Who Can Take Wegovy?

Wegovy is a prescription medicine and not everyone qualifies. The eligibility criteria exist for two reasons: they match the conditions where the medication has been shown to do more good than harm, and they identify people for whom the medication would not be safe.

For Chronic Weight Management (Adults)

The SAHPRA approved indication is for adults with:

• BMI of 30 kg/m² or higher (clinical obesity), or
• BMI of 27 to 29.9 kg/m² with at least one weight related health condition, such as:
  • Type 2 diabetes
  • Pre-diabetes
  • High blood pressure (hypertension)
  • High cholesterol (dyslipidaemia)
  • Obstructive sleep apnoea
  • Cardiovascular disease
  • Polycystic ovary syndrome (PCOS) with metabolic features
  • Severe joint disease where weight reduction would help

Used as an adjunct to a reduced calorie diet and increased physical activity.

For Adolescents (Aged 12 To 17)

Wegovy is approved for adolescents aged 12 and older with obesity. The same dose titration approach is used. Adolescent treatment typically involves:

• Specialist paediatric or adolescent medicine input
• Parent or guardian involvement
• Careful assessment of mental health and eating behaviour history
• Growth and development monitoring

For adolescent use, the consulting doctor will often involve other specialists. Online consultations can initiate the conversation but in person follow up is usually warranted.

For Cardiovascular Risk Reduction

Based on the SELECT trial, Wegovy is also approved to reduce major adverse cardiovascular events in adults with:

• Established cardiovascular disease, and
• BMI of 27 kg/m² or higher

This indication does not require obesity-level BMI. It is specifically for people with existing cardiovascular disease who carry excess weight. More on this.

How To Calculate Your BMI

BMI is calculated as weight in kilograms divided by height in metres squared. Example: 85 kg divided by (1.75 x 1.75) = 27.8.

BMI categories:

• Below 18.5: underweight
• 18.5 to 24.9: normal weight
• 25 to 29.9: overweight
• 30 to 34.9: class 1 obesity
• 35 to 39.9: class 2 obesity
• 40 and above: class 3 obesity

BMI is an imperfect measure. It does not distinguish muscle from fat, so very muscular people can have a high BMI without excess body fat. The consulting doctor looks at BMI alongside waist circumference and other markers.

Who Wegovy Is Not Suitable For

Absolute contraindications

Wegovy should not be used at all if you have:

• Personal or family history of medullary thyroid carcinoma
• Multiple endocrine neoplasia type 2 (MEN2) syndrome
• Prior serious allergic reaction to semaglutide or any of its ingredients

Reasons not to use

Wegovy is also avoided or used with great caution in:

• Pregnancy or planning to conceive within two months
• Breastfeeding
• Active or recent pancreatitis
• Severe gastrointestinal disease, particularly gastroparesis
• Active gallbladder disease
• Severe liver disease (limited data)
• Severe kidney impairment
• Type 1 diabetes (Wegovy is not indicated)
• Active or recent severe eating disorder (case by case)
• Significant uncontrolled mental health condition (case by case)
• Severe diabetic retinopathy (caution, eye assessment first)
• Children under 12 (not approved)

Special Considerations

Older adults

No upper age limit, but older adults may need extra caution around kidney function, multiple medications, and risk of dehydration from gastrointestinal side effects.

BMI just under the threshold

If your BMI is just under 27, the consulting doctor cannot prescribe Wegovy for weight management. This is the SAHPRA approved indication. Other interventions may suit better in the overweight (but not obese, without comorbidities) range.

Previous bariatric surgery

Wegovy can be used after bariatric surgery in some cases, particularly where weight regain has occurred. The altered gut anatomy needs to be considered.

Eating disorder history

A medication that significantly reduces appetite needs careful consideration in anyone with a history of restrictive eating. Some can safely use it under close supervision, others cannot. The consulting doctor will assess.

Mental health considerations

Postmarketing reports have noted depression and suicidal ideation in a small number of patients on semaglutide. People with significant mental health history should discuss this with the prescribing doctor. Treatment is not automatically declined, but it requires honest assessment.

What If You Are Not Eligible

If Wegovy is not appropriate for you, several other approaches may be:

• Liraglutide (Saxenda), an older GLP-1 daily injection
• Orlistat (Xenical), an oral medication that blocks fat absorption
• Structured lifestyle support without medication
• Bariatric surgery for severe obesity

The consulting doctor will discuss alternatives if Wegovy is not suitable.

Frequently Asked