If you’ve opened your phone to any news station or social media app recently, you have likely come across information about a “new miracle weight loss drug!” This category of drugs has received more attention recently as celebrities have been reporting using it to achieve some visibly shocking weight loss results. You might be finding yourself asking:
- What is this drug?
- How does it help with weight loss?
- Is it safe?
- How might it impact nutrition recommendations?
In this blog, our team of dedicated nutrition experts, doctors, and Registered Dietitians weigh in on the growing popularity of these weight-loss medications, their uses, and their practical application.
What is semaglutide medication?
Semaglutide is a medication derived from a class of drugs called glucagon-like-peptide-1, or GLP-1, a type of incretin hormone secreted in the lower intestinal tract in response to ingested nutrients. Brand names of semaglutide include Ozempic, Wegovy (both non-insulin injectables), and Rybelsus (a pill/tablet taken orally).
What is it used for?
The primary use of these medications, per the Federal Drug Administration (FDA), is to be included as part of a treatment plan for type 2 diabetes. These medications are prescribed to lower blood sugar alongside diet and exercise.
Blood sugar regulation is important because excess glucose accumulation in the bloodstream over time can contribute to blood vessel damage and disease states such as diabetes, heart disease, and other organ dysfunction.
Before we dig into semaglutide medication, it’s important to note that when treating type 2 diabetes, there is a course of treatment that is normally followed. First, doctors will often prescribe metformin – a glucose disposal agent used to reduce high blood glucose levels, which occur when the body cannot produce sufficient amounts of insulin from the pancreas (such as in type 1 diabetes, an immunological disease), or when the body cannot utilize insulin properly due to increased adiposity (such as in type 2 diabetes, largely considered a lifestyle-mediated disease) (ADA, 2023; Collins & Costello, 2022). Depending on how a patient responds to a metformin intervention, doctors may elect to prescribe semaglutide as a secondary form of intervention in diabetes management.
Stronger U dietitian, Katie Leahy, RDN, holds a CDCES credential (Certified Diabetes Care and Education Specialist) and explained,“if metformin doesn’t work to improve blood glucose at max dose, then a second agent such as a GLP-1 is added in addition to metformin to help promote blood sugar improvements and help with weight loss for type 2 diabetes if that’s what’s needed. They both target different mechanisms to help with blood glucose so together they work well and are safe to take together unlike some other options.”
Semaglutide was traditionally only approved for the management of type 2 diabetes. However, based on FDA approvals, and insurance coverage, some could be covered for off-label use — i.e., treating obesity in those without type 2 diabetes. Adults with obesity (a body mass index (BMI) greater than 30 kg/m2); or those considered overweight, with a BMI greater than 27 kg/m2 accompanied by weight-related medical problems, including high blood pressure or high cholesterol, may also qualify. (Drucker 2018) The FDA has recently approved Wegovy for weight loss use. Ozempic is still not approved by the FDA for weight loss.
Key Takeaways:
- Semaglutide medication is designed and intended for type 2 diabetes, but off-label use is for adults with a BMI greater than 30 kg/m2 or BMI greater than 27 kg/m2 with a weight-related medical problem per FDA regulation and guidance.
- Semaglutide medication is prescribed alongside diet and exercise regardless of primary or secondary usage.
How does it work?
Individuals with increased adiposity (fat stores) down-regulate insulin production, insulin sensitivity, and natural GLP-1 production from intestinal cells. This leads to an excess of glucose in the bloodstream (hyperglycemia), which can have a significant impact on systemic health, including increased risk of heart disease, hypertension, stroke, and organ dysfunction. As such, the negative effects of high blood glucose (hyperglycemia) can be significant. (ADA 2022; Davies et al. 2022) A primary mode of action of these drugs is to suppress glucagon-induced glucose breakdown in the liver, and help balance these molecules in the blood.
A potent secondary mechanism of action surrounding this class of drugs involves a decrease in gastric emptying rate — meaning ingested food stays in the stomach longer and is released at a slower rate into the small intestine. This lowers hunger-inducing hormone production, reducing overall appetite and caloric intake.
Key Takeaways:
- Semaglutide medication is sold as the brands Ozempic, Wegovy, and Rybelsus.
- These drugs help reduce excess glucose in the blood.
- These medications decrease gastric emptying rate (which means food has a slower transit time from the stomach to the small intestine). This lowers hunger-inducing hormone production.
What are the common doses, risks, and side effects?
Ozempic and Wegovy require one weekly injection to provide effective results, as opposed to daily administration with previous GLP-1’s. The medication itself demonstrates a dose-response relationship — the higher the dose, the more robust the outcome, including the degree of appetite suppression and total weight loss experienced (Drucker, 2018). Medication is incrementally increased depending on medication tolerance and outcomes.
In studies assessing weekly semaglutide injections, upwards of 94% of the subject population completed the trial — demonstrating a significant advantage from previous drug-mediated weight loss trials, who tend to have significantly lower completion rates.
As with all prescriptions, a thorough medical history and understanding of the individual should be conducted to rule out risk factors before taking these drugs. Even if the drug is then prescribed, monitoring ongoing symptoms and communicating with the medical provider is important.
The most common side effects were GI related issues which were experienced by 71% of participants (Rubino et al, 2021). However, this often subsides within a two-week period of continued use. Other less common symptoms include vomiting and diarrhea, which were experienced in a small minority of subjects. Some other side effects of medication administration appear to be in part due to the rate of weight loss, such as rapid weight loss contributing to gallstone formation. This particular occurrence can also be impacted by obesity itself, thus an individual historical assessment (medical history) would be required to assess the role of semaglutide in this (Rubino et al, 2021). Click here to learn more about possible side effects of Ozempic.
Key Takeaways:
- Semaglutide demonstrates a dose-response relationship – the higher the dose, the more robust the outcome, including the degree of appetite suppression and total weight loss experienced
- The most common side effect is nausea.
- Less common symptoms include vomiting and diarrhea, which were experienced in a small minority of subjects.
What are the costs and supply issues?
As off-label usage gains popularity, there is resistance from insurance carriers to cover medication for those without type 2 diabetes. To increase usage, manufacturers have thus provided some degree of assistance, usually a large degree, where they may cover drug prescription for a modest co-pay ($25) by the patient for a predetermined length of time of 1 year — after which the individual may be responsible for additional coverage out of pocket (Lilly 2022). At print, the average annual cost of semaglutide medication without insurance, 1 week (1 dose) of Ozempic can cost ~$300, totaling monthly costs of ~$1,000+.
With increased popularity and usage, manufacturers are struggling to meet growing demands – leaving many patients who meet the criteria for coverage unable to procure these drugs, which may offer life-altering outcomes for their health. Off-label use by those willing to pay the high out-of-pocket costs has contributed to significant supply issues.
What are the impacts of semaglutide on food intake?
The inputs affecting individual appetite and regulatory mechanisms are complex. Our respective biology provides a host of inputs at the neuroendocrine level that impact hunger and satiety, which directly correlate to amounts and types of nutrient ingestion (Maclean et al, 2017). Thus on an individual basis, those with obesity often have a multitude of genetic and psychosocial factors influencing overall food intake, contributing to these increased rates of adiposity. These factors are then compounded by factors such as food availability — as processed, energy-dense food is now more available than ever — as well as advances in food science, which can increase desire to eat food, and total intake of food. Thus the role of the environment, genetics, and learned behaviors throughout the developmental stages of life further contributes to the struggle faced by many to achieve and sustain weight loss.
GLP-1’s, such as Ozempic and Wegovy, can help regulate or normalize physiological responses to food ingestion, making dietary adherence more manageable. Particular benefactors include those patients or individuals that have failed to effectively utilize food tracking, such as counting calories and/or macronutrients, for any number of reasons — whether physical or psychological barriers. As such, these medications can quite literally act as portion control in a vial — prompting feeling full while eating a meal (satiation), as well as extending fullness in-between meals (satiety), which can also decrease food-focused thinking and food cravings.
The drug has such a profound impact on appetite that under-eating can become a concern for some individuals. This may support food tracking or awareness as an effective way to manage overall food intake to ensure minimum nutrient needs are being met, as well as mitigating negative side effects associated with weight loss (such as loss of lean tissue/muscle mass). Many individuals may struggle to meet minimum requirements – in which case, doses can be reduced by their provider to lessen appetite suppression. A nutrition specialist or Registered Dietitian can help educate on caloric density and nutrient density to ensure overall nutrient needs of macronutrients (protein, fat, carbohydrates, fiber, water) and micronutrients (vitamins and minerals) are met.
In cases where individuals are using this type of medication, normal weight loss methodologies — such as recommending voluminous foods — can actually be a potential barrier to achieving nutritional adequacy because these individuals may not be able to consume this amount of food anymore. This highlights the importance of working with an experienced nutrition professional (like a Stronger U Coach) so they can help with the changing focus. For example, a coach can recommend swaps to reduce food volume such as replacing a large dinner salad with a sweet potato which gives similar benefits with the nutrients, calories and carbs but with less food to consume. Supplemental foods (i.e., protein shakes) may be helpful to meet base-level needs without sacrificing overall nutrient ingestion. Another example would be adjusting specific macronutrient composition within a particular meal to help mitigate potential side effects from the medication. With decreased gastric emptying rates, it can be particularly efficacious to move away from high-fat meals, as dietary fat remains in the stomach longer than carbohydrates.
A major nutrition implication surrounding this topic in general is the timeline or length at which these drugs will be used. In particular, these drugs are intended to be used chronically, or long-term, as medication to treat and manage factors that contribute to obesity and corresponding health consequences.
How does the use of semaglutide for weight loss translate into long-term success?
It can be very easy for people to pull back on mindfulness practices due to the medication having such a potent impact on appetite control. Maintaining the practice of mindfulness and awareness of their lifestyle and environment is important for all, and is even more crucial in those who desire to wean off of these drugs. While on this medication for example, someone may not have tolerated a high-fat, high-calorie meal, but then when off of it, they’re able to eat this type of meal again. This is when having lifestyle tools in place is crucial for weight and health.
With the removal of this profound appetite-suppressing effect, some weight gain may be unavoidable — as those biological effectors are also likely to increase.
At Stronger U, rather than hyper-fixating our members’ focus on weight loss as an outcome or a number on the scale, we instead focus on the health-bolstering effects that weight loss correlates. However, it’s important not to automatically assume that further weight loss will further improve health.
Lifestyle interventions and modifications like alcohol consumption, movement, dietary quality, and environment are still of vital importance alongside the use of semaglutide medication. Drugs or medications like these are unlikely to ever reduce the need for qualified nutrition professionals. However, for those that have failed to sustain a caloric deficit necessary for weight loss, this can be a tool that finally allows them to do so. In any case, individuals choosing to use these drugs should always consider working with a nutrition practitioner to monitor symptoms, ensure that those practices implemented while actively losing weight are appropriate, as well as to build the knowledge base necessary to maintain weight loss should they decide to cease usage.
Key Takeaways:
- Individual appetite and satiety hormone regulation is complex.
- Food availability and environment is a huge factor in an individual’s ability to lose and gain weight.
- Some individuals can have such low levels of hunger, under-eating can become a concern.
- Working with a nutrition coach alongside the use of semaglutide medication can help ensure nutrient needs are met and helps preserve lean tissue (muscle).
- Lifestyle interventions and modifications are still of vital importance alongside this effective drug.
- Nutrition and lifestyle tools and education are extremely important for if/when someone stops medication.
Summary
In summary, there are personal physiological factors that deem someone a candidate for semaglutide. There is evidence to support the effectiveness of use for regulating blood glucose in type 2 diabetes and very promising research to suggest it can be used as a tool promoting weight loss. More research is needed to understand the safety and efficacy of using semaglutide long term. With or without this pharmaceutical, nutrition education and lifestyle modification is imperative to make these positive outcomes and changes long-lasting.
Stronger U’s Stance
At Stronger U, we support the sometimes difficult decisions that members make alongside their physician about whether or not to include medication as a part of their plan for weight loss. Our coaches support our members’ journey by providing them with the tools they need to develop the skills necessary to make life-long change— skills that will be needed regardless of medication status. As always, we remain evidence-based, and open-minded to support our members and their well-being both short and long-term.
