Semaglutide (Ozempic and Wegovy) Is Now Approved for Weight Loss In Patients With and Without Diabetes
Semaglutide, also known by its trade names of Ozempic and Wegovy, was recently approved by the Food and Drug Administration (FDA) for weight loss in both diabetics and non-diabetics. Most obesity and metabolic health experts have found this medication to be a very effective intervention for patients seeking to lose weight, who have not been successful losing weight with diet and exercise alone. Semaglutide is reported to be the most effective medicine ever approved by the FDA for weight loss.
This medication has been assessed in studies involving over 4,000 patients. Participants of these studies averaged weight loss of about 10% of body their body weight after about a year of treatment. This weight loss, for the study populations, was generally between 15 and 30 pounds. Obese patients and patients with diabetes sometimes lost up to 20% of their body weight. Most patients had significant reductions in body weight in the first 20 weeks of treatment. Other metabolic health parameters, such as cholesterol, blood glucose, and blood pressure also improved for most patients.
Semaglutide is a “GLP-1 receptor agonist” which has been used for many years to safely lower blood sugar in diabetics. It does
not cause low blood sugar (hypoglycemia) in patients who are not diabetic. Semaglutide is administered by a once weekly patient self-injection.
This drug’s mechanism of action is that it affects several gastrointestinal hormones. This includes the hormone leptin, which slows emptying of the stomach. By slowing stomach emptying, leptin allows the stomach to feel fuller sooner when eating, and for a longer period of time after a meal or snack. This lessens the urge to eat more, and also has a tendency to increase the length of time between meals and snacks. Semaglutide also indirectly affects neurotransmitters in the brain, to cause a feeling of “satiety”. Satiety is the mental feeling of being “satiated” or satisfied that you are full and do not need to continue to eat. Like most medications, semaglutide can have some side effects. These include mostly abdominal bloating, nausea, and possibly either diarrhea or constipation. Up to 80% of patients experience at least minor side effects. However, these side effects are usually transient and mild, and generally completely resolve after days to a few weeks of treatment. Patients who have thyroid disease, or a family history of thyroid cancer, and patients who have a history of pancreatitis (inflammation of the abdominal organ that makes the enzymes to digest food in the intestines) should also not use this medicine.
One important issue with this medication is the potential cost to patients. Semaglutide is often covered by insurance for diabetics, and sometimes covered by insurance for prediabetics (patients with diagnosed “glucose intolerance”). Glucose intolerance can be diagnosed with simple blood tests. It may also be covered by insurance for some obese patients. However, for other patients’ insurance does not cover the cost of this relatively expensive medication.
Semaglutide has been found to be an effective supplemental approach for weight loss in a majority of patients. However, most
knowledgeable metabolic health physicians believe the best initial approach to medically supervised weight loss is a physician managed low carbohydrate diet. This approach includes an evaluation of a person’s level of insulin resistance which is the underlying cause of weight gain (as well as difficulty losing weight) for most patients.
We have found that integration of continuous glucose monitoring (CGM) as part of a physician directed low carbohydrate
weight loss program can be very effective in assisting patients at losing weight. CGM provides the patient and their physician
(through remote monitoring) 24/7 feedback of the patient’s blood glucose. If blood glucose can be kept at a moderate level, the body can then preferentially burn fat for energy (instead of blood glucose) causing weight loss. With this approach blood sugar elevations and “spikes” are avoided. We have found that CGM is a very effective tool to guide diet and is also a great behavioral tool in helping a patient adhere to their low carb diet regimen.
In summary, semaglutide (trade names Ozempic and Wegovy) can be a great supplemental aid to weight loss for some
patients. However, most patients have very good weight loss success with a medically managed low carbohydrate diet guided
by continuous glucose monitoring. For those patients who do not achieve their target weight goals with the low carbohydrate and CGM approach alone, we add semaglutide to help these patients reach their goals.