Approved (FDA / EMA)
FDA (U.S.): Approved: Ozempic (2017) for type 2 diabetes, expanded in 2025 to reduce the risk of kidney function worsening and cardiovascular death in T2D with chronic kidney disease; Rybelsus (2019, tablets) for T2D; Wegovy (2021) for obesity in adults, in 2022 adolescents ≥12 years, in 2024 cardiovascular risk reduction, in August 2025 MASH with moderate-to-advanced fibrosis (accelerated approval); Wegovy 25 mg tablets (December 2025) and a 7.2 mg dose (Wegovy HD, March 2026).
EMA (EU): Approved: Ozempic (Feb 8, 2018) for T2D; Rybelsus (2020, oral) for T2D; Wegovy (Jan 6, 2022) for weight management in adults and adolescents ≥12 years; Wegovy is also available as daily tablets for adults.
Women lose on average more weight than men with the new anti-obesity drugs (semaglutide, tirzepatide) (2025 review). According to the FDA label for Wegovy, in the SELECT cardiovascular trial hip and pelvic fractures were more frequent with semaglutide than with placebo in women (1% vs 0.2%) and hair loss was reported more in women. It must be stopped at least 2 months before a planned pregnancy because of its long half-life, and discontinued if pregnancy occurs. In the alcohol and tobacco trials most participants were women (71% and 83%), and the reduction in sexual behavior in animals was observed in females. View the study →
There is no established standard dose for this case; it is advisable to consult a professional.
Semaglutide 2.4 mg/week produces large, sustained weight loss in people with overweight or obesity WITHOUT diabetes: ≈ −12 kg, −11.8% of body weight, −4.5 kg/m² of BMI and −9.4 cm of waist, in addition to improving blood pressure, glucose and lipids. It is NOT a supplement: it is a prescription medication and digestive effects (nausea) are frequent.
View the study (meta-analysis) →68-week trial: in people with obesity and knee osteoarthritis, weekly semaglutide reduced weight and improved knee pain compared with placebo. Suggests that losing weight with GLP-1 relieves osteoarthritis. Prescription drug.
View the study (study) →26-week randomized trial in 108 people with moderate or severe alcohol use disorder and obesity seeking treatment (53 women and 55 men): semaglutide 2.4 mg/week, added to cognitive-behavioral therapy, reduced heavy drinking days by 41 percentage points versus 26 with placebo (difference −13.7 points). Transient digestive effects. Not approved for addictions: off-label use and with a physician.
View the study (RCT) →Meta-analysis of 14 studies (4 randomized trials and 10 observational) with GLP-1 agonists: the AUDIT alcohol risk score fell 7.8 points on average, with fewer alcohol-related relapses, diagnoses and admissions. The effect was clearer with semaglutide and liraglutide. High heterogeneity between studies.
View the study (meta-analysis) →9-week randomized trial in 48 adults with alcohol use disorder (71% women) at low doses (0.25–1 mg/week): it reduced weekly urges to drink, the amount drunk in a laboratory session and drinks per drinking day, although not the number of days on which drinking occurred. A later trial with oral semaglutide (50 people, 2026) confirmed less craving in daily life and fewer heavy drinking days.
View the study (RCT) →Swedish national cohort of 227,866 people with alcohol use disorder (2006–2023): periods of semaglutide use were associated with 36% fewer admissions for alcohol and 32% fewer for any substance, more than with the drugs approved for alcoholism. It is an association, not proof of cause and effect.
See the study (observational) →Medical records of 85,223 people with obesity: semaglutide was associated with 44% fewer new diagnoses of cannabis use disorder and 38% fewer relapses compared with other weight-loss drugs; replicated in 596,045 people with type 2 diabetes. Association, not cause and effect.
See the study (observational) →Cohort of 33,006 people with type 2 diabetes and opioid use disorder: semaglutide was associated with a 42% to 68% lower overdose risk than other antidiabetic drugs, including other GLP-1s. A randomized trial is under way with 200 people on methadone or buprenorphine treatment to test this.
See the study (observational) →9-week pilot trial in 24 daily smokers (83% women): semaglutide reduced the urge to smoke and weight, but did not significantly change cigarettes per week. A large trial is needed to know whether it helps quit smoking.
View the study (RCT) →Meta-analysis through January 2026 (trials, cohorts and pharmacovigilance): with semaglutide, depression (RR 1.25), anxiety and suicidal ideation or attempts did not increase significantly. Certainty is limited by data heterogeneity: reassuring, not definitive.
View the study (meta-analysis) →In sexually experienced female rats and mice, several GLP-1 agonists reduced sexual behavior and time with the male; by contrast, long-acting ones increased general sociability. It is the closest thing to an affective 'disconnection' in the literature, but it has not been shown in people: in a trial in healthy men, dulaglutide did not change sexual desire.
View the study (preclinical) →⏱ 2 min read
Semaglutide is a synthetic GLP-1 analog that has reshaped the treatment of obesity and type 2 diabetes in just a few years; it is injected once a week and is known commercially as Ozempic (diabetes) or Wegovy (obesity).
It mimics GLP-1, a hormone your gut releases when you eat. It stimulates insulin only when needed, suppresses glucagon, slows gastric emptying, and reduces appetite from the brain.
In obesity without diabetes, at 2.4 mg/week, it reduces weight by ≈ 12 kg, −11.8% of body weight, −4.5 kg/m² of BMI, and −9 cm of waist, with improvements in blood pressure, glucose, and lipids. A magnitude comparable to the least invasive bariatric surgery.
In obesity with knee osteoarthritis, 68 weeks of semaglutide not only lower weight: they relieve joint pain compared with placebo. In obesity without diabetes but with cardiovascular disease, it reduces the risk of major cardiovascular events by around 20%.
Prescription required and slow escalation: start at 0.25 mg weekly and increase every 4 weeks up to the target dose. Subcutaneous injection in the abdomen, thigh, or arm with a prefilled pen. The effect is noticed within weeks and keeps accumulating over months.
Frequent digestive effects in the first months: nausea, vomiting, diarrhea, constipation. Relevant risks: pancreatitis (rare), gallstones from rapid weight loss, and significant loss of muscle mass if not offset with protein and strength training.
Contraindicated in personal or family history of medullary thyroid carcinoma or MEN2, in pregnancy and breastfeeding, and in prior pancreatitis.
GLP-1 does not act only in the gut. There are receptors in the brain's reward circuit (ventral tegmental area, nucleus accumbens, lateral septum, and amygdala). By activating them, semaglutide dampens the dopamine surge in response to whatever "hooks" you: that is why many people who take it to lose weight say they feel less like drinking or smoking.
These are no longer just anecdotes. Three randomized trials in alcohol use disorder (48 people for 9 weeks, 108 for 26 weeks alongside cognitive behavioral therapy, and 50 with the oral version) show less craving and fewer heavy-drinking days. Large registries point in the same direction: fewer hospitalizations for alcohol and other drugs in Sweden, less cannabis use disorder, and fewer opioid overdoses. In tobacco, craving goes down, but it has not yet been shown that people quit smoking.
Today it is a promising complement, not an approved treatment. It works best as an add-on to psychological therapy in people with obesity. It does not replace supervised detoxification, methadone or buprenorphine, or therapeutic support, and there are no data on what happens to craving when it is stopped. There are ongoing trials with opioids and with alcohol in people without obesity.
This is the question behind the so-called "Ozempic personality": social media accounts of people who feel less pleasure, less desire, or a certain emotional distance. What is known so far:
Conclusion: it is plausible that in some people the "high" from certain rewards goes down, and this may be felt as less desire. There is no evidence that it severs emotional bonds. If you notice apathy, lack of pleasure, or emotional coldness, talk to your doctor: it may be due to the dose, the calorie deficit, or a depressive condition that should be evaluated.
Yes: true obesity (BMI ≥30, or ≥27 with comorbidities) that has not responded to well-applied diet and exercise, or type 2 diabetes with inadequate control.
No: to lose two or three kilos for a specific occasion, pregnancy, breastfeeding, a history of the thyroid tumors mentioned, or prior pancreatitis.
It changes what medicine can offer a person with obesity or diabetes when diet, exercise, and other drugs are not enough. The benefits for weight, glycemia, blood pressure, joint pain, and cardiovascular health are real. It requires a prescription, careful escalation, and monitoring of muscle mass; it is not a miracle pill.
Information, not medical advice. Scientific evidence reflects the quality of the studies.