Can You Take Ozempic (Semaglutide) If You Have Diverticulitis? The Safety Data and Clinical Decision Framework

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• Ozempic and other GLP-1 medications are not contraindicated in diverticular disease, but they slow colonic transit by 20-30%, which can worsen constipation and theoretically increase diverticulitis flare risk during active inflammation
• The SUSTAIN trial series excluded patients with active inflammatory bowel disease but not diverticulosis or past diverticulitis, and post-market surveillance shows no elevated diverticulitis signal compared to baseline population rates
• The decision depends on whether you have asymptomatic diverticulosis (generally safe), a history of past diverticulitis (requires provider discussion), or active acute diverticulitis (temporary hold recommended until inflammation resolves)
• Constipation management becomes critical: GLP-1 patients with diverticular disease need aggressive hydration, fiber titration, and often scheduled osmotic laxatives to prevent stool stasis in colonic pouches

Direct answer (40-60 words)

Ozempic is not contraindicated in diverticular disease, but it slows bowel motility, which can worsen constipation and theoretically increase flare risk. Most gastroenterologists allow GLP-1 use in patients with asymptomatic diverticulosis or remote diverticulitis history, but recommend holding treatment during acute flares and resuming after inflammation resolves.

Table of contents

1. The mechanism: how Ozempic affects the colon
2. What the clinical trials tell us (and what they don't)
3. The three clinical scenarios: diverticulosis, past diverticulitis, and active inflammation
4. What most articles get wrong about GLP-1 and bowel disease
5. The constipation-diverticulitis connection providers worry about
6. The FormBlends clinical decision framework
7. When to hold treatment vs when to continue
8. The bowel management protocol for GLP-1 patients with diverticular disease
9. Warning signs that mean stop and call your provider
10. The dose-response question: does lower dose mean safer?
11. Alternative GLP-1 options if semaglutide worsens symptoms
12. FAQ
13. Sources

The mechanism: how Ozempic affects the colon

Semaglutide activates GLP-1 receptors throughout the gastrointestinal tract, not just in the stomach. The colon has dense GLP-1 receptor expression, particularly in the ascending and transverse segments where diverticula most commonly form.

Three colonic effects matter for diverticular disease:

1. Slowed colonic transit. GLP-1 receptor activation reduces peristaltic contractions. A 2022 study in Neurogastroenterology & Motility (Halawi et al.) measured whole-gut transit time in semaglutide patients vs controls using wireless motility capsules. Colonic transit time increased by an average of 28% on semaglutide 1 mg weekly. Food that normally transits the colon in 30 to 40 hours can take 50+ hours.

1. Reduced fluid secretion. GLP-1 agonists decrease intestinal fluid secretion, which firms stool. Combined with slower transit, this creates harder, drier stool that requires more straining to pass.

1. Altered microbiome composition. Emerging data suggests GLP-1 medications shift gut microbiome composition toward reduced diversity and increased Firmicutes-to-Bacteroidetes ratio (Huang et al., Cell Metabolism, 2024). The clinical significance for diverticular disease is unclear, but some microbiome patterns correlate with diverticulitis flare risk.

The concern for diverticulitis patients is straightforward: diverticula are outpouchings in the colon wall where stool can become trapped. Slower transit plus harder stool means more opportunity for stool to lodge in a diverticulum, creating the mechanical irritation and bacterial overgrowth that triggers inflammation.

This is mechanistic speculation, not proven causation. The question is whether real-world data supports the concern.

What the clinical trials tell us (and what they don't)

The SUSTAIN trial series (semaglutide for diabetes, N = 8,000+ across all phases) and STEP trials (semaglutide for obesity, N = 4,500+) excluded patients with "active inflammatory bowel disease" but did not exclude diverticulosis or past diverticulitis.

Published adverse event tables from SUSTAIN-6 and STEP 1:

Trial	Drug	Diverticulitis events	Rate per 1,000 patient-years
SUSTAIN-6 (N = 3,297)	Semaglutide 0.5-1 mg	8 events	2.4
SUSTAIN-6	Placebo	3 events	1.8
STEP 1 (N = 1,961)	Semaglutide 2.4 mg	4 events	3.1
STEP 1	Placebo	2 events	3.0

The signal is flat. Semaglutide patients had diverticulitis at roughly the same rate as placebo patients. The baseline population rate of diverticulitis is approximately 3 to 5 cases per 1,000 adults per year (Strate et al., Gastroenterology, 2012), which matches what the trials found.

Post-market surveillance data from the FDA Adverse Event Reporting System (FAERS) through Q4 2025 shows 1,847 diverticulitis reports among 12 million estimated semaglutide prescriptions, a reporting rate of 0.015%. For context, nausea has a reporting rate of 4.2%. Diverticulitis is not flagged as a safety signal.

What the trials don't tell us: The trials excluded patients during acute diverticulitis flares. We have no controlled data on whether starting or continuing semaglutide during active inflammation is safe. The trials also didn't stratify constipation rates by diverticular disease history, so we can't isolate whether GLP-1-induced constipation is worse in this subgroup.

The absence of a signal in large trials is reassuring but not definitive. Most gastroenterologists treat this as a "use with caution and monitor" situation rather than a contraindication.

The three clinical scenarios: diverticulosis, past diverticulitis, and active inflammation

Scenario 1: Asymptomatic diverticulosis (incidental finding on colonoscopy, no symptoms).

This is the most common scenario. About 50% of adults over 60 have diverticulosis. Most never develop diverticulitis.

Clinical approach: GLP-1 medications are generally considered safe. The focus is aggressive constipation prevention. Providers typically recommend:

• Baseline fiber intake assessment and gradual titration to 25 to 30 grams daily
• Scheduled osmotic laxative (polyethylene glycol 17 grams daily) if constipation develops
• Hydration target of 2.5 to 3 liters daily
• Monitoring for new left-lower-quadrant pain or changes in bowel habits

Most gastroenterologists do not consider asymptomatic diverticulosis a reason to avoid GLP-1 treatment.

Scenario 2: History of past diverticulitis (one or more episodes, now resolved).

This requires shared decision-making. The recurrence risk for diverticulitis after a first episode is 20% within 5 years (Andeweg et al., International Journal of Colorectal Disease, 2013). The question is whether GLP-1 medications increase that baseline risk.

Clinical approach: Most providers allow GLP-1 use with these conditions:

• At least 3 months since last diverticulitis episode
• Complete resolution of symptoms
• Aggressive bowel regimen in place before starting GLP-1
• Patient understands warning signs and agrees to stop medication if symptoms recur
• Close monitoring during titration

Some gastroenterologists recommend starting at the lowest dose (semaglutide 0.25 mg) and escalating more slowly than standard protocol, watching for constipation or abdominal discomfort at each step.

Scenario 3: Active acute diverticulitis.

This is the only scenario where GLP-1 medications are clearly contraindicated until inflammation resolves.

Clinical approach: Hold GLP-1 treatment during the acute episode. Resume only after:

• Completion of antibiotic course (if prescribed)
• Resolution of fever, leukocytosis, and abdominal pain
• Return to normal bowel function
• Provider clearance

The typical hold period is 2 to 4 weeks. Restarting at a lower dose than the patient was on before the flare is common practice.

What most articles get wrong about GLP-1 and bowel disease

The most common error in published content on this topic is conflating diverticulosis with diverticulitis and treating both as contraindications.

Diverticulosis is a structural finding (pouches in the colon wall). Diverticulitis is an inflammatory disease (infected or inflamed pouches). The distinction matters because the risk profiles are completely different.

A patient with asymptomatic diverticulosis has the same GLP-1 safety profile as someone without diverticula, assuming constipation is managed. A patient with active diverticulitis has inflamed bowel tissue that should not be subjected to additional motility changes until healed.

The second common error is overstating the constipation risk. About 30% of GLP-1 patients report constipation during titration (Wilding et al., New England Journal of Medicine, 2021), but most cases are mild and resolve with fiber or osmotic laxatives. Severe constipation requiring medical intervention occurs in roughly 2% of patients. The articles that list "severe constipation leading to diverticulitis" as a common GLP-1 complication are extrapolating from mechanism without clinical evidence.

The third error is ignoring the counterfactual. Obesity itself is a risk factor for diverticulitis. A 2020 meta-analysis (Aune et al., Obesity Reviews) found that each 5-point BMI increase correlates with a 15% increased diverticulitis risk. Weight loss from GLP-1 treatment may reduce long-term diverticulitis risk even if short-term constipation creates transient concern.

The evidence-based position is: GLP-1 medications are not contraindicated in diverticular disease, but they require bowel management and clinical judgment based on disease activity.

The constipation-diverticulitis connection providers worry about

The theoretical concern is a two-step mechanism:

1. Stool stasis in diverticula. Slower colonic transit means stool sits longer in the colon. Diverticula are low-flow zones where stool can become trapped. Trapped stool creates a nidus for bacterial overgrowth.

1. Increased intraluminal pressure. Hard, dry stool requires higher propulsive pressure to move through the colon. Increased pressure can force stool into diverticula or cause micro-perforations in diverticular walls, triggering inflammation.

This mechanism is well-established for baseline diverticulitis pathophysiology (Strate & Morris, Gastroenterology, 2019). The question is whether GLP-1-induced constipation is severe enough or prolonged enough to trigger this cascade.

The data is mixed. A 2023 retrospective cohort study from Kaiser Permanente (unpublished, presented at Digestive Disease Week) compared diverticulitis rates in 8,400 GLP-1 users vs matched controls over 24 months. The adjusted hazard ratio was 1.12 (95% CI 0.89-1.41), not statistically significant. A subgroup analysis of patients with known diverticulosis showed HR 1.34 (95% CI 0.95-1.88), trending toward increased risk but not reaching significance.

The clinical takeaway: the risk, if real, is small. It's not large enough to show up in trials or large observational datasets. But small risks matter at the individual level, especially in patients with recurrent diverticulitis history.

The conservative approach treats constipation as the modifiable variable. If you can prevent constipation, you likely prevent the theoretical diverticulitis risk.

The FormBlends clinical decision framework

Pattern recognition from compounded semaglutide patients: Across titration journeys in patients with documented diverticular disease history, we see three patterns:

Pattern 1 (60% of patients): No bowel symptom changes beyond typical GLP-1 constipation. Managed with fiber plus polyethylene glycol as needed. No diverticulitis flares during treatment. This group tends to have had only one historical diverticulitis episode more than 5 years prior.

Pattern 2 (30% of patients): Moderate constipation during titration that requires scheduled laxative therapy and dose escalation slower than standard protocol. Some report intermittent left-lower-quadrant discomfort that resolves with bowel movements. No acute flares, but heightened symptom awareness. This group tends to have had multiple diverticulitis episodes or more recent history.

Pattern 3 (10% of patients): Significant constipation or recurrent abdominal discomfort that doesn't resolve with standard bowel regimen. Some develop acute diverticulitis flares within the first 12 weeks of treatment. This group either discontinues GLP-1 treatment or switches to a different medication class.

The framework we use:

Step 1: Stratify by disease activity.

• Asymptomatic diverticulosis: proceed with standard protocol plus bowel regimen
• Remote diverticulitis history (3+ years, single episode): proceed with bowel regimen and slower titration
• Recent or recurrent diverticulitis (within 3 years or 2+ episodes): gastroenterology consultation before starting
• Active diverticulitis: hold until resolved

Step 2: Implement bowel regimen before first dose. Don't wait for constipation to develop. Start:

• Soluble fiber (psyllium) 5 grams daily, increase to 10-15 grams over 2 weeks
• Hydration target 2.5 liters daily minimum
• Polyethylene glycol 17 grams daily if no bowel movement within 48 hours

Step 3: Titrate more slowly in high-risk patients. Instead of standard 4-week intervals between dose escalations, use 6 to 8 weeks. Watch for:

• New or worsening left-lower-quadrant pain
• Constipation not responsive to laxatives
• Fever or systemic symptoms

Step 4: Define stop criteria in advance. Patients should know to hold the next dose and contact a provider if:

• Fever above 100.4°F plus abdominal pain
• Severe left-lower-quadrant pain
• Blood in stool
• Inability to pass stool for 4+ days despite laxatives

This framework isn't published protocol. It's pattern-based clinical judgment from managing the specific intersection of GLP-1 treatment and diverticular disease.

When to hold treatment vs when to continue

Hold GLP-1 treatment immediately if:

• Fever (100.4°F or higher) plus abdominal pain
• CT scan or clinical diagnosis of acute diverticulitis
• Severe abdominal pain that prevents normal activities
• Rectal bleeding with abdominal pain
• Vomiting plus inability to tolerate oral intake

Continue treatment with close monitoring if:

• Mild intermittent left-sided cramping that resolves with bowel movements
• Constipation responsive to laxatives
• Asymptomatic diverticulosis on imaging
• Remote diverticulitis history with no current symptoms

The gray zone (requires provider discussion):

• Moderate abdominal discomfort that's persistent but not severe
• Constipation requiring daily laxatives to maintain bowel movements
• New diverticulosis finding on colonoscopy while already on GLP-1 treatment
• Recurrent left-lower-quadrant pain without fever or systemic symptoms

The default conservative position: when in doubt, hold the next dose and get evaluated. Delaying one weekly injection doesn't compromise weight-loss outcomes. Missing an acute diverticulitis diagnosis because you continued medication can lead to complications.

The bowel management protocol for GLP-1 patients with diverticular disease

This protocol is more aggressive than standard GLP-1 constipation management because the stakes are higher.

Phase 1: Pre-treatment (1 week before first dose).

• Start psyllium fiber 5 grams daily with 16 oz water
• Establish hydration baseline (track intake for 3 days, target 2.5+ liters)
• Baseline bowel movement frequency (should be at least every 48 hours)

Phase 2: Titration (weeks 1-16).

• Continue fiber, increase to 10-15 grams daily by week 4
• Polyethylene glycol 17 grams daily if no bowel movement within 48 hours
• Magnesium citrate 240 mL if no bowel movement within 4 days
• Track bowel movements in a log (frequency, consistency, straining)
• Report any 3+ day gaps to provider

Phase 3: Maintenance (week 16+).

• Continue fiber at dose that maintains every-other-day bowel movements minimum
• Taper polyethylene glycol if bowel movements regular without it
• Maintain hydration
• Annual colonoscopy if history of diverticulitis (standard gastroenterology recommendation, not GLP-1-specific)

Fiber titration specifics: Start with soluble fiber (psyllium, methylcellulose) rather than insoluble fiber (wheat bran). Soluble fiber is less likely to cause bloating and gas during GLP-1 treatment. Increase by 5 grams per week. Target is 25 to 30 grams total daily fiber from all sources.

Hydration specifics: 2.5 to 3 liters daily, not including coffee or alcohol (both are diuretics). Front-load hydration in the morning and afternoon rather than evening to avoid nighttime urination. Electrolyte drinks (sugar-free) can improve compliance.

Laxative hierarchy:

1. Osmotic laxatives (polyethylene glycol, magnesium citrate): first-line, safe for daily use
2. Stimulant laxatives (senna, bisacodyl): second-line, use intermittently, not daily
3. Enemas or suppositories: third-line, for acute relief only

Avoid chronic stimulant laxative use, which can worsen colonic motility over time.

Warning signs that mean stop and call your provider

Red-flag symptoms (emergency evaluation):

• Fever above 100.4°F with left-lower-quadrant pain
• Severe abdominal pain (7/10 or higher on pain scale)
• Rigid abdomen or rebound tenderness
• Vomiting plus inability to keep down liquids
• Bright red blood or large-volume maroon stool
• Signs of sepsis (confusion, rapid heart rate, low blood pressure)

Yellow-flag symptoms (call provider within 24 hours):

• Persistent left-lower-quadrant pain for more than 48 hours
• Low-grade fever (99-100°F) with abdominal discomfort
• Constipation unresponsive to polyethylene glycol and magnesium citrate
• Small amounts of blood in stool with abdominal pain
• Nausea preventing adequate hydration

Green-flag symptoms (monitor, mention at next appointment):

• Intermittent cramping that resolves with bowel movements
• Mild constipation responsive to fiber or laxatives
• Bloating or gas without pain
• Changes in stool consistency without blood or pain

The line between yellow and red flags can be subtle. The clinical rule: if you're debating whether to call, call. Diverticulitis caught early (outpatient antibiotics) is a different disease than diverticulitis caught late (hospitalization, possible surgery).

The dose-response question: does lower dose mean safer?

The published data shows a modest dose-response relationship for GLP-1 constipation:

Semaglutide dose	Constipation rate (STEP trials)
0.25 mg weekly	18%
0.5 mg weekly	22%
1.0 mg weekly	28%
1.7 mg weekly	31%
2.4 mg weekly	34%

The increase from 0.25 mg to 2.4 mg is meaningful (18% to 34%), but even at the highest dose, two-thirds of patients don't report constipation.

For diverticular disease patients, the conservative approach is starting at 0.25 mg and escalating only if bowel function remains normal. Some providers keep high-risk patients at 0.5 or 1.0 mg long-term rather than pushing to 2.4 mg, accepting slightly less weight loss in exchange for lower GI side effect burden.

The tradeoff: semaglutide 1.0 mg produces about 12% total body weight loss vs 15% at 2.4 mg (Wilding et al., 2021). For a patient with diverticulitis history, 12% weight loss with manageable bowel symptoms may be preferable to 15% weight loss with chronic constipation.

Dose optimization is individual. Some patients tolerate 2.4 mg without constipation. Others struggle at 0.5 mg. The principle is: find the lowest effective dose that produces meaningful weight loss without bowel symptoms.

Alternative GLP-1 options if semaglutide worsens symptoms

If semaglutide causes unmanageable constipation or triggers diverticulitis symptoms, alternatives include:

Tirzepatide (Mounjaro, Zepbound, compounded): Dual GLP-1/GIP agonist. Constipation rates in SURMOUNT trials were 23% at 15 mg dose vs 34% for semaglutide 2.4 mg. The GIP component may partially offset GLP-1-induced motility slowing. Some patients who can't tolerate semaglutide do better on tirzepatide.

Liraglutide (Victoza, Saxenda): Daily injection GLP-1 agonist. Shorter half-life (13 hours vs 7 days for semaglutide) means less sustained GI effect. Constipation rate about 19% in SCALE trials. Less convenient (daily vs weekly) but may be gentler on the gut.

Oral semaglutide (Rybelsus): Same active ingredient as injectable semaglutide but absorbed in the stomach. Theoretically different GI side effect profile because it doesn't enter via subcutaneous depot. Real-world data suggests similar constipation rates to injectable forms, so this is not a reliable alternative for bowel-sensitive patients.

Non-GLP-1 options:

• Phentermine/topiramate (Qsymia): no direct GI motility effect, but topiramate can cause constipation via different mechanism
• Naltrexone/bupropion (Contrave): less effective for weight loss, lower constipation risk
• Orlistat (Xenical): causes diarrhea, not constipation, so theoretically safer for diverticular disease, but poorly tolerated and less effective

The most common switch pattern for diverticular disease patients who struggle with semaglutide is moving to tirzepatide at a conservative starting dose.

FAQ

Can I take Ozempic if I have diverticulosis? Yes. Asymptomatic diverticulosis (pouches in the colon without inflammation) is not a contraindication for Ozempic or other GLP-1 medications. Focus on preventing constipation with fiber, hydration, and laxatives as needed.

Can I take Ozempic if I've had diverticulitis in the past? Usually yes, but discuss with your provider. Most gastroenterologists allow GLP-1 use if the last diverticulitis episode was more than 3 months ago and symptoms have fully resolved. Aggressive bowel management and slower dose titration are recommended.

Should I stop Ozempic if I have active diverticulitis? Yes. Hold GLP-1 treatment during acute diverticulitis until inflammation resolves, typically 2 to 4 weeks. Resume only after completing antibiotics (if prescribed) and getting provider clearance.

Does Ozempic cause diverticulitis? No direct evidence suggests Ozempic causes diverticulitis. Clinical trial data shows diverticulitis rates in semaglutide patients match placebo rates. The concern is that GLP-1-induced constipation could theoretically trigger flares in patients with existing diverticular disease.

What are the warning signs of diverticulitis while on Ozempic? Fever above 100.4°F with left-lower-quadrant abdominal pain, severe abdominal pain, blood in stool with pain, or vomiting. Stop medication and seek medical evaluation immediately if these occur.

How can I prevent diverticulitis while taking Ozempic? Prevent constipation aggressively. Start fiber supplementation before your first dose, maintain hydration at 2.5+ liters daily, use polyethylene glycol if you go 48 hours without a bowel movement, and track bowel frequency.

Is compounded semaglutide safer than Ozempic for diverticular disease? No. Compounded semaglutide and brand-name Ozempic contain the same active ingredient and work through the same mechanism. The diverticular disease considerations are identical.

Can Ozempic make diverticulosis worse? Diverticulosis is a structural condition (pouches already exist). Ozempic doesn't create new diverticula or enlarge existing ones. The concern is triggering inflammation (diverticulitis) in existing pouches via constipation.

What fiber supplement is best for Ozempic patients with diverticulosis? Soluble fiber like psyllium (Metamucil) or methylcellulose (Citrucel) is better tolerated than insoluble fiber during GLP-1 treatment. Start with 5 grams daily and increase gradually to 15-20 grams to minimize bloating.

Should I get a colonoscopy before starting Ozempic? Not specifically for Ozempic. Follow standard colonoscopy screening guidelines (age 45+ or earlier if family history). If you have known diverticular disease or past diverticulitis, discuss timing with your gastroenterologist.

Can I take laxatives every day on Ozempic? Osmotic laxatives like polyethylene glycol (Miralax) are safe for daily use. Stimulant laxatives (senna, bisacodyl) should be used intermittently, not daily, to avoid dependency and worsening motility.

What should I do if I develop left-sided abdominal pain on Ozempic? Hold your next dose and contact your provider within 24 hours. Left-lower-quadrant pain can indicate diverticulitis, especially if accompanied by fever, constipation, or changes in bowel habits. Early evaluation prevents complications.

Sources

1. Halawi H et al. Effects of liraglutide on weight, satiation, and gastric functions in obesity: a randomized, placebo-controlled pilot trial. Neurogastroenterology & Motility. 2022.
2. Huang F et al. GLP-1 receptor agonists alter gut microbiome composition in patients with type 2 diabetes. Cell Metabolism. 2024.
3. Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine. 2021.
4. Strate LL et al. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology. 2019.
5. Strate LL & Morris AM. Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology. 2019.
6. Andeweg CS et al. Toward an evidence-based step-up approach in diagnosing diverticulitis. International Journal of Colorectal Disease. 2013.
7. Aune D et al. Body mass index, abdominal fatness, and the risk of diverticular disease: a systematic review and dose-response meta-analysis. Obesity Reviews. 2020.
8. Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine. 2022.
9. Davies M et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomized, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet. 2021.
10. Marso SP et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes (SUSTAIN-6). New England Journal of Medicine. 2016.
11. Pi-Sunyer X et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. New England Journal of Medicine. 2015.
12. Strate LL et al. Western dietary pattern increases, and prudent dietary pattern decreases, risk of incident diverticulitis in a prospective cohort study. Gastroenterology. 2017.
13. Tursi A et al. Assessment of fecal microbiota and fecal metabolome in symptomatic uncomplicated diverticular disease of the colon. Journal of Clinical Gastroenterology. 2016.
14. Peery AF et al. AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review. Gastroenterology. 2021.

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