Ozempic for weight loss

UNDERSTANDING SEMAGLUTIDE, OZEMPIC, and WEGOVY for weight loss

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 metabolic health program, focusing on hormone health, food, sleep, and exercise.

HOW DO SEMAGLUTIDE, OZEMPIC, and WEGOVY WORK?

Semaglutide, most widely known as Ozempic and Wegovy, 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.

Studies have suggested that Ozempic increases lipolysis and fatty acid synthesis. In simple terms, this means you have an easier time breaking down and using stored fat for energy.
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). The moral of the story is, semaglutide may improve leptin sensitivity by regulating leptin and preventing resistance to this powerful satiety hormone.

Wegovy & OZEMPIC BENEFITS AND WHAT TO EXPECT

In our clinic, for patients on our Semaglutide Seattle program, we target around one-half to one pound of weight loss per week.

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 OZEMPIC, SEMAGLUTIDE, Wegovy, and MOUNJARO?

Semaglutide

Semaglutide is a GLP-1 receptor agonist and the active pharmaceutical ingredient in both Wegovy and Ozempic. It is FDA-approved for Type 2 diabetes, chronic weight management, and the reduction of major adverse cardiovascular events in adults with Type 2 diabetes and established cardiovascular disease. Clinical trials have demonstrated meaningful metabolic and weight-loss benefits: patients lost an average of ~15% of body weight over 68 weeks, and individuals with Type 2 diabetes achieved an average hemoglobin A1c reduction from 8.3% to 6.4%. In addition to FDA-approved commercial products, semaglutide can also be obtained through specialty compounding pharmacies. When clinically appropriate, we work with trusted 503A/503B pharmacies that operate under state and federal oversight to provide compounded semaglutide, which may offer more flexible titration options and can sometimes be more affordable depending on insurance coverage and availability.

Ozempic

Ozempic contains the same active ingredient (semaglutide) found in Wegovy and compounded semaglutide—the difference lies in FDA indication, branding, and dosing. Ozempic is FDA-approved for Type 2 diabetes and is delivered as a once-weekly injectable pen. The pen is convenient but offers fixed dosing increments: patients typically start at 0.25 mg once weekly, then increase to 0.5 mg, and may further escalate to 1 mg or a maximum recommended 2 mg weekly if additional glycemic control is needed. Although not initially approved for weight loss, Ozempic trials showed significant reductions in body weight, which led the manufacturer to develop and obtain FDA approval for Wegovy as a chronic weight-management version of the same semaglutide molecule.

Mounjaro / Tirzepatide

Tirzepatide is a dual GLP-1 and GIP receptor agonist and is the active ingredient in both Mounjaro and Zepbound. Mounjaro is FDA-approved for Type 2 diabetes, while Zepbound (containing the same molecule) is FDA-approved for chronic weight management. Both are typically delivered as once-weekly auto-injector pens with preset dosing increments. In clinical studies, tirzepatide has demonstrated robust metabolic effects, including greater A1c reductions and greater average weight loss compared to semaglutide in head-to-head trials. Like semaglutide, tirzepatide is also available through certain compounding pharmacies; when clinically appropriate, compounded forms may offer more flexible titration options for patients who benefit from individualized dosing schedules. Cost, insurance coverage, and availability can vary between commercial and compounded products. We seek to use commercial, FDA-approved versions of this medication when possible.

Wegovy (pill & injections)

Wegovy contains the same active ingredient (semaglutide) found in Ozempic and compounded semaglutide—the difference lies in branding, FDA indication, and delivery format. Wegovy is FDA-approved for chronic weight management and is offered primarily as a once-weekly auto-injector pen, with an oral formulation recently approved. While the pen is convenient, it comes in fixed dose increments: patients must start at 0.25 mg weekly and follow preset titration steps up to 2.4 mg, which can feel aggressive for individuals sensitive to gastrointestinal side effects. The oral form also has limited dosing options and must be taken on an empty stomach at least 30 minutes before food or other medications, which some patients find difficult to integrate into daily routines. Compounded semaglutide that is intended to match Wegovy (when sourced from appropriate 503A/503B pharmacies) allows for lower starting doses, smaller titration steps, and broader dosing flexibility. For many patients, this customized approach improves tolerability while maintaining the therapeutic benefits associated with Wegovy’s semaglutide-based mechanism.

WHAT ABOUT the wegovy pill - ORAL OR INJECTABLE SEMAGLUTIDE?

In addition to the injectable form of Wegovy, there is now an oral Wegovy Pill formulation approved for chronic weight management. This builds on earlier approvals of oral semaglutide (such as Rybelsus) for Type 2 diabetes, which demonstrated that Wegovy (semaglutide) can be effective when delivered as a daily tablet. Like its injectable counterpart, the oral Wegovy pill uses the same active ingredient - semaglutide - to support weight loss, but it must be taken on an empty stomach at least 30 minutes before food or other medications. Oral semaglutide generally has limited dosing options compared to injectables, and some patients find the timing requirements more challenging to integrate into their routines. In clinical studies, oral semaglutide has shown meaningful effects on weight and glycemic control, though achieving similar outcomes to injectables often requires consistent use of the higher available dosages. Side effect profiles are similar across oral and injectable semaglutide, and pricing and insurance coverage can vary depending on formulation and plan.

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.

In another study, people who took semaglutide lost, on average, 3.6% of their body weight after 3 months, 5.8% after 6 months, and 8.3% after 12 months.

Compared to semaglutide, those who took tirzepatide lost a greater percentage of body weight each month: an average of 5.9% of their body weight after 3 months, 10.1% after 6 months, and 15.3% after 12 months.

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-1s 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).”

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 Semaglutide Seattle 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. We offer the following programs: Semaglutide Seattle (with Ozempic), Semaglutide Bellevue (with Ozempic).

OUR CLINIC’S PROGRAM

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Weight Loss Calculator

Use this calculator to help determine your personal calorie target for weight loss, taking into account your activity levels.

The Maintenance number indicates the baseline number of calories you burn at your current weight and activity.
The Weight Loss number indicates the maximum number of daily calories to consume for one pound of weight loss per week.
The Deficit number indicates the daily caloric deficit needed for one pound of weight loss per week.

The daily caloric deficit can be achieved by reducing this number of calories you eat daily (Deficit) or burning it off through exercise. We caution against exercising your way to weight loss as this often increases your appetite. Awareness of your caloric intake is imperative for weight loss. To be clear, we always recommend exercising for health. And don’t forget that increasing muscle mass will boost the number of calories your body burns in a day.

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 monthly cost of Ozempic or Wegovy at a commercial pharmacy is around $935. (It is difficult to get insurance to cover the cost of this medication for weight loss.) The average monthly cost of Mounjaro at a commercial pharmacy is around $1,000 to $1,300 per month.

Q. IS Ozempic or Wegovy 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.). The FDA approved Ozempic to treat Type 2 Diabetes.

Q. DOES INSURANCE COVER Ozempic or Wegovy?

A. Most insurance companies do not have great coverage for these medications for weight loss. If you have Type 2 Diabetes, your chances of getting coverage for Ozempic are slightly higher. 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. For more information about side effects, please see our blog post “Side Effects of Semaglutide for Weight Loss.”

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. Is there an oral version of Ozempic?

A. Yes, there is an oral tablet version of Ozempic called Rybellsus. It comes in 7- and 14-mg tablets. The bioavailability of oral semaglutide is limited, so some patients find this to be less effective or less consistent than injections. Also, for this medication to work, it must be taken away from food and water. Adherence or correct compliance with this medication can be poor. Therefore, we tend to recommend injectable medication.

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, or WEGOVY?

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, Ozempic, or Wegovy?

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. For more information about side effects, please see our blog post “Side Effects of Semaglutide for Weight Loss.”