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Ozempic and Wegovy: How to Prescribe in Australian General Practice

Reno Riandito
ozempicwegovyobesity managementgeneral practiceAustralia

A practical guide for Australian GPs on how to prescribe Ozempic and Wegovy, including assessment, PBS criteria, obesity work-up, lifestyle foundations, medication options, and deprescribing obesogenic drugs.

Ozempic and Wegovy: How to Prescribe in Australian General Practice

Ozempic and Wegovy: How to Prescribe in Australian General Practice

Obesity is now one of the most common chronic conditions we manage in primary care. With the rise of GLP-1 receptor agonists such as Ozempic and Wegovy, many patients are asking directly for these medications.

But prescribing them properly requires more than writing a script. It requires structured assessment, behavioural foundations, medication review, and clear clinical reasoning.

Step 1: Do a Proper Obesity Assessment

Before prescribing, confirm that obesity is being assessed comprehensively.

Do not rely on weight alone.

Include:

  • BMI
  • Waist circumference (central adiposity risk)
  • Neck circumference (useful in suspected OSA)
  • Blood pressure
  • HbA1c / fasting glucose
  • Lipids
  • LFTs
  • Thyroid function (if indicated)
  • Sleep apnoea screening
  • Medication review

Obesity is a chronic disease — treat it like one.

Step 2: Establish Behavioural Foundations First

Medication without behavioural strategy leads to relapse.

Using principles from Atomic Habits, focus on small, sustainable changes:

  • Fixed walking schedule (same time daily)
  • Structured grocery list before shopping
  • Remove trigger foods from home
  • Protein-first meal structure
  • Reduce liquid calories
  • Sleep hygiene improvement

Tiny habits compound over time.

Step 3: When to Prescribe GLP-1 Agonists

Ozempic (semaglutide)

  • PBS listed for Type 2 Diabetes
  • Not PBS listed for obesity alone
  • Dose titration:
    • 0.25 mg weekly (4 weeks)
    • 0.5 mg weekly
    • Increase to 1 mg if required

Use in:

  • T2DM with obesity
  • High cardiovascular risk
  • Insulin resistance with poor glycaemic control

Wegovy (semaglutide for weight loss)

  • Indicated for obesity management
  • Higher dosing than Ozempic
  • Titration typically:
    • 0.25 mg weekly
    • Gradually increase up to 2.4 mg weekly

Indicated in:

  • BMI ≥30
  • BMI ≥27 with comorbidities (T2DM, OSA, hypertension, dyslipidaemia)

Mounjaro (tirzepatide)

  • Dual GIP/GLP-1 agonist
  • Increasing evidence for superior weight loss
  • Check current PBS and TGA indications before prescribing

Step 4: Consider Other Pharmacological Options

GLP-1 is not the only tool.

Other medications include:

  • Metformin (especially insulin resistance / prediabetes)
  • Topiramate
  • Phentermine (short-term use)
  • Combination strategies in selected patients

Individualise therapy.

Step 5: Review and Stop Obesogenic Medications

One of the most powerful interventions is deprescribing.

Common obesogenic drugs include:

  • SSRIs (some agents more than others)
  • Gabapentin
  • Pregabalin
  • Quetiapine
  • Olanzapine
  • Valproate

If clinically safe:

  • Reduce dose
  • Switch to weight-neutral alternatives
  • Rationalise polypharmacy

You cannot successfully treat obesity while continuing multiple weight-promoting agents without review.

Step 6: Safety Considerations Before Prescribing

Screen for:

  • Personal or family history of medullary thyroid carcinoma
  • MEN2
  • Pancreatitis history
  • Severe gastroparesis
  • Gallbladder disease risk

Counsel regarding:

  • Nausea
  • Vomiting
  • Constipation
  • Early satiety
  • Risk of lean muscle loss without protein intake
  • Importance of resistance training

Step 7: Ongoing Monitoring

Review every 4–12 weeks:

  • Weight
  • Waist circumference
  • HbA1c (if diabetic)
  • Side effects
  • Adherence
  • Protein intake
  • Muscle preservation

If no meaningful response after adequate dose and duration — reconsider strategy.

Obesity Is Chronic Disease Management

Treat obesity like hypertension or diabetes.

Use:

  • GP Management Plans
  • Team care arrangements
  • Dietitian referral
  • Exercise physiology
  • Sleep clinic referral (if OSA suspected)

Structured care improves long-term outcomes.

For official frameworks and evidence-based prescribing guidance:

👉 RACGP AJGP – Pharmacotherapy for the Management of Overweight and Obesity (April 2025)

👉 Services Australia – Care Plans for Health Professionals

👉 NHMRC Clinical Practice Guidelines for Overweight and Obesity

Final Thoughts

Ozempic and Wegovy are powerful tools — but they are not magic.

The real prescription includes:

  • Measurement beyond weight
  • Habit architecture
  • Medication optimisation
  • Deprescribing weight-promoting drugs
  • Structured chronic disease follow-up

When used correctly, GLP-1 therapies can transform outcomes.

When used alone, they often disappoint.

If you're looking to streamline structured obesity care planning inside general practice:

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