Endocrinologist explains Wegovy: dosing, mechanism, who it is for

The physician opens with the GLP-1 axis: native GLP-1 has a 2-minute half-life, while semaglutide is engineered for ~7-day plasma stability through albumin binding. They explain dual mechanism — central appetite suppression via hypothalamic GLP-1 receptors and delayed gastric emptying — and clarify that Wegovy and Ozempic are the same molecule at different dose ceilings (2.4 mg vs 2.0 mg). Indications are restricted to BMI ≥30, or ≥27 with at least one weight-related comorbidity. The titration schedule is reviewed: 0.25 mg weekly for 4 weeks, then 0.5, 1.0, 1.7, and maintenance 2.4 mg, each step held for 4 weeks unless side effects warrant a slower escalation. They emphasize that fast titration is the single biggest predictor of GI dropout. Side-effect counseling covers nausea, vomiting, constipation, and the rare but serious risks: pancreatitis, gallbladder disease, and the rodent-only thyroid C-cell tumor signal — which they describe as low-confidence but worth disclosure. The physician reviews contraindications (personal/family history of medullary thyroid carcinoma, MEN2), and notes that real-world data so far has not confirmed the rodent signal in humans. Drug interactions are briefly covered, with focus on oral contraceptive absorption around the GI-emptying window. The video closes with their patient-selection framework: prioritize patients with metabolic comorbidities (T2D, OSA, NAFLD), set realistic 6-month re-evaluation milestones, and discontinue if <5% loss by month 6.