By a practising Australian GP
If you’re over 30, you may have noticed a frustrating shift. Your metabolism slows, belly fat clings on, energy dips after lunch, and blood test results start showing the early warnings — raised liver enzymes, creeping blood sugar, or a diagnosis of fatty liver (NAFLD) you never asked for. Perhaps you’ve already tried low-carb diets, gym memberships, meal replacements, and calorie counting. You lose a few kilos, then regain them, plus interest. You feel judged at work, exhausted on weekends, and increasingly worried about long-term health.
Here is the medical reality: obesity and metabolic dysfunction are not simply a lack of willpower. They are chronic, complex conditions driven by hormones, genetics, and the environment. And now, for the first time in Australian medicine, we have a treatment that targets the underlying biology. That treatment is semaglutide.
As a doctor, I rarely use the word “game-changer.” I am using it now.
Semaglutide belongs to a class of medications called GLP-1 receptor agonists. GLP-1 is a natural hormone your gut releases after eating. It signals to your brain that you are full, slows stomach emptying, and helps the pancreas release insulin. Semaglutide is a synthetic, long-acting version of this hormone. In Australia it is available as Ozempic (approved for type 2 diabetes) and Wegovy (approved specifically for weight loss and obesity). Both are given as a once-weekly subcutaneous injection.
In clinical trials, adults using semaglutide lost an average of 15% of their body weight over 68 weeks — a result previously achievable only with bariatric surgery. Even more important, liver fat dropped, inflammation markers improved, blood pressure fell, and many patients with prediabetes returned to normal glucose levels.
| Feature | Ozempic | Wegovy |
|---|---|---|
| TGA-approved indication | Type 2 diabetes | Weight management (obesity/overweight with comorbidity) |
| Typical starting dose | 0.25 mg once weekly | 0.25 mg once weekly |
| Maintenance dose | 0.5–2.0 mg once weekly | 1.7–2.4 mg once weekly |
| Average weight loss | 5–10% body weight | 12–15% body weight |
| PBS subsidised | Yes for diabetes | Not widely subsidised — private script usually required |
Non-alcoholic fatty liver disease (NAFLD) is the most common liver condition in Australia, affecting roughly one in three adults over 40. Left untreated, it can progress to NASH — non-alcoholic steatohepatitis — with inflammation, fibrosis, and eventually cirrhosis. Until recently, there was no approved medication.
Semaglutide has shown remarkable early results. In multiple studies, semaglutide reduced liver fat by 30–50%, normalised ALT and AST liver enzymes, and in a phase 2 NASH trial, resolved steatohepatitis in 59% of patients at the highest dose without worsening fibrosis. While not yet TGA-approved specifically for NASH, semaglutide is widely considered one of the most promising liver therapies available today.
For patients with mildly or moderately elevated liver enzymes due to fatty liver, semaglutide is generally safe and often improves liver function. However, it should be used with caution in decompensated cirrhosis or severe liver failure, as data are limited. Always have baseline and three-monthly liver function tests monitored by your doctor. The good news: most patients see their ALT and AST fall as weight, insulin resistance, and liver fat improve.
One of the most practical pieces of advice I give my patients: take a daily fibre supplement while on semaglutide. Semaglutide slows gastric emptying, which can cause constipation. A soluble fibre supplement such as psyllium husk (Metamucil, Benefiber) helps maintain regular bowel movements, improves satiety, and supports healthy gut bacteria. Start with one teaspoon in a large glass of water daily, increasing to two teaspoons if needed. Always separate fibre supplements from other oral medications by at least two hours.
Constipation is the most common gastrointestinal side effect I see with semaglutide, affecting up to 20–30% of patients. It is usually mild, most bothersome in the first 4–8 weeks, and manageable. The key is prevention rather than waiting until you are uncomfortable.
Let’s go beyond the numbers on the scale. Here is what I see in my clinic after 3–6 months of semaglutide treatment for suitable patients:
Some patients ask whether they can combine semaglutide with other weight loss medications, such as phentermine, topiramate, or naltrexone/bupropion. In Australia, there is no TGA-approved combination of semaglutide with other weight loss drugs. However, a specialist may consider low-dose phentermine as an add-on for short-term appetite suppression in carefully selected patients who have plateaued, provided there are no cardiovascular or psychiatric contraindications. Metformin is sometimes used alongside semaglutide in patients with insulin resistance or PCOS. Never combine weight loss drugs without medical supervision, as side effects — especially nausea, constipation, and heart rate changes — can be additive.
Semaglutide is a powerful medication, but it is not for everyone. You should not take semaglutide if you have:
| Absolute contraindications | Relative cautions / require discussion |
|---|---|
| Personal or family history of medullary thyroid carcinoma (MTC) | History of pancreatitis |
| Multiple endocrine neoplasia syndrome type 2 (MEN2) | Severe gastric motility disorders (gastroparesis) |
| Pregnancy or breastfeeding | Known gallbladder disease |
| Serious hypersensitivity to semaglutide or any ingredient | Diabetic retinopathy (may worsen with rapid glucose improvement) |
| Decompensated liver cirrhosis | Severe renal impairment (eGFR < 15 mL/min) |
Many of my patients are professionals who worry about starting a medication that might affect their job. The good news: semaglutide works in the background and does not cause sedation or cognitive impairment. However, the first few weeks can bring mild nausea, bloating, or intermittent diarrhoea, which may be inconvenient during busy workdays. I advise starting the injection on a Friday evening so any initial side effects occur over the weekend. Keep water and small, bland snacks at your desk. Most patients can continue all normal work activities without issue. If your job involves safety-critical tasks, such as driving heavy vehicles or operating machinery, you should not be impaired by semaglutide itself, but always monitor how you feel initially.
Correct injection technique is essential for both comfort and effectiveness. Semaglutide is available in pre-filled pens with very fine needles. Follow these steps:
If you are over 30, struggling with weight, fatty liver, or the early signs of metabolic disease, semaglutide may be the turning point you have been waiting for. As a doctor, I have seen it transform not just blood results, but entire lives — relationships, careers, and self-esteem. It is not a magic injection. It works best alongside a reduced-calorie diet, regular movement, fibre supplements, and honest medical follow-up. But for many, it finally makes those changes feel possible.
Here is my practical advice:
Do not wait until the damage is irreversible. Fatty liver, prediabetes, and metabolic syndrome are silent but serious. Semaglutide offers a medically proven, once-weekly tool to reverse the trajectory. Speak to your doctor this week. Your future self will thank you.
Disclaimer: This article is for educational purposes only and does not replace individual medical advice. Semaglutide is a prescription-only medicine in Australia. Always consult a registered medical practitioner before starting, changing, or stopping any medication.
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