Efficacy and Safety of Semaglutide for Weight Loss in Overweight or Obese Adults in Bangladesh With or Without Type 2 Diabetes Mellitus

Inclusion Criteria: -Common inclusion criteria for both diabetic and non-diabetic individuals * Informed consent will be obtained before any trial-related activities * Male or female, aged ≥ 18 years at the time of signing the informed consent form * Body mass index (BMI) ≥30 kg/m2 with or without any weight-related comorbidities or ≥25-29.9 kg/m2 with the presence of at least one of the following weight-related comorbidities (treated or untreated): hypertension, dyslipidemia, obstructive sleep apnea or cardiovascular disease (more than three months) For subjects with T2DM * Patients diagnosed with T2DM more than or equal to 180 days prior to the day of screening. * HbA1c up to 12.0% Exclusion Criteria: * Common exclusion criteria for both diabetic and non-diabetic individuals Medical criteria * A self-reported reduction in body weight of more than 5 kg within 30 days before screening, irrespective of medical records * Treatment with any medication for the indication of obesity within the past 90 days before screening (eg. Orlistat, liraglutide, naltrexone/bupropion, diethylpropion, phendimetrazine, and Setmelanotide etc.) * Any previous obesity treatment with surgery or a weight loss device during lifetime * Continued treatment with other GLP-1 agonists, SGLT-2 inhibitor and/or metformin. However, if these drugs can be stopped based on the best clinical judgement of the investigator, the patient can be recruited after stopping the drug and a washout period of two weeks. In case of semaglutide (ORSEMA) the wash out period will be 10 weeks. * Patient taking oral or injectable steroid for other indications * Past history of pancreatitis * Diagnosed case of eating disorders eg. Bulimia nervosa * Patients with a previous history of suicide attempts and major depressive disorder (MDD) according to the DSM-V criteria, schizophrenia or anti-psychotic drug induced obesity * Patients with a personal or family history of medullary thyroid carcinoma (MTC) and/or multiple endocrine neoplasia syndrome type 2 (MEN 2) * Known hypersensitivity to Semaglutide or any of the product components. * History of recent MI (within past three months) * Pregnancy and lactation Laboratory criteria * Incidental diagnosis or Uncontrolled thyroid disease, defined as a thyroid stimulating hormone (TSH) level \> 6.0 mIU/L or \<0.4 mIU/L as measured by the central laboratory at screening. However, well-controlled thyroid disorder can be included if TSH\<6.0 or \>0.4 mIU/L. * Renal impairment, measured as the estimated glomerular filtration rate (eGFR) \<15 ml/min/1.73 m2 For subjects without T2DM * HbA1c more than or equal to 48 mmol/mol (6.5%) For subjects with T2DM * Renal impairment, defined as an estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 (less than 60 mL/min/1.73 m2 in subjects treated with a sodium-glucose cotransporter 2 inhibitor (SGLT2i)). * Uncontrolled T2DM (HbA1c \>12.0%) as these patients may require insulin or other anti-diabetic drug which might potentially interfere the efficacy of semaglutide