What is semaglutide?

Semaglutide is an FDA-approved medication for weight loss in both diabetics (Ozempic) and nondiabetics (Wegovy).  It is a once-weekly injectable medication that is given as a minimal dose to start and gradually increased until a therapeutic dose is reached. Semaglutide belongs to a class of medications called GLP-1. It has been a very effective medication for lowering blood sugar for many years, with the added benefit of weight loss. In response to the weight loss seen in patients with type II diabetes, Novo Nordisk sent semaglutide into FDA trials for approval as a weight loss medication. In 2021, semaglutide was approved, and Wegovy was available to patients as a once-weekly injectable to treat people who are overweight or obese. Currently, Wegovy is not available to new patients because there is a shortage of the medication.

How does semaglutide work?

Semaglutide is effective for two reasons. First, semaglutide acts on the hypothalamus in the brain, which regulates our sensation of hunger. With this action on the hypothalamus semaglutide also alters the food-reward system and prolongs our sense of fullness. Finally, semaglutide slows down the motility of the gastrointestinal tract. Put more simply, semaglutide keeps the food in your stomach for longer than usual, keeping you full longer.

While no medication is without risks and side effects, semaglutide is relatively safe for most people. Semaglutide can be used in people with most heart, liver, and endocrine conditions. Before obtaining a prescription, your provider needs to have a thorough conversation about your medical history to be confident that you are safe to begin taking semaglutide.

How much weight can I lose with semaglutide? 

The average weight loss achieved in most widely published medical studies of semaglutide for weight is about 15% of the initial body weight. Individual loss varies and depends to a great degree on diet adherence. This is, again, why we believe a focused low carb diet in association with the use of a continuous glucose monitor to guide that diet is a very, very effective approach. It is important to remember that semaglutide will help you lose weight, but it will not help you keep it off once you are finished with the medication if you have not gotten to the root problem of the weight gain. In our practice, it is not unusual to see a patient lose 20% of their starting body weight during treatment.

How fast does semaglutide work?

The short answer is that many of our patients begin to lose weight in the first week of taking semaglutide. The first dose is small (0.125 mg), but titrated up to the therapeutic dose. It is primarily used to gently introduce the medication to the body without risking developing severe side effects.

All studies done on weight loss with semaglutide, have shown effectiveness only when it is used in combination with an effective diet plan. At Metabolic MD, we believe the most effective dietary approach is a low carb diet. We will provide you detailed guidance related to your diet while you are on semaglutide. We believe that an extremely effective approach to weight loss is a continuous glucose monitor guided low carb diet in conjunction with semaglutide.

Who Is eligible for weight loss treatment with semaglutide?

There are only two qualifications for treatment with semaglutide:

1. A Body Mass Index BMI over 30 and no weight-related complications or other conditions, OR

2. A BMI over 27 with weight-related complications such as hypertension, high cholesterol, diabetes, obstructive sleep apnea, fatty liver disease, etc.

Does semaglutide have side effects?

Some people can have mild to moderate side effects, however most of these are manageable by proper dosing and some overlap with the intended effect of “feeling full.” Most common side effects are: nausea, diarrhea, vomiting, constipation, mild stomach pain, mild headache, fatigue, feeling bloated, belching, gas, stomach flu, and heartburn.

How fast can you increase the dose?

Semaglutide is taken as a once weekly injection “escalating” dose. This means you start the medication at a low dose, and increase the dosage gradually over a period of weeks. Progression on this regimen assumes side-effects are minimal. 

We weigh several factors when deciding how and when to increase the dose for our patients. The first is whether you experienced side effects during your week of treatment. We will also discuss how well semaglutide managed your hunger. In lower doses, hunger suppression may not be as noticeable and may take a dose escalation to achieve a desired hunger response. How fast we increase the dose for our patients is individualized and tailored to the needs of each patient. The individualized approach allows us to maximize the benefits of the medication while keeping side effects to a minimum.

How do you administer semaglutide?

This medication is a taken as a once-weekly subcutaneous injection. This injection is self- administered at home with VERY SMALL (31 gauge) needle into the abdominal area. It is similar to an insulin injection. The injection cannot be said to be 100% painless, but causes very minimal discomfort for most patients.

Who should not use semaglutide?

There are rare situations where semaglutide is “contraindicated”, meaning an individual with this condition should not use this medicine. The major contraindications to treatment are: 

Patients with a personal or family history of medullary thyroid carcinoma

Patients with a personal or Family History of Multiple Endocrine 

Neoplasia syndrome type 2 (MEN 2) 

diabetic retinopathy, a type of damage to the eye from diabetes

low blood sugar

disease of the gallbladder (patients who have had their gallbladder removed are not included in this group)

decreased kidney function

pancreatitis

Inflammatory bowel disease

Certain Irregular heart beat conditions

Suicidal thoughts or behavior

Is semaglutide covered by insurance?

Ozempic is often covered by most private insurance for those diagnosed with type 2 diabetes. Wegovy is the brand name approved for weight loss in nondiabetics, however it is currently unavailable as there are shortages on this medication. 

Because most insurance programs do not cover semaglutide for weight loss alone, Metabolic MD has entered into relationships with several compound pharmacies to provide this medication at a discount to our patients. We are very sensitive to our patients “OOPs”, that is their “Out Of Pocket Expense”