It has been well-documented that serious health risks multiply as weight increases. Roughly 70% of the US adult population is obese or overweight, driving up risks of type 2 diabetes, strokes, cardiovascular diseases, and specific cancers (1). Losing even 5% of one's total body weight can significantly reduce the risk of developing these devastating chronic illnesses (1).
Semaglutide has been reported to be a safe and effective weight loss tool, particularly for individuals who have tried other strategies without significant success. It has recently been promoted as having additional health benefits. Is it all just hype, or has it truly been proven to be safe and effective? With so many weight loss aids on the market, what makes weight loss injections such as Semaglutide a contender?
What is Semaglutide, Exactly?
To understand Semaglutide, you must know about an important hormone, glucagon-like peptide 1 (GLP-1). This hormone is naturally produced in the intestines, responding to the quality and quantity of food that makes its way there. GLP-1 leaves the intestines, playing multiple roles in the body - including in the brain and pancreas.
GLP-1 can stimulate insulin to be released from the pancreas (to lower blood sugar), act on the brain to reduce appetite, slow the movement of food through the stomach, and promote the feeling of fullness (2).
Semaglutide, a member of the GLP-1 agonist class of drugs, is known for its safety profile. In pharmacology, an agonist is a substance that mimics the action of another substance. This means that Semaglutide, while effective in promoting weight loss, is also designed to be safe for use.
Semaglutide stands out among weight loss aids due to its unique ability to mimic the action of the GLP-1 hormone. It stimulates the same cell receptors as GLP-1 hormones, thereby stimulating insulin, reducing appetite, and providing the feeling of fullness from food, just as the natural GLP-1 hormone does.
Due to its actions on insulin, Semaglutide (as Ozempic) was initially used as a treatment to reduce blood sugar in cases of type 2 diabetes, beginning in 2005 (2). After prescribing this GLP-1 agonist for many years, it was noted that it helped obese diabetics lose weight quickly.
Semaglutide's ability to reduce appetite and assist with weight loss was then studied for many years, spinning off a variation of this GLP-1 agonist called Wegovy that was explicitly marketed to address weight loss in the obese (2). Wegovy was approved in 2021 by the FDA to combat obesity, so it can be used by those who are overweight but do not have diabetes (1).
In March 2024, Wegovy received expanded approval from the FDA to "reduce the risk of heart attack, stroke, and cardiovascular death in adults who are obese or overweight and have cardiovascular disease” (3).
GLP-1 agonists are usually delivered as an injection, though there is now an oral form of the medication. For injections, the medication is loaded into an injector pen, which often has a dial to select the correct dosage (as prescribed by the doctor). Injector pens use very fine, single-use needles that deliver the medication below the skin on a fatty area, feeling much like a light thump or a sting that quickly disappears. Doctors often train their patients to use the injector pen on themselves to deliver the medication into their systems conveniently at home.
Ozempic is currently approved for use in diabetic patients to lower blood sugar. Wegovy is currently approved to treat obesity (rather than diabetes). They are both potent GLP-1 agonists. Additionally, there are other GLP-1 agonists currently on the market (besides these two popular ones) that could be prescribed.
Demonstrated Health Benefits
Weight Loss Aid - There have been many Wegovy studies demonstrating the ability to aid weight loss. One of the largest studies was in adults who did not have diabetes but who were overweight. The average weight of the participants was 231 lbs at the beginning of the study. In the end, those who received Wegovy (rather than a placebo) lost roughly 12% of their total body weight (1). Twelve percent of 230 lbs is almost 28 lbs, a significant amount of weight loss!
Another Wegovy study was done, this time on overweight diabetics (type 2), a nearly equal amount of males and females, and they weighed about 220 lbs. on average. People in this group lost about 6% of their total body weight, about 13 lbs (1).
A longer two-year study, one of the longest-running studies on Wegovy, was completed in February 2019. The mean weight loss from the participants' weight at the beginning of the study was 15.2% in non-diabetics (4).
Over half the participants in the two-year study on Wegovy, a variation of Semaglutide, lost greater than 10% of their body weight, while over one-third lost almost 20% of their beginning body weight (4). This result is incredibly encouraging, especially when considering that 'success' is often declared at losing 5% of body weight. It's a testament to the effectiveness of Semaglutide in promoting significant weight loss.
Positive Metabolic & Cardiac Effects - The two-year study mentioned above produced other impressive results - improvements related to blood sugar levels, cardiovascular health, and inflammation (4):
Decreased waist measurement
Lowered blood pressure
Lowered cholesterol levels (LDL, vLDL, triglycerides)
Reduced fasting insulin and glucose scores
Lowered A1C levels (indicates blood sugar average over three months)
Lowered C-reactive protein scores in blood (inflammation marker)
Multiple Benefits May Allow Reductions in Overall Number of Prescriptions - Because of the multiple benefits listed above, a patient's medications may be streamlined. For example, Semaglutide's cholesterol-lowering effects may eliminate the need to put the patient on cholesterol medications or allow the doctor to lower their cholesterol medication dosages.
Good Safety Profile - Safety and efficacy trials lasting 68 weeks were conducted to determine how well Wegovy works and how safe it is (1). This series of studies involved over 2,600 participants, with 1,500 receiving a placebo for comparison. Side effects were documented, with the vast majority being minor in nature. Semaglutide works very well for weight loss and is well-tolerated. Since the medication has been around for almost 20 years, the risks have been identified, and strategies to lower those risks are well-known by competent doctors.
Who is a good candidate?
Anyone struggling to lose weight and carrying 30 or more extra pounds on their frame is a good candidate. Other considerations that may indicate you are a good candidate for Semaglutide injections are (2):
~ A body mass index (BMI) greater than 30
~ A lower BMI of 27, but with a concurrent condition such as elevated blood pressure or high cholesterol scores
~ Have the inability to lose weight even when restricting calories and exercising
~ Have a past of yo-yo dieting (multiple cycles of weight loss, but then gaining it all back)
Semaglutide works in patients who struggle to maintain a specific diet, are prohibited from certain types of exercise, or have a metabolic status that strongly resists weight loss. Those who are obese, diabetic, courting diabetes, or who have high blood pressure or heart disease especially benefit from this medication.
Risks
All medications carry some risk. The vast majority of the risks incurred with Semaglutide are not serious. However, rare circumstances can increase the risk of a serious negative outcome.
The Low Risks - The most frequently reported side effects are usually mild, of low risk to overall health, and involve appetite and digestion. Lowering the dosage usually corrects these low-risk symptoms which include nausea, vomiting, indigestion, belching, diarrhea, constipation, and/or abdominal pain (1).
The Serious Risks - The most severe risks involve aggravating certain types of tumors (1). Additionally, there can be irritation (inflammation) of the pancreas and gallbladder (1). In rare instances, Semaglutide can severely affect mood and heart rate (1). Having a complete health history on file at your doctor's office is essential, with a doctor overseeing your weight loss.
Skin Tone - Rapid and significant weight loss can lead to fat loss in the face. For some, this could mean more noticeable wrinkles or skin that has lost its firmness. Since these effects are usually minor, cosmetic treatments can counter them. For those who lose a lot of weight (over a hundred pounds, for example), the skin around the waist, breasts, arms, or thighs may not be able to shrink fast enough. Slow weight loss and regular exercise counter this problem in most people. Those who do get some loose skin may choose elective surgery to remove skin that cannot shrink back to the new, smaller body size.
Blood Sugar Levels - Remember, Semaglutide is for the obese, not the person who is close to a healthy body weight. In those who are not obese and not diabetic, Semaglutide may lower the blood sugar to an uncomfortable or even dangerous level (1). Blood sugar levels should always be taken into consideration. Frequent monitoring may need to occur (when beginning Semaglutide) for those with naturally low blood sugar or those who have dangerous dips. If one is diabetic, the dosage of Semaglutide should be calculated with the insulin dosage in mind.
Benefits of Semaglutide
The results of using Semaglutide for weight loss are reliable. Usually, it will result in weight loss even for those who have always struggled to lose weight.
Semaglutide typically works for those who find diets hard to maintain due to constant feelings of hunger or who struggle with surges of severe hunger.
For those who are prohibited from exercising, Semaglutide usually enables weight loss.
For those whose metabolism adjusts as food is restricted (resulting in little or no weight loss despite eating fewer calories and exercising), this medication enables weight loss.
The delivery mechanism of a weekly shot is generally painless and easy to maintain. Patients can be taught to deliver the injection themselves, so there is no need to come to the office weekly for a shot.
One’s diet does not have to be perfect for weight loss to occur. (Though, it works much better and overall health improves if highly processed and sugary foods are removed. Altering the diet also sets a successful pattern for the future, when Semaglutide injections are withdrawn.)
Once a good amount of weight is lost, other weight loss strategies become easier. Many people report that they feel more active and can incorporate walks, dancing, and other physical activities that promote additional weight loss. Since appetite is reduced, binge eating is diminished, and it's easier to stick to a diet high in nutrients but low in sugar and artificial ingredients.
Once the user's weight reaches a healthier range, joint and muscle pain often disappears! It's also not unusual for one’s mood to improve because people like what they see when they look in the mirror.
Some patients can lower or remove medications as their weight drops off! (That's why it's essential to be monitored by a doctor, especially for those who have diabetes or take heart medications.)
Semaglutide can be used long-term, but the patient can withdraw from it once the weight is closer to a healthy level for their frame. Changing dietary habits and incorporating regular movement during treatment helps maintain weight loss and prevent weight gain after the medication is withdrawn.
Evaluation for Weight Loss
At TCIM, we like to present the full range of options for patients, including diet modification, movement, nutritional supplements, and/or medication. There is no one-size-fits-all weight loss treatment. Please make an appointment with one of the TCIM doctors to be evaluated for a weight loss plan, and mention Semaglutide if interested. If it's been a while since you've had a physical, we encourage scheduling an Executive Physical to discover and treat health risks that often accompany high body weight. Let us help and support you as you move toward a leaner, happier, more vibrant you.
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
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Sources
1. Office of the Commissioner. FDA approves new drug treatment for chronic weight management, first since 2014 [Internet]. U.S. Food And Drug Administration. 2021. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014
2. Diet MC. Considering GLP-1 medications? What they are and why lifestyle change is key to sustained weight loss [Internet]. Mayo Clinic Diet. 2024. Available from: https://diet.mayoclinic.org/us/blog/2023/considering-glp-1-medications-what-they-are-and-why-lifestyle-change-is-key-to-sustained-weight-loss
3. Wegovy: Uses, dosage, side effects, warnings [Internet]. Drugs.com. Available from: https://www.drugs.com/wegovy.html
4. Garvey WT, Batterham RL, Bhatta M, Buscemi S, Christensen LN, Frías JP, Jódar E, Kandler K, Rigas G, Wadden TA, Wharton S. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nature Medicine [Internet]. 2022 Oct 1;28(10):2083–2091. Available from: https://www.nature.com/articles/s41591-022-02026-4