Short answer
Wegovy is the brand name of semaglutide 2.4 mg, a GLP-1 receptor agonist for weight management injected once a week. In the approval trial, adults with obesity lost on average 14.9 per cent of their body weight over 68 weeks. Whether semaglutide suits you is assessed by a doctor; at OpenClinic24 this happens by video.
Key facts
STEP 1 (NEJM 2021, 1,961 participants): minus 14.9 per cent body weight after 68 weeks versus minus 2.4 per cent with placebo.
STEP 5 (Nature Medicine 2022): a stable loss of 15.2 per cent after two years, versus 2.6 per cent with placebo.
SELECT (NEJM 2023, 17,604 participants with heart disease without diabetes): 20 per cent fewer heart attacks, strokes and cardiovascular deaths.
Dose escalation over 16 weeks: 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, then 2.4 mg a week.
Stop at least two months before a planned pregnancy; not used in pregnancy or breastfeeding.
What Wegovy is
Wegovy is the brand name of semaglutide at doses up to 2.4 mg a week, approved for weight management. Semaglutide is a GLP-1 receptor agonist: it mimics the gut hormone GLP-1, which is released after eating. In the brain it strengthens fullness and reduces appetite, in the stomach it slows emptying, and in the pancreas it increases insulin release when blood sugar is raised.
The same substance is in Ozempic, at lower doses and approved for type 2 diabetes. Wegovy is the product developed, studied and approved for treating obesity and overweight with related conditions. It has been approved in the EU since 2022 and available in Germany since 2023. The product information in the EMA’s assessment report sets out use, contraindications and side effects. The difference from Ozempic is explained in Ozempic (semaglutide).
What the trials show
Semaglutide 2.4 mg was studied in the STEP programme. All participants, including those on placebo, received diet and exercise support.
| Trial | Question | Duration | Result with semaglutide | Comparison |
|---|---|---|---|---|
| STEP 1 (NEJM 2021) | obesity without diabetes, 1,961 participants | 68 weeks | minus 14.9 % | placebo minus 2.4 % |
| STEP 5 (Nature Medicine 2022) | long-term effect | 104 weeks | minus 15.2 % | placebo minus 2.6 % |
| STEP 4 (JAMA 2021) | continuing or switching to placebo after 20 weeks | 68 weeks | a further minus 7.9 % | placebo plus 6.9 % |
| SELECT (NEJM 2023) | heart disease and overweight without diabetes, 17,604 participants | about 40 months on average | 20 % fewer major cardiovascular events | placebo |
STEP 1 is the basis of the approval, and STEP 5 shows the effect stays stable over two years while treatment continues. The key study for benefit beyond weight is SELECT: in people with overweight and established cardiovascular disease but no diabetes, semaglutide reduced the risk of heart attack, stroke or cardiovascular death by 20 per cent. For people without heart disease this benefit has not been shown in the same way.
Who may be eligible
Wegovy is approved for adults with a body mass index of at least 30, or at least 27 with at least one weight-related condition such as high blood pressure, prediabetes or type 2 diabetes, abnormal blood lipids, sleep apnoea or cardiovascular disease. Under certain conditions it is also approved for adolescents from 12 years. The German S3 guideline on obesity treats medication as one building block of an overall plan.
Semaglutide is not used in pregnancy and breastfeeding; according to the product information it is stopped at least two months before a planned pregnancy. It is not recommended with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2. Caution applies after previous pancreatitis, with gallstones, diabetic eye disease and severe digestive disorders. Anyone with an eating disorder involving vomiting needs a different treatment first. More in Getting a weight loss injection prescribed.
Weight loss with medical support
A doctor assesses by video whether a medical treatment is an option for you and then supports you with a plan and follow-up appointments. The decision is made case by case.
Check eligibility in 5 questionsDose escalation and use
Semaglutide is increased step by step so that the digestive tract can adapt. According to the product information the dose rises every four weeks: 0.25 mg in weeks one to four, 0.5 mg in weeks five to eight, 1 mg in weeks nine to twelve, 1.7 mg in weeks 13 to 16 and from week 17 the maintenance dose of 2.4 mg. A poorly tolerated step can be kept for longer. The injection is given on a fixed weekday, regardless of meals.
A missed dose is taken if no more than five days have passed since the planned day; otherwise it is skipped. Small portions, eating slowly, little fat at first, enough fluids and less alcohol reduce nausea noticeably. A protein-rich diet and strength training protect muscle. Before anaesthesia, the anaesthetic team should know about the treatment because the stomach empties more slowly.
Side effects
In STEP 1, nausea occurred in 44 per cent, diarrhoea in 32 per cent, vomiting in 24 per cent and constipation in 23 per cent, compared with 17, 16, 7 and 10 per cent on placebo. Symptoms were mostly mild to moderate and mainly during escalation; 7 per cent stopped because of side effects, versus 3 per cent on placebo. Less common are gallstones, gallbladder inflammation and pancreatitis. In 2025 the EMA classified NAION, a circulation disorder of the optic nerve, as a very rare side effect affecting up to 1 in 10,000 people. More in Side effects of weight loss injections.
Thinking long term
Semaglutide treats obesity; it does not cure it. In STEP 4, those who switched to placebo after 20 weeks regained 6.9 per cent over 48 weeks, while those who continued lost a further 7.9 per cent. In the STEP 1 extension, two thirds of the weight lost had returned on average one year after stopping. How to plan stopping is covered in Stopping weight loss injections.
Everyday habits matter as much as the injection: protein at every meal, strength training two to three times a week and patience, as weight loss is fastest in the first months and levels off after about a year. Even 5 per cent less weight measurably improves blood pressure, blood sugar and joint pain.
Costs and insurance
German statutory health insurance does not cover Wegovy, because § 34 (1) SGB V excludes medicines for weight reduction and appetite control. Private insurers decide according to the policy and medical justification. Medical support is billed under the German fee schedule for doctors (GOÄ). The overview is in Weight loss injections.
When you need urgent medical help
Call 112 for severe upper abdominal pain radiating to the back, shortness of breath or swelling after the injection and sudden loss of vision. For ongoing vomiting, signs of dehydration or yellowing skin outside surgery hours, call the German on-call medical service on 116 117 and pause the next dose until a doctor has assessed you.
When you need help immediately
- Severe, persistent upper abdominal pain radiating to the back: possible pancreatitis
- Colicky pain in the upper right abdomen, fever or yellowing of the skin: possible gallstones
- Sudden loss of vision or rapidly worsening sight
- Ongoing vomiting with signs of dehydration: very little urine, dizziness, racing heart
- Swelling of the face or tongue, shortness of breath after the injection
With these warning signs call the emergency number 112. Outside office hours the medical on-call service is available on 116 117. In these situations a video consultation does not replace an in-person examination.
Sources
- Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). New England Journal of Medicine, 2021. DOI: 10.1056/NEJMoa2032183 Study
- Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nature Medicine, 2022. DOI: 10.1038/s41591-022-02026-4 Study
- Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT). New England Journal of Medicine, 2023. DOI: 10.1056/NEJMoa2307563 Study
- Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance (STEP 4). JAMA, 2021. DOI: 10.1001/jama.2021.3224 Study
- Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 2022. DOI: 10.1111/dom.14725 Study
- Wegovy (semaglutide): European public assessment report (EPAR) and product information. European Medicines Agency (EMA), 2025. Authority
- PRAC concludes eye condition NAION is a very rare side effect of semaglutide medicines Ozempic, Rybelsus and Wegovy. European Medicines Agency (EMA), 2025. Authority
- S3 guideline Obesity: prevention and treatment (AWMF register number 050-001). German Obesity Society, AWMF, 2024. Guideline
- § 34 German Social Code, Book V: excluded medicines. Federal Ministry of Justice, gesetze-im-internet.de, 2026. Law
All sources were retrieved during the medical review. Studies are linked by DOI; guidelines and laws in their current version.
Frequently Asked Questions
What is Wegovy?
Wegovy is the brand name of semaglutide at doses up to 2.4 mg a week, approved for weight management. Semaglutide mimics the gut hormone GLP-1, strengthens fullness, reduces appetite and slows stomach emptying. Wegovy is injected under the skin once a week with a prefilled pen, alongside diet and exercise.
How much weight do people lose with Wegovy?
In the STEP 1 approval trial, adults with obesity without diabetes lost on average 14.9 per cent of their body weight after 68 weeks, compared with 2.4 per cent on placebo. In STEP 5 the loss stayed at about 15 per cent over two years. Some people lose much more, others respond little; averages are not a promise for an individual.
Who is Wegovy approved for?
For adults with a body mass index of 30 or more, or 27 or more with at least one weight-related condition such as high blood pressure, prediabetes, abnormal blood lipids, sleep apnoea or cardiovascular disease. Under certain conditions it is also approved for adolescents from 12 years. It complements diet and exercise rather than replacing them.
How is the Wegovy dose increased?
According to the product information the dose is raised every four weeks: 0.25 mg, 0.5 mg, 1 mg, 1.7 mg and from week 17 the maintenance dose of 2.4 mg a week. A step can be kept longer if poorly tolerated. A missed dose is taken if no more than five days have passed since the planned day; otherwise it is skipped.
Does Wegovy protect the heart?
In the SELECT trial of 17,604 people with overweight and existing cardiovascular disease but without diabetes, semaglutide 2.4 mg reduced the risk of heart attack, stroke or cardiovascular death by 20 per cent compared with placebo. This applies to this high-risk group; a similar benefit has not been shown in the same way for people without heart disease.
What are the side effects of Wegovy?
In STEP 1, 44 per cent reported nausea, 32 per cent diarrhoea, 24 per cent vomiting and 23 per cent constipation, mostly mild to moderate and during escalation. Less common are gallstones and pancreatitis. The EMA classifies a circulation disorder of the optic nerve as a very rare side effect. Sudden worsening of vision needs urgent medical assessment.
What happens when you stop Wegovy?
For most people the weight comes back. In the STEP 1 extension, on average two thirds of the weight lost had returned one year after stopping, and blood pressure and blood lipids moved back towards baseline. Treatment is therefore planned for the long term, together with lasting changes in diet and exercise.
Does health insurance pay for Wegovy?
German statutory health insurance does not cover Wegovy, because § 34 SGB V excludes medicines for weight reduction and appetite control. Private insurers decide according to the policy and medical justification. A written cost enquiry with a medical report before starting provides clarity.
About the author
Note: This article provides general information and does not replace individual medical advice, diagnosis or treatment. If you have symptoms, contact a doctor; in an emergency call 112.
