Momentary it is more a hype than a solid decision, because longterm medication may have longterm unwished adverse effects.

(5% weight reduction is the FDA's minimum standard for weight loss drugs)

The Step Trials contain most of the pertinent information.

1. Step 1

Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183

• Intervention: semaglutide 2.4 mg plus a lifestyle intervention vs placebo plus lifestyle intervention (68 weeks)

• Average weight loss, intervention: 14.9% reduction from baseline
• Average weight loss, placebo: 2.4% reduction from baseline
• 5% weight loss, intervention: 86.4%
• 5% weight loss, placebo: 31.5%
• 10% weight loss, intervention: 69.1%
• 10% weight loss, placebo: 12%
• 15% weight loss, intervention: 50.5%
• 15% weight loss, placebo: 4.9%

2. Step 2

Davies M, Færch L, Jeppesen OK, et al. Semaglutide 2·4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. The Lancet. 2021;397(10278):971-984. doi:10.1016/S0140-6736(21)00213-0

• Intervention: semaglutide 2.4 mg vs placebo (68 weeks)

• Average weight loss, intervention: 9.6% reduction from baseline
• Average weight loss, placebo: 3.4% reduction from baseline
• 5% weight loss, intervention: 68.8%
• 5% weight loss, placebo: 28.5%

3. Step 3

Wadden TA, Bailey TS, Billings LK, et al. Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity: The STEP 3 Randomized Clinical Trial. JAMA. 2021;325(14):1403-1413. doi:10.1001/jama.2021.1831

• Intervention: semaglutide, 2.4 mg vs placebo for weight management as an adjunct to intensive behavioral therapy with initial low-calorie diet in adults with overweight or obesity.

• Average weight loss, intervention: 16.0% reduction from baseline
• Average weight loss, placebo: 5.7% reduction from baseline
• 5% weight loss, intervention: 86.6%
• 5% weight loss, placebo: 47.6%
• 10% weight loss, intervention: 75.3%
• 10% weight loss, placebo: 27%
• 15% weight loss, intervention: 55.8%
• 15% weight loss, placebo: 13.2%

4. Step 4

Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224

• Intervention: After 20 weeks (16 weeks of dose escalation; 4 weeks of maintenance dose),2 .4-mg/wk semaglutide maintenance dose plus lifestyle intervention vs. placebo plus lifestyle intervention

• Average weight loss, intervention: 7.9% reduction from baseline
• Average weight loss, placebo: 6.9%% increase from baseline

5. Step 5

Garvey WT, Batterham RL, Bhatta M, et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med. 2022;28(10):2083-2091. doi:10.1038/s41591-022-02026-4

• Intervention: semaglutide 2.4 mg vs. placebo (both plus behavioral intervention) for 104 weeks (adults with obesity, or overweight with at least one weight-related comorbidity, without diabetes.)

• Average weight loss, intervention: 15.2% reduction from baseline
• Average weight loss, placebo: 2.6% reduction from baseline
• ≥5% weight loss, intervention: 77.1%
• ≥5% weight loss, placebo: 34.4%

6. Step 6

Kadowaki T, Isendahl J, Khalid U, et al. Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an east Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial. The Lancet Diabetes & Endocrinology. 2022;10(3):193-206. doi:10.1016/S2213-8587(22)00008-0

• Intervention: semaglutide 2.4 mg vs. semaglutide 1.7 mg vs. placebo for 68 weeks (asian patients)

• Average weight loss, intervention 2.4 mg: 13.2% reduction from baseline
• Average weight loss, intervention 1.7 mg: 9.6% reduction from baseline
• Average weight loss, placebo: 2.1% reduction from baseline
• ≥5% weight loss, intervention 2.4 mg: 83%
• ≥5% weight loss, intervention 1.7 mg: 72%
• ≥5% weight loss, placebo: 21%

7. Step 7 Not published yet

Ozempic (semaglutide) is indicated for lowering A1C in patients with type 2 diabetes. Although it may help to lose some weight but its not indicated for weight loss.

Ozempic may cause serious side effects, including inflammation of pancreas (pancreatitis), changes in vision, hypoglycemia, kidney failure, gallbladder, etc. Most common side effects may include nausea, vomiting, diarrhea, abdominal pain and constipation.

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