[Column] Wegovy reshaped the obesity outpatient care landscape

“It’s a Wegovy world.”

That’s how I feel when I see obese outpatients these days. As a surgeon whose primary focus is on surgical treatment rather than medication, this situation feels quite unfamiliar.

In the past, outpatient visits were almost entirely related to bariatric surgery. On a typical day, 70 percent of these visits involved post-operative patient care, while the remaining 30 percent were pre-operative consultations.

However, after Wegovy was introduced in Korea in October 2024, the outpatient landscape began to shift—gradually at first, then dramatically by January of this year. Nearly half of all outpatients are now being considered for Wegovy prescriptions.

“Is Wegovy any different?” Obese patients have been prescribed various anti-obesity medications—typically appetite suppressants—for years, so their trust in such treatments is limited. Many have experienced the yo-yo effect: starting a medication, seeing some improvement, only to eventually gain back even more weight than before.

I tell them, “Yes, it’s only been about six months of experience, but Wegovy is very different from the medications we’ve used in the past.”

I explain to patients how Wegovy is distinctly different from existing obesity treatments, summarizing that “more than 90 percent of patients in clinical trials achieved meaningful weight loss, with sustained results for over 16 weeks. Side effects are significantly lower, the once-weekly subcutaneous injections are convenient, and it may also help prevent serious cardiovascular complications such as myocardial infarction.”

Then they ask, “How much do I need to take?” I respond, “You need to set a realistic goal and gradually taper down from there.”

The truth is, Wegovy does have its limitations. Like other obesity medications, it can lead to a steep yo-yo effect once discontinued, and the cost is significant. It’s simply too expensive for most people to use indefinitely.

For prescribing physicians, it’s important to be confident that this new obesity treatment is truly superior to existing options. However, given the yo-yo nature of weight regain after discontinuation, prescribing it without considering long-term goals and follow-up can feel quite burdensome.

I still recommend Wegovy to my patients, saying, “Weight loss is important, but so is what comes after.” From a surgeon’s perspective, having such an effective medication is a welcome addition to the treatment of obesity.

It cannot be overstated that obesity is a disease that often relapses and becomes chronic—this is hard to dispute. I want to emphasize once again that it's crucial to start with a well-thought-out long-term plan to minimize the yo-yo effect and to consider the cost-effectiveness of the treatment.

Dr. Kim Yong-jin is one of the leading authorities on bariatric surgery in Korea. He has performed more than 4,500 cases of bariatric surgery, and was the first surgeon in Korea and the fifth in Asia to be certified as a “Master Surgeon” in bariatric diabetes surgery by the U.S. Surgical Review Corporation (SRC), the world's leading surgical evaluation and certification organization. After training at Asan Medical Center, he worked as a professor of surgery at Soonchunhyang University Seoul Hospital from 2005 to 2019. He currently serves as the Director of the Obesity and Diabetes Surgery Center at H+ Yangji Hospital. -- Ed.