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Recently, weight loss drugs have been a popular topic of discussion – in news media, in Hollywood and online. Comedian Jimmy Kimmel cracked a joke about Ozempic at the Oscars and Tesla CEO Elon Musk tweeted that the secret to his weight loss is Wegovy. Both Ozempic and Wegovy are brand names for semaglutide. Ozempic was first approved in 2017 to treat type 2 diabetes, and Wegovy was approved to treat obesity in 2021.

As the medical director for Obesity Medicine at TMH Physician Partners - Endocrinology, Obesity & Diabetes (formerly the Tallahassee Memorial Metabolic Health Center), I prescribe these drugs to patients to help them lose weight. When used in conjunction with lifestyle changes like diet and exercise, these drugs can help patients with type 2 diabetes and obesity live a happier, healthier life. But there are misconceptions about these drugs, and many questions too. Here’s what you should know.

What is Semaglutide?

Semaglutide is known as a glucagon-like peptide-1 receptor agonist, or GLP-1 Ra, which stimulates your pancreas to produce more insulin, lowering your blood sugar levels and decreasing your appetite.

Ozempic and Wegovy are name brands for Semaglutide. Ozempic was FDA-approved in 2017 after being tested on patients with type 2 diabetes for safely lowering A1c – average blood sugar levels. One of the side effects of the drug is weight loss.

Because so many patients taking Ozempic experienced weight loss, Novo Nordisk, the company that owns semaglutide, went through the FDA testing process again. This time, instead of testing the drug on patients with type 2 diabetes, the drug was tested on patients without diabetes to specifically monitor their weight. After this process, semaglutide was approved for weight loss under the brand name Wegovy in 2021.

Both drugs are given via subcutaneous injection.

How Does Semaglutide Work?

1. GLP-1 Receptor Activation: Semaglutide binds to and activates the GLP-1 receptors in the pancreas and other target tissues, mimicking the effects of the natural GLP-1 hormone.

2. Blood Sugar Regulation: By activating GLP-1 receptors in the pancreas, semaglutide stimulates the release of insulin in response to high blood sugar levels. Insulin helps transport glucose into cells, lowering blood sugar levels.

3. Suppression of Glucagon Release: Semaglutide also reduces the release of glucagon, another pancreatic hormone. Glucagon raises blood sugar levels by promoting the release of glucose from the liver. By inhibiting glucagon, semaglutide helps control blood sugar levels.

4. Slowing Gastric Emptying: Semaglutide also slows down the emptying of the stomach, which can help regulate the absorption of nutrients, including glucose, in the digestive system. This action contributes to a feeling of fullness and reduced appetite.

5. Appetite Regulation: By acting on the brain’s appetite centers, semaglutide can promote a sense of fullness and reduce food intake.

How Does Wegovy Work to Cause Weight Loss?

Wegovy is designed for patients with obesity to help them eat fewer calories, and in turn, lose weight. When partnered with a healthy diet and exercise, taking Wegovy can lead to significant weight loss.

Because Wegovy decreases the appetite, it’s important to ensure that what you eat contains enough protein and other nutrients to stay healthy. You’ll also want to make sure you stay hydrated and drink plenty of water.

The foundation for all successful long-term weight loss is lifestyle change, which includes diet, exercise and healthy habits. Lifestyle change is the cornerstone of our Obesity Medicine Program at TMH where our team works closely with patients to identify which avenue is right for them. Often, that involves both medications and lifestyle change. Meal replacement and bariatric surgery can also be taken into consideration.

How Effective Are Weight Loss Drugs?

When used for more than 12 weeks, Wegovy can lead to major weight loss. The combination of diet, exercise and weight loss medication can have an even greater effect than diet and exercise alone.

A patient taking Wegovy for one year could see a total body weight loss of 3 to 12% more than if they were trying to lose weight with diet and exercise. While 3 to 12% may not seem like much, losing that weight can have significant health benefits such as lower blood pressure.

Who is Using These Drugs?

While many people are using Ozempic and Wegovy for type 2 diabetes and obesity, some are using semaglutide “off-label” for weight loss. Using a drug “off-label” means using it for something other than its FDA-approved use. For example, using Ozempic, which is FDA-approved for diabetes, for weight loss. Currently, because of the increased demand for these drugs, there is currently a nationwide shortage of both Ozempic and Wegovy.

Are There Side Effects?

As with any medication, there are side effects. Patients taking semaglutide can experience dizziness, fatigue, diarrhea, constipation, gassiness, headache, nausea, vomiting, pain, low blood sugar, less fullness in the face, vivid dreams, hair loss or bloating. These side effects may improve over time. If they don’t, patients should consult their healthcare provider.

In rare cases, patients may experience pancreatitis, gallbladder issues, kidney damage or thyroid tumors. Recently, some patients have reported stomach paralysis, which can lead to excessive vomiting and suicidal thoughts.

Your healthcare provider can discuss these side effects and risks with you. It’s essential to discuss your medical history, current medications and any concerns you have with your healthcare provider before starting any medication. Regular follow-up appointments with your healthcare provider are important to monitor your progress, adjust the dosage if necessary and address any potential side effects or concerns.

What Happens if You Stop Taking Semaglutide?

Because these prescriptions are designed for long-term use, patients who use semaglutide for weight loss may gain some or all their weight back if they stop taking the medication. However, those who practice healthy lifestyle changes may be able to mitigate weight gain.

Does Insurance Cover These Drugs?

Insurance coverage for semaglutide may vary depending on your specific insurance plan and the indication for which it is prescribed (e.g., diabetes management or obesity treatment). Insurance coverage policies can change over time, so it's essential to check with your insurance provider or your healthcare team to get the most up-to-date information regarding coverage.

For diabetes management, some insurance plans may cover semaglutide if it is prescribed as part of the treatment for type 2 diabetes. However, coverage may be subject to certain criteria, such as prior authorization or specific medical conditions that meet the insurance company's guidelines.

Regarding obesity management, coverage for semaglutide may be more limited, as it was originally developed as a diabetes medication. However, some insurance plans may offer coverage for semaglutide when used for weight management if specific criteria are met, such as a BMI above a certain threshold and evidence of unsuccessful weight loss attempts with other methods.

It's essential to contact your insurance provider and consult with your healthcare provider’s office. They can guide you through the process of verifying coverage and, if necessary, explore alternative options.

Are Compounded Versions of These Drugs Safe?

Some people who want to use semaglutide but can’t get a prescription have looked elsewhere – like pharmacies outside of U.S. or compounding pharmacies. Compounded versions of the drug are not approved by the FDA or Novo Nordisk, the owner of semaglutide. In fact, Novo Nordisk is suing a list of medical spas, weight loss clinics and compounding pharmacies who have allegedly sold copycat versions of the drug.

It's important to note that semaglutide is a prescription medication and should only be used under the supervision and guidance of a healthcare professional. The appropriate use of semaglutide, including dosage and monitoring, will depend on the individual’s specific medical condition and needs. As with any medication, there may be potential side effects and interactions with other drugs, so regular follow-up with a healthcare provider is essential.

Taking a Comprehensive Approach to Weight Loss

While a weight loss drug may seem like a magic pill, you should talk to your healthcare provider about a holistic approach that can ensure long-term success.

At TMH, we provide comprehensive obesity medicine care with a host of options to help you reach your weight loss goals – whether that’s lifestyle change on its own, Wegovy, another medication, meal replacement or bariatric surgery.

Our robust, multidisciplinary team is here to help you through your weight loss journey. If you’d like to get started today, you can contact our team.

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Angelina Cain, MD