Semaglutide (Ozempic, Rybelsus, Wegovy) is a drug normally used for treating type 2 diabetes. However, it has also been found to promote significant weight loss in non-diabetics. Currently, brand name Wegovy is the only version the FDA has approved for weight loss.
A recent study from the New England Journal of Medicine showed patients treated with Semaglutide had an impressive loss of about 15% of total body weight after 68 weeks. These patients did titrate their weekly dose up to 2.4mg and about 7% of the treatment group discontinued treatment due to gastrointestinal side effects. All participants also received counseling on diet and exercise. Some of the patients in the treatment group may have had “pre-diabetes” and thus may have done better than others.
How does Semaglutide work?
Semaglutide mimics our body’s naturally produced glucagon-like peptide 1 (GLP-1) which is produced in the gut in response to eating. GLP-1 causes a release of insulin which helps lower blood sugar. It also inhibits the release of another hormone called glucagon, which is expressed from the pancreas to help raise blood sugar. These two direct effects make it fairly clear how Semaglutide helps control blood sugar.
The main effect that helps with weight loss is the role GLP-1 plays in slowing the motility or movement of the gut and suppressing the appetite. By slowing gut motility the stomach is slower to empty, thus leaving a person feeling “full” sooner and for a longer period of time. GLP-1 also communicates directly with hunger control centers in the brain that send a message that we are “full”. The appetite suppression seems to be the main reason why Semaglutide induces weight loss.
What is the downside?
First of all, study participants who lost weight with Semaglutide, tended to regain the weight when they stopped taking the medication. Also, about half the weight loss was fat but the other half was muscle. Clearly, ongoing diligence with diet and exercise are going to be necessary to maintain weight loss and muscle mass.
Another other issue is cost. We’ve had patients report that the cash price for Wegovy is about $1200-1400 per month. Use of any other brand of Semaglutide than Wegovy is considered “off label” which means the drug is being used for something other than that for which it is approved. Note that about 20% of all drugs are used off label.
Side effects
Most side effects of semaglutide are mild with the most common being gastrointestinal, such as nausea, constipation, gas, bloating or indigestion. Dizziness, fatigue and headache are the next common. A rare side effect is gastroparesis which means a paralyzed stomach. Semaglutide is contraindicated in patients with a history of medullary thyroid cancer, multiple endocrine neoplasia, gallbladder disease or pancreatitis. The FDA recommends Wegovy for weight loss only if you have a body mass index (BMI) of 30 or a BMI of 27 or more with at least one weight-related condition such as high blood pressure, high cholesterol or type 2 diabetes.
How is Semaglutide dosed?
Typically, in diabetics, and in the weight loss study mentioned above, Semaglutide is increased to the maximum dosage. With 5 different strengths, and monthly increases, it would then take 4 months to get to the maximum strength. We are finding that most patients in our clinic have few side effects and also achieve significant weight loss at lower doses.
Our weight loss program
In our clinic we use various weight loss “catalysts” that consistently help patients lose weight. But our goal, our challenge, is to make that stick. To that end we address underlying issues that contribute to weight gain in the first place, such as hormone deficiencies or imbalances, gut health including testing for delayed food allergies, leaky gut or dysbiosis, removal of toxin accumulations that impair metabolism, etc.
We also have a health coach on staff to guide patients in choosing the right meal plans and a private studio in our office used to teach aerobic activities, strength training and yoga – all of which improve insulin sensitivity and metabolism.
Semaglutide is proving to be yet another effective tool for weight loss, but it’s only a catalyst. By putting the other components into action long term weight loss is a much more realistic outcome.
Author
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.
