Semaglutide (wegovy) is now FDA-approved as a weight loss medication

The long-awaited approval of semaglutide 2.4 mg weekly injection for weight loss has been considered a “game-changer” by obesity experts. This is because the weight loss in clinical trials is far superior to any other weight loss medication. Semaglutide is a second-generation injectable medication, which will eventually replace the first-generation liraglutide (Saxenda, Victoza). Semaglutide has been approved as Ozempic and Rybelsus to treat diabetes. The difference is the dose for weight loss is more than double the dose for diabetes. In my experience, most patients do not lose much weight with the oral version, Rybelsus which is more of a niche drug for diabetics who can’t take injections.

Being sold under the name wegovy (pronounced wee-GOH'-vee), many have already noticed the subliminal messaging in the name and use of all lowercase, i.e., we go the way of a smaller person. Weight loss results with semaglutide 2.4 mg are superior to other pharmaceuticals, averaging 15% weight loss, about 35 pounds. But many patients lose much more than the average, with some achieving results comparable to bariatric surgery.

Body weight is tightly regulated by hormones that act primarily in the hypothalamus. Semaglutide is a long-acting synthetic version of a hormone known as glucagon-like peptide- 1 (GLP-1)  agonist that works by making you feel full. Reducing body weight triggers adaptive mechanisms to prevent starvation. Even when someone is overweight, the body perceives weight loss as starvation and vigorously defends against weight loss as a survival mechanism. Decreased GLP-1 levels are part of this human adaptive response to weight loss. Lower GLP-1 means increased hunger and weight regain. This is a normal human biology. In the end biology always wins out over willpower, so with even the best intentions, the weight is regained. But semaglutide (and its predecessor liraglutide, aka Saxenda and Victoza) fight biology with biology, not willpower. Semaglutide works especially well because it is very long-acting synthetic version of GLP-1 with powerful effects on appetite, satiety, and satiation. Finally, we have a medication that effectively addresses the biological hormonal adaptations that occur with weight loss.

No one disputes the importance of a healthy lifestyle and behavior modification that is necessary for successful weight loss. But, when you have a medication that is effective enough to combat the biological changes that occur with weight loss, you do not have to work so hard with behavioral modification, it just comes naturally.

Semaglutide for weight loss is self-administered as an injection from a prefilled pen once a week. The dose starts small and gradually increases over several weeks, primarily to reduce the side effects of nausea, diarrhea, constipation, abdominal pain, and bloating. Once downside to semaglutide is the price which can be over $1000 per month without insurance coverage.

Currently, weight loss medications approved by the Food and Drug Administration (FDA) for weight loss.

phentermine (Adipex-P®, Lomaira®)*

phendimetrazine (Bontril®)*

benzphetamine (Regimex®, Didrex®)*

orlistat (Xenical®, alli®)†

phentermine and topiramate ER (Qsymia®)†

Plenity®

naltrexone HCl and bupropion HCl (CONTRAVE®)†

liraglutide injection (Saxenda®)†

semaglutide injection (wegovy®)†

*Approved for short term use
†Approved for long term (chronic) use

Remember, these medications are not a magic bullet but simply a tool to help you sustain common sense lifestyle changes. There is no perfect medication for obesity. A medication that may work for a family member or a friend may not be the ideal medication for you. Treating obesity can be complicated so it is best to work with a knowledgeable health care professional who is dedicated to working with you over the long term.

If you’d like to learn more about permanent weight loss, please feel free to call us or schedule an appointment with Dr. Isaacs using the online booking tool on this website.

Author
Scott Isaacs, MD Endocrinologist and Weight Loss Specialist

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