How Effective Is Wegovy®? What the STEP Trials Say About Real Weight Loss

Fatty liver disease, particularly non-alcoholic fatty liver disease (NAFLD) and its more severe form, non-alcoholic steatohepatitis (NASH)—is now one of the most common liver conditions globally. Affecting up to 1 in 3 adults in New Zealand, it’s closely linked to overweight and obesity, type 2 diabetes, and insulin resistance.

But there’s promising news: GLP-1 receptor agonists, such as Wegovy (semaglutide), originally developed for diabetes and weight loss, are now showing powerful benefits for people with fatty liver disease.

Let’s look at how they work and what the latest research says.

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What Is NAFLD and Why Does It Matter?

NAFLD occurs when excess fat builds up in liver cells, not caused by alcohol. Over time, this fat can lead to inflammation (NASH), fibrosis (scarring), cirrhosis, and even liver cancer.

Unfortunately this a silent epidemic—often with no symptoms until the damage is severe.

Risk factors include:

• Obesity
• Insulin resistance
• Type 2 diabetes
• High cholesterol and triglycerides

There is currently no approved medication specifically for NAFLD or NASH. The mainstay of treatment has been lifestyle changes like weight loss and exercise. But maintaining long-term weight loss can be incredibly challenging.

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Enter: GLP-1 Receptor Agonists

GLP-1s (glucagon-like peptide-1 receptor agonists) are medications that:

• Improve insulin sensitivity
• Slow gastric emptying
• Reduce appetite
• Lead to substantial weight loss

Wegovy (semaglutide) is one of the most potent GLP-1s, approved for chronic weight management in New Zealand. But its benefits extend beyond weight loss.

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What the Research Says: GLP-1s and Liver Health

Here are some key studies and findings that show how GLP-1s can improve fatty liver disease:

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1. Semaglutide Improves NASH Histology

In a randomised controlled trial published in The New England Journal of Medicine (2021), researchers gave semaglutide to patients with biopsy-proven NASH.

✅ 59% of patients had NASH resolution with no worsening of fibrosis—compared to just 17% on placebo.

📖 Reference: Newsome PN et al. (NEJM, 2021) [1].

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2. Weight Loss Drives Liver Fat Reduction

GLP-1s induce 10–15% total body weight loss in many patients.

Even a 5–10% weight reduction is enough to significantly improve liver fat, inflammation, and fibrosis [2].

Semaglutide helps people reach these targets more reliably than diet and exercise alone.

📖 Reference: Armstrong MJ et al., The Lancet, 2016 [2].

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3. Reduces Liver Fat on Imaging

A 2020 study in The Lancet Gastroenterology & Hepatology found that semaglutide significantly reduced liver fat content on MRI-based imaging, even in non-diabetic individuals with NAFLD.

📖 Reference: Flint A et al., Lancet Gastroenterol Hepatol, 2020 [3].

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4. Improves Cardiometabolic Risk Factors

GLP-1s don’t just help the liver—they also improve:

• Blood sugar control
• Blood pressure
• Lipids (LDL, triglycerides)

These improvements reduce the overall cardiovascular risk in people with NAFLD, which is a leading cause of death in this population.

📖 Reference: Marso SP et al., NEJM, 2016 (LEADER trial) [4].

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5. Promising Real-World Data

Recent real-world cohort studies have shown that people with NAFLD on GLP-1 therapy experience reductions in liver enzymes (ALT, AST), indicating better liver function over time.

📖 Reference: Newsome PN et al., J Hepatol, 2021 [5].

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Are GLP-1s Right for You?

If you have fatty liver disease GLP-1s like Wegovy could offer a dual benefit:

✔️ Sustained weight loss

✔️ Improvement in liver health

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At rfynd, we offer a medically supported GLP-1 weight loss program that includes:

• Prescription access (Wegovy, Saxenda, or similar)
• Specialist clinician support
• Nutrition and lifestyle coaching
• Optional liver health monitoring

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Final Thoughts to consider

Fatty liver disease is more common—and more serious—than many people realise. Fortunately, science is catching up. GLP-1 medications like Wegovy are emerging as powerful tools, not just for weight loss but for protecting your liver and reducing long-term health risks.

Want to explore if Wegovy is right for your liver health journey?

👉 Book a consultation with one of our rfynd medical team today

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What About Bariatric Surgery for Fatty Liver Disease?

While medications like Wegovy are powerful tools for weight loss and liver health, for some people—particularly those with a BMI >30 —metabolic (bariatric) surgery may offer the most dramatic and lasting improvement in fatty liver disease.

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Here’s what the evidence shows:

1. High Rates of NASH Resolution and Fibrosis Improvemen

In one of the largest long-term studies published in Gastroenterology (2015), researchers followed 180 patients with biopsy-proven NASH who underwent bariatric surgery.

✔️ 85% achieved NASH resolution

✔️ 34% had fibrosis regression

📖 Reference: Lassailly G et al., Gastroenterology, 2015 [6].

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2. Massive Reductions in Liver Fat and Inflammation

A meta-analysis published in Obesity Surgery (2020) reviewed 32 studies and found bariatric surgery resulted in:

• 91.6% reduction in steatosis
• 81.3% resolution of NASH
• 65.5% improvement in fibrosis

📖 Reference: Lee Y et al., Obes Surg, 2020 [7].

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3. Liver Function Markers Improve Quickly

Within 6–12 months of surgery, liver enzymes (ALT, AST) typically fall to normal or near-normal levels. Improvements often occur before full weight loss is achieved, suggesting mechanisms beyond just fat loss—such as improved insulin sensitivity and gut hormone regulation.📖 Reference: Mathurin P et al., Journal of Hepatology, 2009 [8].

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‍4. Lowers Risk of Cirrhosis and Liver-Related Death

A large retrospective study from JAMA (2021) showed that bariatric surgery in patients with obesity and NAFLD was associated with:

• 48% reduced risk of developing advanced liver disease
• 70% reduction in liver-related mortality

📖 Reference: Aminian A et al., JAMA, 2021 [9].

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5. Reduces Overall Cardiometabolic Risk and Mortality

Since NAFLD is a multi-system disease, patients benefit not only from improved liver health but also:

• Better blood sugar control
• Improved lipid profile
• Lower cardiovascular risk and cancer risk
  

📖 Reference: Sjöström L et al., New England Journal of Medicine, 2007 [10].

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Surgery vs. Medication: Complementary Options

While GLP-1s and bariatric surgery both improve fatty liver disease, the choice depends on the individual:

• GLP-1s are ideal for those seeking non-invasive therapy or who aren’t surgical candidates.
• Bariatric surgery offers a more pronounced and durable option—especially for those with a BMI>30.

At rfynd, we work with you to explore both options, offering:

• GLP-1 medical weight loss programs
• Bariatric surgery with trusted surgeons
• Ongoing liver monitoring and health coaching

Want to explore if bariatric surgery is right for your liver health journey?

👉 Book a consultation with one of our rfynd surgeons today.

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Starting Wegovy® is a big decision — and feeling your best while on it is key to success. At rfynd Weight Loss, we’ve guided many women and men through the ups and downs of weight loss medications. Below are practical, simple tips to help you manage the most common side effects of Wegovy.

1. Nausea, Vomiting, and Diarrhoea

These usually settle over time. Here’s what helps:

• Eat small, bland meals – Think toast, rice, or soup.
• Avoid greasy or spicy food, especially in the first few hours after your injection.
• Stay hydrated – Sip water or electrolyte drinks often.
• Ginger tea or peppermint can ease nausea.

2. Constipation

Constipation can linger longer than other symptoms, but there’s help:

• Add fibre slowly into your diet (oats, veggies, kiwi fruit).
• Drink 2+ litres of water daily.
• Stay active – a daily walk supports gut movement.
• Consider a gentle laxative (e.g. macrogol or docusate) if needed – check with your clinician.

‍3. Hair Thinning

Hair loss may occur with rapid weight loss:

• Ensure you’re getting enough protein and essential nutrients.
• Consider a salon shampoo designed to prevent hair loss.
• Most people notice regrowth within a few months.

4. Gallbladder Care by:

• Avoiding extreme fasting or crash diets.
• Staying well-hydrated.
• Eating regular meals with some healthy fats to keep bile flowing.

5. Heart Rate & Skin Sensations

These usually don’t require treatment, but keep your medical team updated if symptoms persist.

When to Seek Help

Contact your health care professional if you:

• Have severe stomach pain
• Experience symptoms of low blood sugar (shaking, sweating, confusion)
• Notice changes in vision
• Are feeling unsure about how you're coping

📖 Want more information? Read our blog on Understanding Wegovy® Side Effects for a full breakdown.

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Wegovy® (semaglutide) offers a promising new path for many who haven’t seen the changes they want. But like all prescription medications, Wegovy®  can come with side effects — and it’s completely normal to feel a bit nervous. At rfynd Weight Loss, we believe in supporting you through your journey with care, empathy, and accurate information. Below, we’ve summarised the known side effects from the New Zealand Medsafe Data Sheet on Wegovy®  to help you understand what to expect and when to seek support.

💬 The Most Common Side Effects: Gut Reactions

Gastrointestinal issues are the most frequently reported side effects of Wegovy, especially during the first few weeks when your dose is being gradually increased.

• Nausea – experienced by about 44% of people. Typically lasts on average for 8 days.
• Diarrhoea – reported by around 30% lasting 3 days on on average
• Vomiting – seen in roughly 25% usually on 2 days in duration.
• Constipation – 24% of patients experienced this with symptoms that can last a few weeks.

These symptoms are usually only mild to moderate and most people find they ease with time.

🧡 Other Digestive Symptoms to Know About

Some people also experience:

• Bloating
• Reflux or indigestion
• Stomach pain
• Gas or belching
• Hiccups

If you already have moderate kidney problems, these symptoms might be stronger — so it’s important to discuss this with your rfynd Weight Loss doctor.

💊 Less Common but Important Reactions

• Gallstones (Cholelithiasis) – Found in 1.6% of patients, with 0.6% developing gallbladder inflammation (cholecystitis). Please note, gallstone are very common even in those not on Wegovy®.  Furthermore, significant weight loss by any means can lead to forming gallstones. It’s important to seek medical care if you experience severe abdominal pain.
• Hair loss – Reported in 2.5% of people. This is usually mild and happens more with greater weight loss (20%+), and often resolves on its own.
• Increased heart rate – A mild average increase of 3 beats per minute was seen. Around 26% of people had a temporary rise of 20+ bpm.
• Skin sensations – Tingling or sensitive skin reported by 2.1%. Typically mild and settles with time.
• Pancreatitis – Rare (0.2% incidence). It’s important to seek medical care if you experience severe abdominal pain.
• Kidney stones (Urolithiasis) – Occurred in about 1.2% of patients.

🔍 What About People with Type 2 Diabetes?

For those with diabetes:

• Low blood sugar (Hypoglycaemia) – Especially if taking sulfonylureas. It was seen in 6.2% of patients using Wegovy.
• Eye health (Diabetic retinopathy) – Observed in 4% of patients. Discuss with your clinician if you have existing eye disease.

👧🏽 And for Teens?

Wegovy®  was studied in adolescents (12–17 years) for 68 weeks. Side effects were similar to adults, but gallstones occurred in 3.8%. Let your doctor know if you experience severe abdominal pain. There is no long-term data yet on use beyond 68 weeks in this age group.

🙋‍♀️ What Does This All Mean for You?

Most side effects are manageable and temporary. The rfynd clinical team is here to guide you with a judgment-free, professional approach. We offer tailored plans that include monitoring, support, and education — because sustainable weight loss should never feel isolating or overwhelming.

👉🏽 What’s Next?

If you’re considering Wegovy® or already taking it, you might find our companion blogs helpful:
📖 Strategies to Manage Side Effects of Wegovy® – practical tips, food strategies, and when to check in with your rfynd Weight Loss clinician.

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