As popularity of weight loss drugs continues to soar, here’s what a dietitian would like you to know.

When it comes to weight management, there is currently one intervention that is more popular than the once widely held Ketogenic diet. While semaglutide might not ring a bell, it has been the reason for the rapid weight loss of celebrities, real housewives, social media influencers, tech moguls, and the like. This wonder drug, sold by Novo Nordisk under the names of Ozempic, Rybelsus and Wegovy, has surged in popularity for its off-label use as weight loss drug.

If you are looking to manage your weight and are wondering if this medication is right for you, you’ve come to the right place.

In this article we’ll examine:

• The role semaglutide plays in blood sugar control.
• The two types of GLP-1 receptor agonists.
• The difference between FDA approved semaglutide products.
• Who is appropriate for Ozempic and Wegovy.
• If weight loss with semaglutide is permanent.
• The risks of GLP-1 receptor agonists.
• If weight loss drugs are right for you.

What is Semaglutide?

Semaglutide belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists that have been used in type 2 diabetes treatment for almost 20 years. GLP-1 receptor agonists mimic the GLP-1 hormone which is released in the gastrointestinal tract in response to eating.

There are three main ways that GLP-1 receptor antagonists help manage blood sugar:

• Increase insulin production. GLP-1 receptor agonists stimulate insulin secretion after a meal when blood glucose levels are elevated.
• Slow stomach emptying. GLP-1 receptor agonists have been shown to cause delayed gastric emptying, in turn prolonging the feeling of satiety or fullness after eating.
• Inhibits glucose (aka sugar) release from the liver. GLP-1 receptor agonists also suppress a hormone called glucagon, which triggers your liver to convert stored glucose (glycogen) into a usable form and then release it into your bloodstream.

What Are the Different Types of GLP-1 Receptor Agonists?

GLP-1 receptor agonists are classified as short-acting or long-acting.

Short-acting GLP-1 receptor agonists such as Rybelsus remain in your body for less than a day. They help control blood sugar levels after a meal and are typically taken once or twice per day.

Long-acting GLP-1 receptor agonists such as Ozempic and Trulicity work for a full day or even a week after administration. They help control blood sugar throughout the day and night.

What is the Difference Between Brands?

There are currently three US Food and Drug Administration (FDA)-approved semaglutide products:

The FDA first approved the Ozempic in 2017 to treat type 2 diabetes. It’s available in doses 0.5 mg to 2 mg and is self-administered with weekly with a disposable pen injection device. According to the FDA, Ozempic is also approved to reduce risk of heart attack, stroke, or death in adults with type 2 diabetes mellitus and known heart disease.

In 2019, the FDA approved Rybelsus, a daily oral medication which addition to diet and exercise can help control blood glucose in adults with type 2 diabetes. It’s available in 7 mg or 14 mg tablets.

Then, in 2021, the agency approved Wegovy, which contains a higher dose of the active ingredient semaglutide, for chronic weight management for adults with obesity or those who are overweight with at least one weight-related condition such as type 2 diabetes, high cholesterol, or hypertension. In 2022, it was approved children aged 12 years and older with obesity. Like Ozempic, Wegovy requires a weekly pen injection, but at a higher dose of 2.4 mg.

Eli Lilly’s tirzepatide, approved in 2022 as Mounjaro, has been shown in double-blind, randomized, controlled trial to have substantial weight-loss effects involving people with obesity who do not have type 2 diabetes. Tirzepatide is a GLP-1 receptor agonist, like semaglutide, combined with a glucose-dependent insulinotropic polypeptide (GIP) analogue. Like semaglutide, tirzepatide mimics natural hormones that suppress hunger.

All four medications are only available with a prescription, and there are no approved generic versions.

Who is Supposed to Take Ozempic and Wegovy?

Wegovy was specifically approved as a weight management drug for obese individuals (body mass index of 30 or higher) or overweight individuals (body mass index of 27 or higher) with at least one-weight related condition. Ozempic, as stated above, is meant to improve blood glucose management in adults with type 2 diabetes. Despite this distinction, Ozempic is better known as a weight-loss drug given its popularity and name recognition in social and mainstream media.

It’s not unusual for doctors to prescribe medications for “off-label” use or for a different purpose from what the medication is explicitly intended for. Prescribing Ozempic for weight loss is considered an “off-label” use. However, Ozempic is not available at the 2.4 mg dose which has been shown to have the largest efficacy for weight loss.

How Long Does Semaglutide Keep the Weight Off?

A study published in JAMA found that overweight or obese adults who completed a 20-week run-in period with semaglutide, 2.4 mg once weekly, ongoing and persistent weight loss over the following 48 weeks with continued use of the once-weekly treatment. Conversely, study participants which switched to the placebo at week 20, gradually regained weight within a year of stopping the drug when the trial ended. These published findings highlight the reason why semaglutide is approved for long-term weight management.

Obesity is a highly prevalent, complex, and chronic disease associated with increased risk of developing type 2 diabetes, high blood pressure, dyslipidemia and atherosclerosis. While many obese individuals lose weight with diet and exercise, long-term weight loss is difficult to achieve. The chronicity of obesity requires treatments that can maintain and maximize weight loss. Anti-obesity medications such as semaglutide included as part of a comprehensive wellness action plan can help individuals achieve lasting obesity control and provide independent health benefits, including decreased cardiovascular risk.

What Are the Risks?

The most common adverse effects are serious gastrointestinal issues including nausea, vomiting, diarrhea, and constipation. Many of these side effects lessen over time.

A recent study found that GLP-1 agonists may also increase risk of developing acute pancreatitis, gastroparesis and bowel obstruction but not gallbladder disease.

GLP-1 agonists like semaglutide lifelong weight management medications meant to be taken long-term. As such, there is still much not known regarding the adverse effects that may occur over time, especially in those taking the medications for obesity.

Are Weight Loss Drugs Right for You?

Ozempic and Rybelsus can are F.D.A approved medications for type 2 diabetics who have struggled to manage their diabetes with oral antidiabetic medications such as sulfonylureas.

Wegovy has been approved for obese individuals who have struggled with weight management. Despite the American Medical Association (AMA) urging doctors to avoid relying on BMI, a prescription for Wegovy requires individuals to have a BMI of 30 or greater or 27 or greater with at least one “weight-related condition” such has hypertension; type 2 diabetes or hyperlipidemia.

Regulators approved Zepbound, a tirzepatide, the newest weight loss drug, for people with a BMI of 30 or greater, or 27 or greater with a weight-related condition.

It is important to note that these medications can be expensive without insurance coverage. The list price for Wegovy is approximately $1,350 for 28-day supply, with a monthly supply of Ozempic costing slightly less at approximately $935 for a month supply. Individuals who don’t meet the criteria for receiving these medications will likely have difficulty obtaining insurance reimbursement.

Given that the popularity for these drugs continues to increase, the demand is outgrowing the supply. Several news outlets have reported that pharmacies are experiencing a shortage of these medications with even patients with diabetes and obesity failing to obtain access to them.

Your past medical history will factor significantly in whether weight loss drugs are appropriate for you. For example, those with a history of autoimmune disorders, thyroid disease, or hormonal imbalances will likely have some level of metabolic dysfunction until the underlying condition is addressed and brought under control. Request your that your primary care physician refer you to a registered dietitian nutritionist for medical nutrition therapy which will provide you with personalized nutrition interventions.

For someone who has only 10-15 pounds to lose and is otherwise healthy, it stands to reason that managing your weight by manipulating your meal composition, increasing strength training, improving gut health, managing stress and improving sleep hygiene may be just as effective route to consider.

Consider Working with a Dietitian

Carter Hall Lifestyle would be honored to support you on your health and wellness journey. Our services range from nutrition counseling to personal training, to comprehensive wellness coaching. We accept several insurance plans to nutritional counseling. Book a wellness discovery to learn more about how we can best help you meet your specific wellness goals. We would be happy to work with your care provider to determine if weight loss medications are right for you.