Semaglutide for managing overweight and obesity

In September, the GLP-1 receptor agonist semaglutide (Wegovy) became available on the NHS for weight management in accordance with NICE guidance, in conjunction with increased physical activity and reduced calorie intake. Importantly, Wegovy, licensed for weight management, differs from Ozempic (also semaglutide), which is only licensed for treating type 2 diabetes and not weight loss.

Clinical trials have shown that after one year of treatment, a 15 per cent reduction in body weight can be achieved when Wegovy users take the medication alongside increased physical activity, diet modification and behavioural support.

NICE recommends that Wegovy is used:

• For a maximum of two years within a specialist weight management service providing multi-disciplinary treatment of overweight or obesity (including but not limited to tiers 3 and 4 of the NHS weight management pathway), and:
• Users have at least one weight-related comorbidity, and:
  • a BMI of at least 35.0kg/m2, or
  • a BMI of 30.0kg/m2 to 34.9kg/m2 and meet the criteria for referral to specialist weight management services in NICE's guideline on identification, assessment and management obesity. 

Note that NICE diverges from the Summary of Product Characteristics, which states that Wegovy is to be used in adults with an initial BMI of:

•  ≥30.0kg/m2 (obesity), or
• ≥27.0kg/m2 to ≤30.0kg/m2 (overweight) with at least one weight-related comorbidity.

Weight-related comorbidities include hyper-tension and cardiovascular disease. In mid-2023 NICE stated that it was “unable to make a recommendation” about the use of semaglutide for managing overweight and obesity in young people aged 12 to 17 years. The SPC, however, now includes treatment for adolescents (≥12 years) with:

• Obesity and
• Body weight above 60kg as an adjunct to a reduced-calorie diet and increased physical activity for weight management.

The SPC includes a table with further advice about BMI based on age and sex.Prior to the commercial availability of Wegovy, Ozempic had been used off-label for weight management. As Wegovy is now available, there should be no more off-label use. However, should this happen, it is important to note that the two products are not equivalent as the licensed doses and dose escalation schedules are different.