New Analysis Confirms Wegovy Can Sustain Weight Loss for 4 Years and Support Heart Health

Key Takeaways

  • A new analysis shows that Wegovy is effective for long-term weight loss, with users maintaining weight loss for at least four years.
  • The medication shows significant cardiovascular benefits and appears to reduce the risk of heart disease independently of weight loss.
  • The findings bolster an understanding of how safe and effective Wegovy is for long-term use, as well as the ways it affects the body beyond weight loss.

A new analysis of the longest study of the obesity medication Wegovy (semaglutide) shows it can help people safely lose weight and sustain it for at least four years.

The SELECT trial, which ended in 2023, showed that Wegovy can reduce the risk of heart disease, opening avenues for insurance coverage of the drug. The new, long-term analysis of the trial confirms that Wegovy is safe and effective after years of use across all sexes, races, body sizes, and geographic groups.

A major takeaway from the study is that heart health seems to improve for people on Wegovy, even if they don’t lose much or any weight, according to Harlan Krumholz, MD, SM, a professor of medicine at Yale School of Medicine and incoming editor-in-chief of the Journal of the American College of Cardiology (JACC), who wasn’t involved with the study.

“This finding shifts our understanding, emphasizing semaglutide’s potential as a cardiovascular medication beyond its role in weight management. Soon, we might be calling it a heart health drug for people with obesity rather than an anti-obesity drug,” Krumholz said in an email to Verywell.

A second study, posted as a preprint last week by JACC, supported that finding. It showed that Wegovy could benefit people with heart failure and obesity, independently of weight loss. Krumholz said this supports the idea that Wegovy could be used as a heart failure treatment as well as an obesity medication.

About 6% of respondents to a Kaiser Family Foundation poll said they are taking a GLP-1 receptor agonist drug, like Wegovy, Ozempic, or Mounjaro. Novo Nordisk said about 25,000 people are starting Wegovy every week.

Weight Loss From Wegovy Is Sustained for Four Years

The SELECT trial included over 17,600 participants who took Wegovy between 2018 and 2021. The analysis posted last week by JACC is the first of several sub-papers focusing on different aspects of that trial.

The paper showed that people who took Wegovy for four years lost weight over about 65 weeks and sustained that weight loss for the entire period. The observation period was twice as long as previous studies.

After four years, participants lost an average of about 10% of their body weight. That’s lower than the 15% average in prior studies. This may be because the participants did not receive the maximum dose of Wegovy and were not required to follow lifestyle changes, unlike in the STEP trial that evaluated weight loss, according to Donna Ryan, MD, professor emeritus at the Pennington Biomedical Research Center and senior author of the study.

After two years, 12% of people on Wegovy reached a “healthy” BMI zone (less than 25 kg/m2), compared to about 1% in the placebo group. More than half who took the treatment no longer had obesity based on BMI class.

The researchers broke down the results by demographic subgroups, such as age, sex, starting BMI, race, and ethnicity. They found that all subgroups achieved “robust” weight loss.

Ryan said people with a BMI between 27 and 30 (in the overweight category) lost the least weight compared with people with higher BMI.

“This was unexpected. They should have higher exposure to the medication,” Ryan told Verywell in an email. “We think it is a mathematical issue. No one loses weight forever—they lose to a plateau, and those who were closer to their plateau had proportionally less weight to lose.”

Changes in BMI alone are not enough to judge how well the drug is working, she added. Improvements in blood glucose and A1c levels, blood pressure, lipid levels, mobility, and satisfaction in one’s body are equally important.

Ryan said it’s not possible to estimate whether Wegovy will lead to sustained weight loss over longer periods, but “sustaining weight loss for four years is very reassuring.”

Wegovy Seems to Benefit the Health Regardless of Weight Loss

The SELECT trial showed a 20% reduction in heart health outcomes, including heart attack, stroke, and cardiovascular death.

Both the new analysis and the JACC study bolstered that finding.

In the JACC study, researchers found that people with obesity-related heart failure who took semaglutide saw a reduction in a biomarker that helps diagnose heart failure and predict the disease’s prognosis. For those with the highest levels of this biomarker, semaglutide improved their heart health enough that it rivals other heart medications, the authors wrote.

In an analysis of the SELECT data presented at the European Congress on Obesity last week by John Deanfield, BChir, a professor of cardiology at University College London, semaglutide appeared cardioprotective regardless of the participant’s BMI. Even those who lost less than 5% of their body weight on semaglutide had fewer major cardiovascular events than the placebo group did.

There are several ways cardiovascular function improves when someone with obesity loses weight. For instance, losing weight can lead to lower blood pressure, meaning the heart doesn’t have to work as hard to pump.

The finding that cardiovascular improvement is independent of weight loss suggests other mechanisms might be at play, though scientists aren’t yet sure what they are, Krumholz said. It may involve semaglutide’s potential ability to reduce inflammation, protect the kidneys, and minimize fat deposits around the heart.

“Regularly monitoring cardiovascular risk factors, such as blood pressure, cholesterol, and glucose levels, is essential while taking semaglutide,” Krumholz said. “What is most important here is for people to stay on the medication.”

More Support for Expanded Use Indications for Wegovy

In March, the Food and Drug Administration (FDA) granted Wegovy a new indication to reduce the risk of heart attacks and stroke in people with heart disease who are overweight or obese. Soon after, Medicare announced that it would cover Wegovy for people with a prior heart attack, stroke, or peripheral artery disease.

“The compelling evidence from the SELECT and [JACC] studies should encourage broader insurance coverage for semaglutide. Demonstrating significant health benefits strengthens the case for making these medications more accessible,” Krumholz said.

Veronica Johnson, MD, an assistant professor of medicine at the Northwestern University Feinberg School of Medicine, said she expects semaglutide use will lead to even more health benefits beyond direct weight loss.

In the meantime, she said the current studies indicate that some patients may not need to take the highest dose amounts to see meaningful health benefits from taking semaglutide.

“Quite often, insurance may not continue to cover the medication for patients unless they get to the maintenance dose,” Johnson said. “I hope the results from this study allow for the prescribers of the medication to have a little more leeway in their prescribing practices and it not be determined based on insurance.”

What This Means For You

If you are taking Wegovy, talk to your doctor about how to keep track of changes to your health beyond BMI. Even if you do not achieve your goal weight, your heart health may improve.

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