Ozempic® was first introduced by Danish pharmaceutical manufacturer, Novo Nordisk. In 2017, Ozempic® was approved by the FDA as a long-term treatment for type 2 diabetes. Not only did it lower blood sugar levels, but patients taking the medication also experienced weight loss as a side effect. After further research, Novo Nordisk adjusted the dosing of Ozempic® to optimize it for weight loss and patented it under the medication name Wegovy®. The FDA approved Wegovy® in 2021, and it did not take long for the demand for the medication to exceed supply. When Wegovy® became scarce, medical providers began prescribing Ozempic® as an alternative, which led to supply shortages for that medication as well. Because both medications are on the FDA’s shortage list, some pharmacies are now being allowed to compound them in their generic form, Semaglutide. The medications differ in cost, dosing and their FDA indications but all three versions contain the same active ingredient and they all increase insulin production and assist with weight loss.
These medications mimic the hormone, glucagon-like peptide-1 (GLP-1). GLP-1s predate the release of Ozempic® and have been used to control blood sugars and help people manage type 2 diabetes. They work by increasing insulin production, slowing down stomach emptying, and acting on the brain to reduce appetite and cravings. Because GLP-1s mimic glucose, once the pancreas releases more insulin, the insulin now circulating the body can “grab hold” of glucose, such as from the foods you eat, and pull it into the body’s tissues, then utilize it as energy instead of it being converted and stored as body fat. Over time, this reduces blood sugar levels which in turn eventually begins to lower HgbA1c levels as well. Some “side effects” include appetite suppression, decreased pleasure from cravings, and slower gastric digestion, meaning you get to feel fuller, for longer!
The interest in GLP-1s significantly increased when patients taking the medication started losing weight. Since then, the formulations have been optimized for weight loss. Today’s GLP-1s remain active longer. Dosing is once-weekly subcutaneous injections compared to original GLP-1s that required dosing to be performed twice a day. GLP-1s have also become more affordable over the years and easier to access. Most countries have approved the use of GLP-1s for type 2 diabetes or weight loss.
Very. Obesity doctors consider a loss of 5% of body weight a success for weight loss interventions and is the benchmark for many medications. Semaglutide however, shattered previous expectations with studies showing average changes in body weight of -15.2% when combined with diet and exercise. The outcomes of Semaglutide resemble those of weight loss surgery, drawing the comparison of the medication to a “chemical gastric bypass.”
There’s always a downside, right? The most commonly reported side effects are mild but include nausea, constipation, and indigestion. However, there are mitigation techniques that offer relief from these side effects, and in studies, only 4.1% of participants stopped the medication due to adverse effects. The majority of clients who take Semaglutide find that the benefits far exceed any gastrointestinal distress caused by the medication.
Researchers have been cautious with GLP-1s given the history of weight loss medications. However GLP-1s are not amphetamines, they are designed for long-term use to control type 2 diabetes because the condition is usually life-long. As such, No unexpected safety issues have arisen to date. Concerns have been raised though with medications sourced from outside the U.S. The FDA issued a safety warning regarding purchasing “medicine online from unregulated, unlicensed sources that can expose patients to potentially unsafe products that have not undergone appropriate evaluation or approval, or do not meet quality standards.” A good rule of thumb is to always ask where your medications are coming from.
Rebound weight gain is the greatest concern for clients when they discontinue using weight loss medications. Even bariatric surgery patients face this challenge. For this reason, we encourage gradual lifestyle changes as part of our weight loss programs. Once clients begin to see weight loss results, they gain the motivation to exercise more frequently and make healthier eating choices. There is also anecdotal evidence of Semaglutide users losing interest in a range of addictive and compulsive behaviors including drinking alcohol, smoking, over-eating, shopping, biting nails, and picking at skin. Further research is being done but it is known that GLP-1s affect dopamine pathways in the brain, making addictive behaviors less rewarding. This helps explain why Semaglutide clients find it easier to make healthy dietary changes.
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