Weight Loss With Semaglutide
A New Miracle Weight Loss Drug? UNDERSTANDING SEMAGLUTIDE, OZEMPIC, WEGOVY, AND MOUNJARO
Semaglutide is a glucagon-like peptide-1 (GLP-1) agonist medication that’s prescribed under the brand names Ozempic® and Wegovy®. Originally developed to treat diabetes, Semaglutide is safe and highly effective for long-term weight loss and management. We have been successfully using GLP-1s for years at our clinic in conjunction with our four-pillar metabolic health program - focusing on the four key elements that dictate a healthy metabolism: food, sleep, emotional wellness, and exercise.
HOW DO SEMAGLUTIDE, OZEMPIC, WEGOVY, AND MOUNJARO WORK?
Semaglutide, most widely known as Ozempic, is a GLP-1 agonist, meaning it mimics the peptide hormone GLP-1. The GLP-1 peptide is a naturally occurring hormone produced by the gut that sends signals to the brain affecting metabolism and appetite. While all of the mechanisms by which GLP-1 agonists assist with weight loss are not yet fully understood, below are the well-established ways in which these injectable medications can contribute to weight loss:
GLP-1s stimulate the secretion of insulin and slow the release of glucagon, thereby keeping blood sugar low. This effect on blood sugar facilitates lipolysis or fat-burning.
GLP-1 agonists work on leptin and ghrelin, impacting hunger and satiety signaling. Patients generally experience a significant reduction in cravings and find it much easier to manage choices around food (i.e. chronic snacking or obsessive food thoughts that often accompany a calorie-restricted diet).
GLP-1s slow stomach emptying, which helps patients feel fuller faster and leads them to eat a much lower volume of food.
Several medical publications have suggested that GLP-1 agonists can assist with the conversion of white fat to brown fat - which is the fat we have in greater quantities in our youth and is more metabolically active and rich in mitochondria. This is suggested to be one possible mechanism of why GLP-1s might improve metabolic rate.
GLP-1s may work to lower your set point. Your set point is the weight your body naturally gravitates towards due to the interaction between metabolic health, genetics, and environment. When you restrict calories, your natural biology will resist weight loss to defend its set point. Research has shown that overweight patients who have more difficulty losing weight may have a functional deficit in GLP-1 signaling. GLP-1s may help resist the metabolic slowdown that happens in response to weight loss and calorie restriction.
Leptin mainly acts on your brain stem and hypothalamus, inhibiting or preventing hunger and regulating energy expenditure. When you are well-fed, leptin levels should be high, signaling your body to suppress appetite and burn off fat cell energy as fuel. Overweight or obese people can become leptin-resistant, meaning the brain does not respond as sensitively to leptin. Leptin resistance can lead to feelings of excessive hunger and sluggish use of stored energy (i.e. fat). GLP1 agonists, especially when accompanied by low-carb diets, avoidance of highly processed foods, or time-restricted eating, seem to help reverse leptin resistance. These dietary changes and weight loss made easier by GLP1s directly target the pathophysiology of leptin resistance.
OZEMPIC BENEFITS AND WHAT TO EXPECT
In our clinic, for patients being prescribed Ozempic, we target around one pound of weight loss per week. For patients with a smaller amount of weight to lose, even half a pound per week is acceptable.
According to a large, randomized controlled study, at the maximum dose of Ozempic for weight loss, obese patients lost an average of 6% of their body weight at week 12, 12% at week 28, and 15% at week 68.
Food cravings will diminish, making strategic food choices (i.e. a high protein, low carbohydrate diet), portion control, and time-restricted eating easier.
Ideally, GLP-1s not only lead to weight loss and improved metabolic health, they also enable patients to cement healthy habits gained in the process.
Our clinic’s goal when prescribing Ozempic is to keep our patients on the lowest dose while equipping them with the tools to maintain the food, exercise, sleep, and emotional wellness habits required for long-term success.
Ozempic can help reduce inflammation and metabolic dysfunction (i.e. insulin and leptin resistance) and has been associated with a reduction in blood pressure.
GLP-1s have been shown to regulate cholesterol and triglycerides in Type 2 diabetics by modulating key enzymes of lipid metabolism in the liver.
Studies have shown that Ozempic reduces cardiovascular events in Type 2 diabetics and reduces cardiovascular disease.
WHAT’S THE DIFFERENCE BETWEEN SEMAGLUTIDE, OZEMPIC, WEGOVY, AND MOUNJARO?
Semaglutide
This is a GLP-1 agonist - and is the active ingredient or drug in Ozempic and Wegovy. Semaglutide is not sold generically at a commercial pharmacy. Weight loss clinicians often work closely with a specialty pharmacy to utilize the generic form of this medication. The advantage of using this generic form from a compounding pharmacy is greater dosing adjustability as concentrations can be tailored. It is often less expensive for the patient and can be combined with B12 or carnitine for weight loss support. Semaglutide does not come as a pen injector - rather, it comes in a small vial and is administered using an insulin needle. Drawing up this medication with an insulin needle allows for smaller, more personalized dose increases - allowing the patient to avoid some of the annoying side effects like nausea. I will often start patients at 0.14 mg per week and instruct patients to increase by as little as two units at a time. While some patients may eventually land at the full weight loss dose (up to 2.4 mg per week), I typically find that patients often successfully lose weight at lower dosage ranges.
Ozempic
This is also a drug constituted of the active ingredient Semaglutide and delivered via injection once per week. This drug and delivery has been FDA-approved for Type 2 diabetes. It comes as a pen-injector to make it easy for the patient to administer. For Type 2 diabetes patients, the starting dose is 0.25 mg weekly, and the pen has presets that dictate dose increases as follows: starting dose - 0.25 mg, after four weeks - 0.5 mg once weekly if tolerating and further diabetes control is needed, the patient will increase to 1 mg weekly. If glycemic control is not achieved, 2 mg weekly is the maximum recommended dose. In Ozempic drug trials, such significant weight loss was noted amongst participants that this drug was later developed and approved as a weight loss medication (named Wegovy).
Wegovy
This is a drug constituted of the active ingredient Semaglutide and delivered via injection once weekly to assist with weight loss. As mentioned above, after observing incidental weight loss in drug trials of Ozempic, the same pharmaceutical company, Novo Nordisk, went on to develop Wegovy, a weight-loss version of Ozempic. This drug and delivery has been FDA-approved for weight loss. The only differences between Ozempic and Wegovy are the drug name and the dosing increments. Wegovy comes as a pen injector to make it easy for the patient to administer. The downside of the pen-injector is that the patient cannot start lower than 0.25 mg weekly - even at this low starting dose, many patients experience intolerable side effects. Wegovy dosing starts at 0.25 mg weekly, and, as with Ozempic, there are pre-set ramping increments. Patients are instructed to ramp up to 2.4 mg per week for weight loss. For many patients, this 2.4 mg per week dose can be overkill.
Mounjaro
This is a first-in-class drug that works as both a GLP-1 and a GIP agonist (the generic name is Terizipide). This drug was FDA-approved for Type 2 diabetes in May 2022 but is not more frequently being used off-label for weight loss. Mounjaro also comes as a pen injector to make it easy for the patient to administer. What has been promising about Mounjaro is that similar to GLP-1 agonists, it is a diabetes medication that can lead to weight loss. In clinical trials, patients taking Mounjaro lost a significant amount of weight (more than patients on Ozempic or Wegovy). Additionally, it paired well for people with diabetes on insulin, as it seemed to limit the weight gain that patients taking insulin typically experience.
WHAT ABOUT RYBELSUS - ORAL OR INJECTABLE SEMAGLUTIDE?
Both Rybelsus and Ozempic are approved GLP1s to treat Type 2 Diabetes. Rybelsus was approved in 2017, two years after Ozempic. Similar to Ozempic, Rybelsus is frequently used off-label for weight loss. The main difference is that Rybelsus is an oral tablet versus an injectable version like Ozempic. Meta-analysis studies suggest that they have similar weight-loss outcomes. However, for the drugs to result in similar weight loss outcomes, a maximum dosage of Rybelsus was required compared to a medium dosage of Ozempic. Both drugs have similar side effects and list pricing.
WHAT DOES THE RESEARCH SAY?
Studies show that there is a direct correlation between GLP-1 agonists and weight loss. In clinical trials of Wegovy as an adjunct to lifestyle modification, participants lost an average of 15 percent of their body weight – with more than half the people treated with Wegovy losing more than 15 percent of their starting weight - up to five times the average weight loss seen with traditional diet and exercise plans. Other studies concluded that “in adults with overweight (with at least one weight-related comorbidity) or obesity, semaglutide treatment led to substantial, sustained weight loss.” In another study, “stimulation of GLP-1R by the agonist … leads to body weight loss independent of reduction in food intake. Instead, this weight loss is caused by the activation of the thermogenic program in BAT (brown adipose tissue).”
OUR CLINIC’S PROGRAM
We have treated countless patients over the past five years - with the majority of them reaching their goal weight and keeping the weight off. We assess every prospective patient to determine if Semaglutide (i.e. Ozempic or Wegovy) is the right path to weight loss for them. Patients joining the program begin with an in-office consultation and body composition analysis on our SECA Scale (the gold standard for medical body comp analysis). The program includes the medication, weekly B12 or MIC Fat Burner injections, dietary recommendations, an Intermittent Fasting Guide (for those who are interested), and ongoing clinical support. Patients continue with the program in 90-day increments for as long as they find it necessary and beneficial to achieving or maintaining their goal weight.
FREQUENTLY ASKED QUESTIONS
Q. WHAT IS MY BMI AND DOES MY BMI NEED TO BE OVER 30 TO USE SEMAGLUTIDE?
A. You can use the BMI Calculator below to determine your BMI. Semaglutide is used on-label for people with a BMI over 30 or overweight with accompanied co-morbidities (i.e. high blood pressure, high cholesterol, etc.). This medication can be used off-label in patients wanting to lose weight without comorbidities based on the clinical judgment of the provider.
BMI Values for Women and Men 18 and Older
Underweight < 18.5
Normal weight 18.5–24.9
Overweight 25–29.9
Obesity > 30
Q. HOW MUCH DOES THE MEDICATION COST?
A. The average daily cost of Ozempic or Wegovy at a commercial pharmacy is around $900 to $1,350 per month. (It is difficult to get insurance to cover the cost of this medication for weight loss.)
Q. IS THIS MEDICATION APPROVED BY THE FDA?
A. Wegovy was recently approved by the FDA to treat weight loss for individuals with a BMI of 30 or higher (considered the obese category) and individuals with an overweight BMI (25 - 30) who also have a weight-related comorbidity (high blood pressure, high cholesterol, fatty liver disease, etc.).
Q. DOES INSURANCE COVER THIS MEDICATION
A. Most insurance companies will not cover Wegovy for weight loss. If a patient has Type 2 Diabetes, they generally need to fail other diabetes medications before being covered for Ozempic.
Q. WHAT ARE THE MOST COMMON SIDE EFFECTS?
A. Common side effects include nausea, changes in bowel habits, acid reflux, and, more rarely, abdominal pain or vomiting. If you are experiencing severe abdominal pain or vomiting, it is important to contact our clinic or, in severe cases, report to the Emergency Room. That said, very few patients report severe side effects.
Q. HOW MUCH WEIGHT CAN I EXPECT TO LOSE?
A. Wegovy conducted a study with 1,900 adults who were obese or overweight with comorbidity (high blood pressure or high cholesterol) and found that people lost a median of 15% of their weight while on a target weight loss dose of medication (2.4 mg/week). When managing patients on Semaglutide, our target is for patients to aim for approximately one pound of weight loss each week. Weight loss might be faster in the beginning for some patients and may slow as patients get closer to their target weight.
Q. DO I HAVE TO SIGNIFICANTLY CHANGE MY DIET?
A. In our experience, a diet focused on high-quality proteins, vegetables, and slow-burn carbohydrates tends to be a healthy and sustainable diet for most patients. We like to leave flexibility for patients’ personal or cultural preferences (i.e. pescatarian, vegetarian, dairy-free, etc.). General tenants that most medical professionals can agree upon include focusing on whole foods and avoiding highly processed foods and sugar, and at least some consciousness around white, starchy carbohydrates. We also introduce people to the concept of intermittent fasting, which, for some patients, can be an effective tool and made easier when on Semaglutide. Below are some general dietary recommendations that may help enhance weight loss efforts:
Focus on high-quality proteins. A general goal is to consume one gram per pound of body weight per day to avoid substantial muscle loss when losing weight.
Eat a fibrous diet. Focus on vegetables that are high in fiber and low on the glycemic index.
It is okay to consume slow-burn carbohydrates such as legumes, lentils, or quinoa.
Avoid fried foods or highly processed or fatty foods as they take longer to digest.
Limit or avoid simple, fast-burn carbohydrates such as rice, breads, bagels, and pasta
Limit alcohol intake.
Drink at least 32 oz of water a day to avoid constipation.
Q. IS EXERCISE NECESSARY?
A. While exercise isn’t as important as what you eat for weight loss, sustainable exercise habits have been proven to keep the pounds off. According to the National Weight Control Registry (a database of people across the U.S. who have lost at least 30 pounds and have kept it off for at least a year), the number one thing these people have in common is a daily exercise routine. Also, remember, while exercise may not be required for weight loss - it is imperative for optimizing your health and well-being.
Q. CAN I LOSE WEIGHT FAST WITH SEMAGLUTIDE, OZEMPIC, WEGOVY, OR MOUNJARO?
A. Literature suggests that patients lose an average of 15% of their body weight. Our goal is to have most patients lose approximately one pound each week. The speed with which you lose weight will depend on the amount of weight you need to lose as well as the dedication you put into supporting the medication’s effects with healthy lifestyle choices (food, exercise, emotional health, and sleep).
Q. WHAT IS THE AVERAGE LENGTH OF THE PROGRAM?
A. The duration of your program will depend on the amount of weight you want to lose as well as how effective the drug and your individual lifestyle changes are. The Wegovy study referenced above, which boasted an average of 15% body weight reduction, was a 17-month study at the maximum dose of 2.4 mg of semaglutide.
Q. WHERE CAN I BUY SEMAGLUTIDE?
A. Semaglutide is not available over the counter and must be prescribed by a physician. Semaglutide is not a supplement - it is a prescription medication. We highly recommend you work with a doctor who is familiar with GLP-1s, understands the intricacies of their use for weight loss, is effective at personalizing dosing, and is well-versed in helping patients integrate dietary and lifestyle interventions.
Q. DOES SEMAGLUTIDE HAVE ANY SERIOUS SIDE EFFECTS?
A. In rodents, Semaglutide medications and medications that work like Semaglutide, caused thyroid tumors, including thyroid cancer. It is not known whether or not Semaglutide will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma in humans. Other serious but rare side effects include pancreatitis, gallbladder problems, low blood sugar, kidney problems, allergies, increased heart rate, and depression or thoughts of suicide. The more common and less concerning side effects include nausea, changes in bowel habits, heartburn, bloating, belching, and fatigue. In our clinic, focusing on the lowest possible dose for weight loss helps to mitigate these side effects.
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