in India. However, the expiration of their patents in India in 2026 will open the door for Indian pharmaceutical companies to develop generic versions of these medications.

4. Is Rybelsus available in India?

• Yes, Rybelsus, an oral Semaglutide, has been marketed in India since 2022.
• It is indicated along with diet and exercise to improve blood sugar in adults with type 2 diabetes.
• It’s available in three strengths: 3mg, 7mg, and 14mg. 

5. What are the US FDA-approved indications of Ozempic?

• Management of type 2 diabetes along with diet and exercise.
• To reduce the risk of major cardiovascular events in adults with type 2 diabetes and established cardiovascular disease.
• To reduce the risk of sustained estimated glomerular filtration rate decline, end-stage kidney disease, and cardiovascular death in adults with type 2 diabetes and chronic kidney disease.

6. Which is the newly approved indication of Ozempic?

• On January 28, 2025, Novo Nordisk revealed that the U.S. FDA has granted approval for Ozempic® to reduce the risk for worsening kidney disease and cardiovascular death in adults with both type 2 diabetes and chronic kidney disease. 
• The approval was based on the phase 3b results of the international FLOW kidney outcomes trial
• This trial involved over 3,500 participants with chronic kidney disease and type 2 diabetes, who were randomly assigned to receive either 1mg Semaglutide weekly or a placebo in addition to standard care.
• Semaglutide 1 mg demonstrated a significant 24% reduction in relative risk for the deterioration of kidney disease, the development of end-stage kidney disease, and death resulting

7. Is Ozempic approved for weight loss?

• No, Ozempic is not approved for aesthetic weight reduction that has gained significant attention through social media and the influence of celebrities.

8. What are the FDA-approved indications of Wegovy?

• Wegovy has been approved for weight management in obese adults and pediatric patients ≥ 12 years.
• It is intended to be used alongside a reduced-calorie diet and enhanced physical activity for the chronic management of weight in:
  • Adult patients who have an initial body mass index (BMI) of either:
    • ≥30 kg/m², or
    • ≥27 kg/m² when accompanied by at least one weight-related comorbidity, such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  • Pediatric patients ( ≥ 12 years ) with an initial BMI at the 95th percentile or greater for age and sex.

9. Can Wegovy and Ozempic considered the same?

• Wegovy and Ozempic refer to the same medication, Semaglutide.
• Ozempic is specifically designated for individuals with diabetes, having received FDA approval in 2017.
• In contrast, Wegovy was approved in 2021 for those who are obese or overweight and face additional health issues.
• They are simply prescribed under different names, with minor variations in dosage and indications.

10. How does Semaglutide aid in weight reduction and treating type 2 diabetes?

• Semaglutide delivers its benefits through activation of GLP-1 receptors primarily located in the gastrointestinal tract, pancreas, and brain.
• Upon activation of the GLP-1 receptor, Semaglutide enhances glucose-dependent insulin secretion and helps to lower blood glucose levels.
• Simultaneously, it also causes delayed gastric emptying, reduced appetite and energy intake.
• In addition, Semaglutide acts on GLP-1 receptors located in the hypothalamus (part of the brain that controls hunger) may help to suppress hunger, reduce food cravings, and increase the perception of fullness.

11. How much weight loss has been documented in studies involving Semaglutide?

• STEP clinical trial program
  • The Semaglutide Treatment Effect in People with Obesity (STEP) clinical trial program is assessing the efficacy of once-weekly subcutaneous Semaglutide at a dosage of 2.4 mg in overweight or obese individuals without diabetes.
  • Throughout Steps 1, 3, 4, and 8, participants receiving Semaglutide 2.4 mg experienced mean weight losses between 14.9% and 17.4% at the 68-week.
• STEP-UP obesity trial
  • On January 17, 2025, Novo Nordisk announced the results of the 72-week STEP-UP obesity trial, which included 1,407 non diabetic adults with BMI ≥30 kg/m².
  • The results indicated that a subcutaneous dose of 7.2 mg of Semaglutide resulted in a weight loss of 20.7%, while an overall reduction of 18.7% was observed, irrespective of the participants’ adherence to the treatment.

12. How long Semaglutide can be used for weight management?

• Semaglutide long-term efficacy and safety have been confirmed for up to 2 years. It can be a feasible option for chronic weight management.

13. Does using Ozempic or Wegovy cause permanent weight loss?

• No, while Ozempic or Wegovy can produce significant and lasting weight reductions, they are not considered permanent fixes.

14. Is rebound weight gain seen with Ozempic or Wegovy?

• Yes, weight regain after ceasing Ozempic or Wegovy is common. The medication’s impact on appetite and digestion diminishes, potentially resulting in heightened feelings of hunger and cravings.
• A study revealed that a year after stopping the administration of once-weekly subcutaneous Semaglutide 2.4 mg and engaging in lifestyle modifications, participants regained approximately two-thirds of the weight they had initially lost.
• Thus, maintaining a healthy lifestyle characterized by balanced eating and regular exercise can help alleviate this issue and support weight loss maintenance.

15. What are the dosage forms and strengths of Ozempic and Wegovy available?

• Ozempic – Injections are available as a single-patient-use pen that delivers doses of 0.25 mg, 0.5 mg, 1 mg or 2 mg.
• Wegovy- Injections are available as a single-patient-use pen that delivers doses of 0.25 mg, 0.5 mg, 1 mg, 1.7 or 2.4  mg

16. What is the dose, frequency and route of administration of Ozempic and Wegovy?

17. What are the common side effects of Semaglutide?

• The adverse reactions most frequently observed include nausea, vomiting, diarrhea, abdominal pain, and constipation.

18. What are the serious side effects associated with Semaglutide?

• Semaglutide may cause serious side effects, including:
  • Possible thyroid tumors, including cancer
  • Severe allergic reaction 
  • Pancreatitis
  • Gallstones, infections of the gallbladder
  • Diabetic retinopathy (damage to the eye’s retina) leading to vision issues
  • Hypoglycemia (Low blood sugar)
  • Acute Kidney injury due to dehydration
  • Increased heart rate

19. What is Ozempic face?

• Patients who experience swift weight loss frequently report a considerable loss of facial fat, resulting in multiple cosmetic alterations. These alterations can manifest as wrinkles, sunken eyes, a hollowed look, sagging jowls around the neck and jaw, and changes in the contours of the cheeks, lips, and chin. This adverse facial effect has led to the introduction of the term “Ozempic Face.”

20. What are the latest safety risks of Semaglutide, as highlighted by the new studies?

• Risk of blindness – According to a study featured in JAMA Ophthalmology, patients taking Semaglutide were found to have a greater probability of blinding eye disease, i.e. Non-arteritic anterior ischemic optic neuropathy, than those who did not take the medication. Nonetheless, additional research is essential to examine the hypothesis, and patients ought to be aware of this information until more studies are conducted.
• Gastroparesis (Stomach paralysis) – New findings have highlighted a relationship between drugs like Semaglutide and a condition termed gastroparesis. One of the prominent long-term effects of diabetes is gastroparesis, which constitutes nearly one-third of all cases. Semaglutide is chiefly employed in the treatment of type 2 diabetes mellitus. This situation highlights the importance of recognizing medication-induced gastroparesis as a potential diagnosis, particularly in those with risk factors.
• Suicidal thoughts– A new research investigation has found a correlation between the administration of Semaglutide drugs and the occurrence of suicidal ideation among patients with antidepressant use. Conversely, other recent studies have revealed that there is no connection between Semaglutide usage and depressive symptoms or suicidal tendencies in individuals who do not have existing mental health conditions.

Further Reading

• https://pmc.ncbi.nlm.nih.gov/articles/PMC10611613/
• https://www.jprasurg.com/article/S1748-6815(24)00417-0/abstract
• https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00059-7/fulltext#:
• https://pmc.ncbi.nlm.nih.gov/articles/PMC7434819/#Sec3
• https://www.ozempic.com/prescribing-information.html
• https://pubmed.ncbi.nlm.nih.gov/37402640/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC8736331/#Sec3
• https://www.medscape.com/viewarticle/ozempic-receives-new-indications-chronic-kidney-disease-2025a10002ac
• https://www.nejm.org/doi/10.1056/NEJMoa2403347
• https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-
• https://www.novonordisk.com/news-and-media/news-and-ir-materials/news-details.html?id=915087
• https://pmc.ncbi.nlm.nih.gov/articles/PMC9542252/#dom14725-sec-0017
• https://pmc.ncbi.nlm.nih.gov/articles/PMC9272494/
• https://pubmed.ncbi.nlm.nih.gov/35441470/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC10092086/
• https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/215256s007lbl.pdf
• https://www.ozempic.com/how-to-take/side-effects.html
• https://www.nature.com/articles/d41586-025-00173-5
• https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or#:~:text=Wegovy%20should%20not%20be%20used%20in%20patients%20with%20a%20history,or%20suicidal%20behaviors%20or%20thoughts
• https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255
• https://pmc.ncbi.nlm.nih.gov/articles/PMC11454535/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC10874596/
• https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2822453