Semaglutide/GLP-1: Your Latest FDA-Approved Option for Sustainable Weight Loss
Semaglutide: A Potential Game-Changer
Obesity is a condition that currently affects over 40% of adults in the United States. Another 30% are considered overweight. This puts these adults at risk for heart disease, stroke, and diabetes and is linked to an increased risk of certain types of cancer. Losing just 5% to 10% of body weight has been associated with a reduced risk of cardiovascular disease in adult patients who are overweight or obese. It has also been shown to lower the risk of getting diabetes by 58%. While there is no “magic pill” that will cure obesity immediately, researchers have created a variety of medications to address various aspects of an individual’s struggle with weight. When diet and exercise alone do not offer the expected and desired results, obesity must be viewed differently. Instead of being a willpower problem, it is a chronic metabolic disease. With this renewed understanding of obesity, practitioners and patients can work together to find a solution that works for their bodies and lifestyles.
The ultimate goal? Health, of course. Losing weight can improve self-perception and mood, but the emphasis should always be on health and not achieving a certain size- although that certainly is a desired by-product. The goal of anti-obesity medications is to reset the “set point,” a term that describes a weight range the body tries to maintain. It’s important to understand this weight range varies from person to person. By resetting this “set point,” patients have a better chance of losing weight and maintaining that weight loss. Anti-obesity medications can also help with other weight-related medical problems such as high blood pressure, cholesterol levels, blood sugar levels, and delaying the onset of type 2 diabetes. The GLP-1 medications, in particular, have also been found to decrease the occurrence of repeat heart attacks and strokes, particularly in those with type 2 diabetes.
What It Is
Anti-obesity medications have been around for decades, and there are several currently in use. Semaglutide is the first of a new generation of highly effective obesity medications. And it is proving to be one of the most effective weight loss solutions available. Similar products for diabetes have been out for years, such as the brand names Rybelsus, Wegovy, and Ozempic. What sets this apart is that it can be used with Phentermine for maximum weight loss. Semaglutide, when successful, can help someone shed up to 15% of their body weight. That’s 30 pounds on a 200-pound patient!
The drug—and class of medications—is not new. This class of GLP-1 analogue medications has been used for over 15 years to treat Type 2 Diabetes (Semaglutide specifically was FDA-approved in 2017 for diabetes). In June of 2021, the FDA approved it as a weight loss medication. GLP-1s are different from older weight-loss medications (like Phentermine) classes. They work on key underlying metabolic pathways to support sustained weight loss, not a quick fix. GLP-1s are not stimulants, non-habit forming, and are clinically proven to be the most effective medications for long-term results. They work on the same receptors as powerful, naturally-occurring GLP-1 hormones that exist in your body. GLP-1s also have far-reaching benefits, including reducing inflammation and cardiovascular disease risk to help you lose weight and live a longer and healthier life.
Semaglutide is for weight management in adults whose:
- BMI is 27 kg/m², and suffer from diabetes and high blood pressure, or
- BMI is greater than 30kg/m².
What It Isn’t
Semaglutide is not a type of insulin or a substitute for insulin. Semaglutide does stimulate your pancreas to release insulin when glucose (sugar) is present. Practitioners will not prescribe this medication to patients with Type 1 Diabetes since your primary physician should regulate insulin.
Semaglutide is not a stimulant. However, you can take Semaglutide in conjunction with Phentermine or Phendimetrazine, both stimulants.
How Does It Work?
You receive Semaglutide through a subcutaneous injection under the skin or by mouth. It then mimics a hormone called glucagon-like peptide-1 (GLP-1), which is secreted in the gut and targets receptors throughout the body, including the brain. GLP-1 sends the brain the “I’m full” signal when a person is eating. In short, this medication helps you feel full earlier. The result? Little desire to reach for seconds or need a snack in an hour or two.
Semaglutide also decreases “gastric emptying.” This is the process by which stomach contents move into the first part of the small intestine as part of the digestive process. However, this effect wanes over time. The main way Semaglutide helps treat obesity is through its action in the brain.
Individuals with Type 2 Diabetes secrete less GLP-1 in response to eating compared to those who do not have the condition. Experts believe that’s also true for people with obesity. With Semaglutide, people are receiving more GLP-1, albeit in a synthetic form. They’re essentially getting back more of that hormone, which helps them feel full.
Dosage and Results
The medication dose increases gradually over a period of time to reduce gastrointestinal side effects. Patients will slowly work their way up to the target dose, at which time they will see the most weight loss. It is important to keep in mind that weight loss can take time, and patients see the best results when they combine medication with a healthy diet and exercise.
Semaglutide is a weekly injection. Do not take more than once a week. The dose will increase slightly over time as needed. Physicians will monitor the dosage for each patient.
For many people, the medication appears to work really well. The results of a clinical trial published in The New England Journal of Medicine showed that—in addition to the 12.5% mean weight reduction above the placebo group (which included lifestyle interventions only)—more than a third of the participants (many of whom weighed more than 200 pounds) lost 20% of their weight. During the trial, overweight and obese adults without diabetes taking once-weekly subcutaneous Semaglutide in addition to lifestyle intervention saw substantial, sustained, clinically relevant mean weight loss of 14.9%, with 86% of participants attaining at least 5% weight loss.
Compared to other weight-loss drugs, including Phentermine, injectable Semaglutide was substantially more effective.
Safety and Clinical Trials
Semaglutide is considered safe and effective when used as indicated. A clinical trial study recently published in The Lancet has discovered that using multiple doses of Semaglutide along with Cagrilintide is a safe treatment option. Another research studied the safety profile of oral Semaglutide against Sitagliptin for 52 weeks. The results revealed that most patients tolerated Semaglutide well and showed significant weight reduction and lower HBA1C. Additionally, a 2021 clinical review revealed that both oral and injectable formulations of Semaglutide are safe and effective in lowering sugar and weight management and are associated with a lower risk of hypoglycemia.
Side Effects and Considerations
The most common side effects include nausea, diarrhea, vomiting, constipation, abdominal (stomach) pain, headache, fatigue, dyspepsia (indigestion), dizziness, abdominal distension, eructation (belching), hypoglycemia (low blood sugar) in patients with type 2 diabetes, flatulence (gas buildup), gastroenteritis (an intestinal infection) and gastroesophageal reflux disease (a type of digestive disorder). Patients who experience a severe allergic reaction must stop the medication immediately and seek medical help. And while around 50 percent of people on Semaglutide complain of mild nausea, vomiting, and constipation, it’s still well tolerated in 95 percent of the patients.
Semaglutide also carries a boxed warning about thyroid C-cell tumors occurring in rodents (with unknown risk in humans). Do not use Semaglutide if there is a family history of certain thyroid cancers or pancreatitis, or in people with Type-1 diabetes. In addition, people who use other blood sugar-lowering medications should use Semaglutide cautiously.
Hypoglycemia may occur in patients taking other medications known to lower blood sugar levels. You should not use Semaglutide if you are pregnant or breastfeeding. Patients should exercise caution if they have a severe GI condition. Always speak to your trusted provider if you have any specific questions.
Regarding how long a patient should remain on Semaglutide for weight loss, the FDA will continue to review data for this new indication. We know study participants received treatment for 68 weeks (about 1.5 years) during each of the four trials conducted by the company. Therefore, the approval is for this length of time.
Currently, insurance does not cover Semaglutide for weight loss, and it can be quite expensive ($800-$1400 per month). Valley Medical Weight Loss is thrilled to offer this medication to our patients thru our FDA-approved pharmacy for only $50 per weekly injection. Packages are 10 for $450.
We are happy to offer a consultation if you would like to learn more about Semaglutide and other weight loss treatments. Booking an appointment is unnecessary as we are a walk-in-only clinic. Simply come in at your convenience, Mon, Tue, Thu, or Fri between 9 am-4:30 pm, or Saturdays from 8 am to 1:30 pm, or you can contact us HERE with any questions.
By Jodi Jaffe
May 16, 2022