Weight Loss Medications: What Really Works and How to Start Treatment in Georgia

People ask about Wegovy and Ozempic for good reason. These were the first medicines on which people in clinical trials lost about 15% of their body weight on average, and on tirzepatide (Mounjaro) even more. For comparison, the previous generation of drugs gave an average of a few percent. Below we look at which weight loss medicines are approved, who they are prescribed for, what results to expect, which of them are currently sold in Georgia, and which doctor is the easiest place to start.

The main point first: these medicines work, but they are best chosen together with a doctor. Not because that is the rule, but because each of them has its own limitations, and in one consultation a doctor can check which medicine is right for you.

When weight loss medicines are prescribed

The World Health Organization describes obesity as a chronic disease that needs long-term treatment, not a quick course "before summer" (WHO, 2025). In this treatment, medicines are added to diet and physical activity, not used instead of them. The European product information for every medicine in this article says the same.

According to the product information from the European Medicines Agency (EMA), these medicines are indicated for adults if:

• their body mass index (BMI) is 30 or higher;

• or their BMI is between 27 and 30 and they have at least one weight-related condition: prediabetes or type 2 diabetes, high blood pressure, cholesterol problems, sleep apnoea, heart disease.

BMI is calculated by dividing your weight in kilograms by your height in metres squared. For example, at a height of 1.70 m and a weight of 90 kg, BMI is about 31. For teenagers the thresholds are different and are based on age-specific charts, and only a doctor decides on treatment.

If your BMI is below 27 and you want to lose a few kilograms, these medicines are not indicated according to their product information. EMA specifically asks that GLP-1 medicines not be used for "cosmetic" weight loss, that is, by people without obesity or weight-related conditions: for these patients, doctors are advised to offer lifestyle changes, and the extra demand worsens shortages for people with diabetes (EMA, 2024). In this situation a dietitian is a more useful place to start.

Which medicines are approved

The table lists the medicines that EMA has authorised for treating obesity. The figures show the average weight loss in the key clinical trial. This is not a promise: some people lose more, some less.

Independent Cochrane reviews give a similar picture: compared with placebo, tirzepatide reduces weight by about 16%, semaglutide by about 11% and liraglutide by 4–5%. The review authors note that most of the trials were funded by manufacturers and that long-term data are still limited (Cochrane, 2025).

Semaglutide: Wegovy and Ozempic

They contain the same substance but are two different medicines. Wegovy is approved for weight loss in adults and in adolescents from 12 years of age. Ozempic is approved only for treating type 2 diabetes. They have different doses, pens and product information. Using Ozempic for weight loss is off-label use, and EMA explicitly asks that this not be done (EMA, 2024).

Semaglutide belongs to the GLP-1 group: it resembles a hormone the body makes itself, one that helps regulate appetite. The medicine acts on the appetite centres in the brain, so you feel less hungry and feel full sooner.

Tirzepatide: Mounjaro

Tirzepatide acts on two hormone receptors at once, GIP and GLP-1. In the European Union it is sold under a single name, Mounjaro, and is approved both for treating type 2 diabetes and for weight loss in adults. In the United States the same medicine is sold for weight loss as Zepbound (FDA, 2023).

Liraglutide: Saxenda

The predecessor of semaglutide from the same group. It needs daily injections, and the effect is smaller on average. According to the product information, treatment is stopped if weight has fallen by less than 5% after 12 weeks on the full dose.

Orlistat: Xenical and generics

Capsules that act in the gut rather than on appetite: part of the fat in food is not absorbed and leaves the body with the stool. Hence the main side effects: oily stools, sudden urges to go to the toilet and wind, especially after fatty meals. The effect is moderate. In the four-year XENDOS trial, type 2 diabetes developed less often on orlistat, mostly in people whose glucose tolerance was impaired from the start. In the EU, orlistat 60 mg is sold without a prescription to adults with a BMI of 28 or higher.

Naltrexone/bupropion: Mysimba

Tablets that act on the appetite and "reward" centres in the brain. They have a long list of contraindications (more on that below), so they are never started without a doctor. If weight has not fallen by at least 5% after 16 weeks, the medicine is stopped. Since 2025 there is one more condition: once a year the doctor and the patient assess cardiovascular risk together and decide whether to continue treatment (EMA, 2025).

Less common options

In the United States, phentermine is approved only as a short-term add-on to diet, for a few weeks (FDA label). Setmelanotide (Imcivree) is prescribed only for rare forms of obesity: genetic syndromes confirmed by testing, and obesity after damage to the hypothalamus (EMA). We found neither of them in Georgian pharmacy chains or in the medicines registry.

What results to expect

Weight comes off gradually, over months: in the main trials, results were measured after 56–72 weeks of treatment. The average figures in the table come from people who were also changing their diet and moving more.

To be honest about what happens after stopping: in the STEP 1 trial, a year after finishing semaglutide, participants had regained about two thirds of the weight they had lost (Wilding et al., 2022). In another trial, STEP 4, people switched to placebo started gaining weight, while those who continued treatment kept losing it. This is why WHO regards these medicines as long-term treatment (WHO, 2025). How long to take them and what to do afterwards is best discussed with a doctor before the first injection.

There is a benefit for the heart, too. In the SELECT trial, in people with excess weight and existing heart disease, semaglutide lowered the risk of heart attack, stroke and cardiovascular death by 20% (Lincoff et al., 2023).

In December 2025 WHO issued its first recommendation on these medicines. It is conditional: semaglutide, tirzepatide and liraglutide may be used for the long-term treatment of obesity in adults, except during pregnancy. WHO explains that the recommendation is conditional because data on long-term effectiveness, safety and stopping treatment are still limited, and advises combining treatment with support for diet and physical activity (WHO, 2025).

Side effects and who should not take them

The most common side effects of semaglutide, tirzepatide and liraglutide involve digestion: nausea, vomiting, diarrhoea, constipation and abdominal pain. They are usually stronger in the first weeks, while the dose is being gradually increased. Severe vomiting and diarrhoea can cause a lot of fluid loss, which sometimes affects the kidneys.

Less often, more serious complications occur:

• acute pancreatitis, inflammation of the pancreas. The sign is severe, persistent abdominal pain that may spread to the back. With pain like this, see a doctor straight away;

• gallstones;

• NAION, sudden loss of vision in one eye caused by reduced blood supply to the optic nerve. It is a very rare complication of semaglutide, affecting up to 1 in 10,000 people. If your vision suddenly gets worse, see a doctor without delay (EMA, 2025).

EMA reviewed reports of suicidal thoughts in people taking GLP-1 medicines and found no causal link (EMA, 2024).

The European product information for Wegovy, Mounjaro and Saxenda lists only one formal contraindication: allergy to any of the ingredients. But there are situations in which they are not used or are used with caution, and these are exactly what a doctor will check at the first consultation:

• pregnancy and planning a pregnancy. Semaglutide and liraglutide are not used during pregnancy, and tirzepatide is not recommended. Semaglutide is stopped at least 2 months before a planned pregnancy, tirzepatide at least 1 month before. Semaglutide and liraglutide are not used while breastfeeding;

• past pancreatitis, severe stomach and bowel diseases, including severe gastroparesis;

• diabetic retinopathy: it can temporarily get worse when blood sugar falls quickly, so your eyes need to be monitored. Read more in our article on diabetic retinopathy;

• diabetes treated with insulin or sulfonylureas: combined with them, the risk of hypoglycaemia rises, and the doctor will adjust your treatment;

• medullary thyroid cancer or MEN2 syndrome in you or your relatives. In the US Wegovy label this is a contraindication (FDA); the European one does not include it, but thyroid C-cell tumours were found in rodents. Your doctor will ask about your family history.

If you are going to have surgery under general anaesthesia or deep sedation, tell the anaesthetist that you are taking a GLP-1 medicine: the stomach empties more slowly, and this is taken into account before the procedure.

Orlistat has different contraindications: chronic malabsorption in the gut, cholestasis (impaired bile flow) and breastfeeding. It can weaken the effect of some medicines, including oral contraceptives in case of severe diarrhoea, so show your doctor a list of everything you take.

Mysimba has the most contraindications: uncontrolled blood pressure, current or past seizures, bipolar disorder, bulimia or anorexia, opioid use, severe liver or kidney disease, and several more. Blood pressure and pulse are measured before treatment starts.

What is available in Georgia

We checked the catalogues of the major pharmacy chains and the state medicines registry of the Georgian Ministry of Health on 12 October 2026. We were unable to check the Aversi chain. The situation changes, so below is only what we saw on that date.

• Ozempic and Mounjaro are listed in the catalogues of major Georgian pharmacy chains, but they can only be bought in a pharmacy on presentation of a Form 100 medical certificate from a doctor; they are not sold online. On that date these medicines were not listed in Georgia's state medicines registry. Rybelsus semaglutide tablets, which are also intended for treating diabetes, are sold the same way.

• Wegovy was not in the catalogues of the major chains.

• Saxenda, Xenical and the recently registered Mysimba are listed in the registry as prescription-only. Xenical and other orlistat 120 mg products are in the chains' catalogues; we did not find Saxenda or Mysimba there. Check availability at a specific pharmacy with your doctor or the pharmacy. In the registry, orlistat 60 mg is classified as over-the-counter.

We explain what Form 100 is and where to get it in our article on finding a doctor in Georgia. We do not list prices: they change, so check them at the pharmacy.

Be careful: "semaglutide" from the internet and supplements

Demand for these medicines is high, and so is the number of fakes. WHO states plainly that demand has led to the spread of falsified and substandard products (WHO, 2025). In 2023 EMA reported falsified Ozempic pens found at wholesalers in Europe and advised buying medicines only from legal pharmacies (EMA, 2023).

The US Food and Drug Administration (FDA) warns that unapproved versions of these drugs have not been checked for safety or quality, and that the salt forms "semaglutide sodium" and "semaglutide acetate" found in such products differ from the active substance in approved medicines (FDA).

In practice, this means the following. A pen bought through an ad or on Instagram may contain the wrong substance or the wrong dose, and there is no way to check this at home. Capsules and teas "with an Ozempic effect" are sold as dietary supplements: they have nothing to do with semaglutide, nobody has tested them as medicines, and they are not among the obesity treatments approved by EMA. If you want to try treatment, the safer route is through a doctor and a pharmacy.

Where to start: which doctor to see

You can start with one of these doctors, depending on your situation:

• Endocrinologist. The main specialist for obesity and metabolism. They will check your hormones and blood sugar, rule out contraindications and, if a medicine is needed, choose the right one.

• Dietitian. Helps with nutrition, with or without medication. A good first step if you want to lose a little weight or if medicines are not indicated for you. We wrote about how food affects how you feel during the day in our article on sweet breakfasts.

• General practitioner. If you are not sure where to start. A GP will order basic tests, measure your blood pressure and refer you to the right specialist.

• Gynecologist-endocrinologist. For women whose excess weight comes with an irregular cycle or polycystic ovary syndrome (PCOS). The 2023 international PCOS guideline notes that weight is gained more easily with this syndrome and allows weight loss medicines for adults alongside lifestyle changes (Teede et al., 2023).

For your first consultation, it helps to bring a list of all the medicines you take and any recent test results, and to know your weight and height.

This article is for information only and does not replace a consultation with a doctor. Information on the availability of medicines in Georgia was checked on 12 October 2026.