Educational content only. This article is for informational purposes and does not constitute medical advice. Erica is not a physician. Always consult a qualified healthcare provider before making any health decisions.
Most people walking into a semaglutide consultation are focused on one question: can I get it? That's understandable. But the appointments that go best are the ones where patients come in having done some homework.
These are the five questions I'd want answered before starting — questions your doctor may not volunteer unless you ask.
The SELECT trial showed that semaglutide reduces major cardiovascular events by 20% in people with existing cardiovascular disease and obesity. This is a meaningful benefit that may make semaglutide particularly compelling if you have CV risk factors.
On the other hand, if you have a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 (MEN2), semaglutide carries a black box warning and is contraindicated. History of pancreatitis is another important consideration.
Ask your doctor how your specific history affects the risk-benefit calculation — not just whether you're eligible, but why the calculus looks the way it does for you specifically.
Semaglutide is started at a low dose and titrated up over months to reach the therapeutic dose of 2.4mg weekly (for Wegovy). The standard schedule increases the dose every 4 weeks.
Most of the GI side effects — nausea, vomiting, diarrhea — are worst during escalation and improve once the dose stabilizes. For some people, moving slower through the escalation schedule significantly improves tolerability without meaningfully affecting efficacy.
Ask whether your prescriber is willing to hold at a lower dose for an extra 4 weeks if you're experiencing significant side effects. A good prescriber will say yes — this is standard practice, not a special accommodation.
This is the question most people don't ask, and it matters a lot for long-term outcomes. Studies on GLP-1s consistently show that a significant portion of weight lost is lean mass, not just fat. In some analyses, muscle loss accounts for 25-40% of total weight lost.
The evidence suggests that resistance training and higher protein intake (1.2-1.6g per kg of body weight) can meaningfully mitigate lean mass loss during GLP-1 therapy. Ask your doctor whether they have a protocol for this, or whether they can refer you to a dietitian who specializes in this area.
If the answer is "just try to eat enough protein," that's a sign the practice may not be thinking holistically about body composition outcomes.
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A responsible prescriber should have a monitoring plan. At minimum, this typically includes:
Ask specifically what you should watch for and when to call. Acute and severe abdominal pain that radiates to the back — a possible sign of pancreatitis — warrants stopping the medication and seeking immediate care. Your doctor should tell you this.
STEP 4, the withdrawal study, showed that people who stopped semaglutide after achieving weight loss regained about two-thirds of the lost weight within a year. This doesn't mean the drug doesn't work — it means it works while you're taking it, like most medications for chronic conditions.
The question of whether semaglutide is a short-term intervention or a long-term medication is something you should have a clear conversation about. If the plan is to use it temporarily to lose weight and then stop, understand what the data says about maintenance. If the plan is long-term use, understand what that means for cost, monitoring, and what happens if you eventually need to discontinue.
A prescriber who presents semaglutide as a simple fix without discussing long-term strategy isn't giving you the complete picture.
Write these down before your appointment. Bring a list. Doctors appreciate informed patients, and a 15-minute appointment goes fast. If a prescriber is dismissive of these questions, that tells you something important about how they approach patient care.
For a deeper dive into the trial data behind semaglutide, read my complete evidence guide.
