Wegovy and Ozempic are the same drug — different dose
Both are semaglutide. Ozempic is approved for type 2 diabetes at lower doses (up to 1 mg). Wegovy is approved for weight management at higher doses (up to 2.4 mg). The liver effects are the same molecule — but the higher dose drives greater weight loss, which usually translates to greater liver fat reduction.
What semaglutide does to MASLD and MASH
MASLD (metabolic-associated steatotic liver disease, formerly NAFLD) affects roughly 30% of Australian adults. MASH is the inflammatory form. Semaglutide was approved by the FDA for MASH in August 2025 based on the ESSENCE Phase 3 trial, which showed:
- Histological MASH resolution in 62.9% of treated patients (vs 17% on placebo)
- Fibrosis improvement in 36.8% of treated patients
- Liver stiffness reductions on elastography greater than weight loss alone would predict
Australian GP guidance now positions semaglutide alongside lifestyle as a first-line consideration for MASLD/MASH in eligible patients.
Do you need a liver scan before starting Wegovy?
If you have metabolic risk factors — high BMI alone qualifies — the answer is usually yes, via a FIB-4 first then elastography if indeterminate. The MJA September 2025 consensus statement recommends FIB-4 as the screening tool, with elastography as the next step when FIB-4 doesn't clearly rule fibrosis out.
Monitoring schedule on Wegovy
- Baseline: FIB-4 + LFTs. Elastography if FIB-4 is indeterminate or high.
- 3 months: Repeat LFTs.
- 6 months: LFTs + weight + blood pressure.
- 12 months: Full repeat — FIB-4, LFTs, lipids. Repeat elastography if indicated at baseline.
Frequently asked questions
Is Wegovy approved for fatty liver in Australia?
Wegovy is TGA-approved for weight management. The MASH indication for semaglutide was approved by the FDA in August 2025; TGA approval for MASH specifically is anticipated. Off-label use for MASLD is common in Australian metabolic practice.
Can Wegovy reverse MASH?
The ESSENCE Phase 3 trial showed histological MASH resolution in 62.9% of patients on semaglutide vs 17% on placebo, with fibrosis improvement in 36.8%. Reversal is meaningful but not guaranteed in all patients.
Wegovy liver enzymes — what's normal?
Transient mild ALT/AST elevations in the first 1–3 months are common as liver fat reduces. Persistently elevated enzymes or symptomatic changes should be investigated with your GP.
How often should I monitor my liver on Wegovy?
Baseline FIB-4 and LFTs, then LFTs at 3 and 6 months, with a full repeat at 12 months. Elastography is appropriate at baseline if FIB-4 is indeterminate and repeated annually thereafter while at risk.
Find a liver scan clinic before starting or early on Wegovy
A baseline elastography gives you and your GP an objective measure of liver health you can track as Wegovy delivers weight loss over 6–12 months.
This page is educational and not medical advice. Always discuss your GLP-1 treatment and liver monitoring with your GP.