Semaglutide: What Does It Do

Semaglutide comes in a dose of 2.4 milligrams and is injected subcutaneously once per week. The drug at the retail level is known as Wegovy. Some people know about semaglutide for the management of type 2 diabetes. If it is used at a dose of 1.0 milligrams then it’s called Ozempic. Ozempic was approved many years ago so we have some data on long-term effects.

Semaglutide is a glucagon-like peptide 1 receptor agonist, GLP-1 for short, is a naturally occurring hormone that is released by the body when food, particularly carbohydrates, hits the stomach. GPL-1 is released by cells in the small intestine, and it does several important things. First, it signals the pancreas to release insulin to move sugar out of the blood and into the cell.  It also slows gastric emptying, which leads to greater feelings of fullness. And then finally, these GLP-1 receptor agonists are hitting a part of the hypothalamus that stimulates fullness or what’s known as satiation receptors, so people feel full earlier when they’re eating and don’t eat as much food. So these 3 actions support weight loss.

GLP-1 has a very short life when it’s released. It’s active for about two to three minutes, so you have a temporary feeling of fullness. But these new drugs, semaglutide 2.4 milligrams, have a seven-day half-life. So people are feeling greater fullness and less hunger for longer periods of time, and as a result, they are just eating less and less tempted by all the cues in the toxic food environment. Desert, snacking, and thinking about food often is significantly reduced. 

In our experience, our patients are losing 10-12 lbs per month, depending on their initial weight and their adherence to the nutrition guidelines we provide.  The majority of the weight loss is fat loss or visceral fat loss.  This is so important for improving one’s metabolic and overall health.  For those patients who do not clean up their diet, they struggle a bit more.  We provide nutrition counseling and planning for all of our patients and Semaglutide allows for a more liberalized diet, which is great.  Patients are learning how to eat normally.

When you lose visceral fat, the body begins to get into a healthier state.  Blood pressure normalizes, cholesterol normalizes, joint pain subsides, digestive issues improve, mental clarity improves the list goes on.

Approximately 15% of our patients experience side effects.  Of the 15%, approx 5% need to stop the medication.  Common side effects include nausea, constipation, and fatigue, but we have strategies in place to help patients through the initial period.

• Some strategies include:
• Magnesium supplementation
• probiotics
• Digestive enzymes
• chewing food more thoroughly
• eating smaller meals
• drinking water between meals rather than with meals

Semaglutide is given by subcutaneous injection. We have not had any patients refuse it because of this. We teach them how to do the injection and the fear goes away immediately because the needle is tiny and you really can’t even feel it. 

There is a lot of talk about what happens after you stop the medication.  The information out there is meant to scare people into staying on it long-term.  When you lose fat, primarily visceral fat, you improve your metabolic health. When you are in a healthier metabolic state, you are less vulnerable to weight regain. 

Now, if you haven’t changed your poor eating habits and haven’t lost much weight while on Semaglutide then you will likely regain your weight back. Weight regain largely depends on your metabolic health.  If you still have high visceral fat levels then you are more likely to gain weight.  So we encourage our patients to stay on Semaglutide until they get close to a normal level of visceral fat.

Semaglutide can help those who continue to eat a less optimal diet but it’s an expensive way to maintain or lose weight gradually.

You must be willing to make some changes.  Who thought that we are that naive to think that weight loss will stick if you go back to unhealthy eating habits? Like anything else, you have to work at it.  You don’t need to be perfect but you need to be prepared to make some changes.