Ozempic (semaglutide) in the treatment of obesity

What is Ozempic?

Ozempic (semaglutide) is a prescription medicine approved for the treatment of type 2 diabetes. Patients treated with Ozempic often lose weight as well, but in Sweden, Wegovy (semaglutide 2.4 mg) is the preparation specifically approved for weight management in adults (BMI ≥ 30 or BMI ≥ 27 with weight-related comorbidity). Treatment decisions must always be made by a physician based on the indication and the individual’s circumstances (2,3).

How does Ozempic work?

Ozempic contains semaglutide, a GLP-1 receptor agonist that mimics the natural hormone GLP-1 (glucagon-like peptide-1). GLP-1 is normally released from the small intestine after a meal and plays several key roles in regulating appetite, satiety and blood glucose (2,3).

By enhancing these natural processes, Ozempic contributes to several beneficial effects:

• Reduced appetite and increased satiety: The medicine affects the brain’s appetite centre, causing satiety to occur earlier and last longer. This reduces energy intake and supports weight loss.
• Slower gastric emptying: Ozempic delays stomach emptying, which stabilises post-meal blood glucose levels and enhances satiety.
• Improved blood glucose control: The treatment stimulates insulin secretion at elevated glucose levels and suppresses glucagon production, contributing to more stable glucose levels.

Together, these mechanisms support long-term weight loss and improved metabolic health, making semaglutide an effective treatment option for overweight and obesity.

Clinical effect

Semaglutide, the active substance in Ozempic and Wegovy, has shown clear effects on both blood glucose control and body weight in clinical studies. In the separate STEP programme, where a higher dose of semaglutide (2.4 mg; Wegovy) was used for individuals with overweight or obesity without diabetes, an average weight loss of around 15–17% was achieved after 68 weeks (2).

Who can be treated with Ozempic?

Ozempic is a prescription medicine approved for people with type 2 diabetes. Wegovy is approved for weight management in people with a BMI ≥ 30, or BMI ≥ 27 with weight-related comorbidities such as high blood pressure, type 2 diabetes or other risk factors that increase the likelihood of complications. Treatment should always be part of a long-term plan including lifestyle support.

Off-label prescribing of Ozempic for obesity should be avoided when Wegovy is available. Treatment must always be prescribed by a physician and used as part of a long-term plan for health and weight control, including physical activity, dietary changes and other lifestyle modifications (1-3).

Treatment with Ozempic

Ozempic should be used as directed by a physician and taken regularly for optimal effect, usually once weekly. The medicine is administered as an injection according to medical instruction. The injection is given into the subcutaneous fat of the abdomen, thigh or upper arm using a pre-filled pen.

After injection, semaglutide is absorbed gradually, influencing appetite regulation and contributing to reduced hunger and subsequent weight loss.

The starting dose is typically 0.25 mg. The dose may gradually be increased depending on how the body responds and on the physician’s recommendation. This gradual titration allows the body to adjust and reduces the risk of potential side effects. It is not always necessary to increase to the highest dose; treatment continues at the dose that provides good effect.

It is important to use the medicine continuously and not stop too early, as the effects on blood glucose and weight can diminish quickly if treatment is interrupted (2). Treatment should always be monitored medically and integrated into a long-term weight management programme. Patients also need to understand that semaglutide is not a miracle drug and should be combined with lifestyle changes (3).

Weight loss and lifestyle changes

To achieve the best possible results from Ozempic, a comprehensive strategy is required. This means combining the medicine with healthy changes such as improved eating habits, regular physical activity, stress management and good sleep — ideally with support from healthcare professionals.

Diet for healthy weight with Ozempic

Weight loss requires a calorie deficit, meaning energy intake must be lower than energy expenditure. Medication can facilitate this by increasing satiety and reducing hunger, which commonly occurs during calorie restriction.

With reduced energy intake, it is important that the diet is nutrient-dense to meet the body’s needs for vitamins, minerals and protein. Adequate protein supports better satiety, preservation of muscle mass during weight loss, and improved body composition — especially when combined with strength training (3).

Treatment should always be individualised based on the patient’s current eating habits, preferences and circumstances, with adjustments made accordingly.

The importance of physical activity

Physical activity is an important part of comprehensive weight loss treatment. It can enhance the effect of medical therapy, support overall wellbeing, and help prevent or reduce side effects. It also contributes to preserving muscle mass, improving metabolism and increasing psychological wellbeing. Regular movement can help reduce stress, improve sleep and lower the risk of complications.

Recommendations include combining different forms of activity:

• Everyday movement: taking the stairs, walking, cycling or standing more often.
• Aerobic activity: such as brisk walking, swimming or cycling.
• Strength training 2–3 times per week is particularly emphasised to preserve muscle mass and support healthy body composition (4).

Recommendations should always be adapted to the individual’s abilities, limitations, health status and goals.

Sleep and rest

Adequate sleep is important for healthy weight regulation. Lack of sleep affects several hormonal systems controlling appetite, satiety and energy balance (5).

Lower levels of stress

Chronic stress can lead to elevated cortisol levels, affecting both appetite regulation and metabolism. What is perceived as stressful is highly individual and influenced by personality, life circumstances and previous experiences. Support and treatment should therefore be adapted to each individual’s needs.

For some, reducing external stressors is essential; for others, strengthening recovery capacity and developing coping strategies is more important. Regular movement, sufficient sleep and stress-reducing techniques can be valuable components of this work (6).

Common side effects

The most common side effects of Ozempic are gastrointestinal. They are usually mild to moderate and often decrease after the first weeks of treatment (1,2).

Common side effects include:

• Nausea
• Diarrhoea
• Vomiting
• Constipation
• Gas or bloating

Nausea is the most frequent side effect and occurs mainly during the first weeks when the dose is gradually increased. For many people, symptoms decrease once the body has adjusted to the treatment.

How to relieve gastrointestinal symptoms

To help relieve symptoms, patients can:

• Eat smaller portions
• Eat slowly and stop when feeling full
• Avoid fatty, spicy or fried foods
• Drink water frequently in small amounts
• Avoid carbonated drinks
• Engage in regular physical activity

If symptoms persist or significantly affect daily life, the patient should contact healthcare services for assessment, advice and support.

Other side effects

Ozempic can also cause an increased heart rate. The risk of hypoglycaemia increases mainly when combined with insulin or sulfonylureas; dose adjustments of these may be needed. In rare cases, more serious side effects can occur, such as pancreatitis or gallstone disease. It is important that patients contact a doctor if severe or persistent symptoms arise (1,2).

Important considerations during weight loss treatment

Semaglutide is not a rapid-acting weight-loss drug; it works gradually over time. Patience, consistency and a holistic approach are required to achieve sustainable results (1,3).

Stopping treatment without medical supervision may cause blood glucose or weight to rise again, which is why changes should always be made together with a healthcare provider.

Patients should also be informed that semaglutide is unsuitable or must be used with caution in certain situations, such as in people with type 1 diabetes, certain thyroid conditions or a history of pancreatitis. It is also not given to pregnant or breastfeeding individuals or those planning pregnancy within two months. Thorough medical assessment is therefore essential before treatment begins (1,3).

Summary – Ozempic

Ozempic is approved for people with type 2 diabetes. Wegovy is approved for weight management in individuals with BMI ≥ 30, or BMI ≥ 27 with weight-related comorbidity such as high blood pressure, type 2 diabetes or other risk factors for complications. Treatment should always be part of a long-term plan including lifestyle support. Off-label use of Ozempic for obesity should be avoided when Wegovy is available.

Treatment must be prescribed by a physician and incorporated into a long-term plan for health and weight control, including physical activity, dietary changes and lifestyle modification. By influencing hunger and satiety signals, the active substance provides effective support for healthy weight loss. Treatment is administered as a once-weekly injection and works best when combined with physical activity, dietary adjustments and proper support from healthcare professionals.

For many people, semaglutide treatment leads not only to better blood glucose control but also to improved health and quality of life.

References

1. European Medicines Agency. (2018). Ozempic : EPAR – summary for the public. Retrieved November 13, 2025, from https://www.ema.europa.eu/en/medicines/human/EPAR/ozempic
2. Bergmann, N. C., Davies, M. J., Lingvay, I., & Knop, F. K. (2023). Semaglutide for the treatment of overweight and obesity: A review. Diabetes, Obesity and Metabolism, 25(1), 18–35. https://doi.org/10.1111/dom.14863
   Tillgänglig via: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14863
3. Konstantinos C Koskinas, Emeline M Van Craenenbroeck, Charalambos Antoniades, Matthias Blüher, Thomas M Gorter, Henner Hanssen, Nikolaus Marx, Theresa A McDonagh, Geltrude Mingrone, Annika Rosengren, Eva B Prescott, the ESC Scientific Document Group. Obesity and cardiovascular disease: an ESC clinical consensus statement. European Heart Journal. 2024;45(38):4063–4098. https://doi.org/10.1093/eurheartj/ehae508
4. World Health Organization (WHO). WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. Available at: https://www.who.int/publications/i/item/9789240015128
5. Chaput JP, McHill AW, Cox RC, Broussard JL, Dutil C, da Costa BGG, Sampasa-Kanyinga H, Wright KP Jr. The role of insufficient sleep and circadian misalignment in obesity. Nat Rev Endocrinol. 2023 Feb;19(2):82-97. doi: 10.1038/s41574-022-00747-7. Epub 2022 Oct 24. PMID: 36280789; PMCID: PMC9590398.
6. Lengton R, Schoenmakers M, Penninx BWJH, Boon MR, van Rossum EFC. Glucocorticoids and HPA axis regulation in the stress-obesity connection: A comprehensive overview of biological, physiological and behavioural dimensions. 2025. Available at: https://pubmed.ncbi.nlm.nih.gov/39623561/

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