When patients come to see me for weight loss, almost all of them have been concerned about their weight for a long time. Many have done their research on "Dr. Google" and already have an idea of what they would like to try. I have seen a lot of misconceptions about Semaglutide, and downright fear from what people are seeing online and in social media, and I feel it’s time we discuss Semaglutide and separate rumor from fact.
What is Semaglutide?
Semaglutide has many names – Ozempic, Wegovy, Rybelsus are the most recognizable. It’s a GLP-1 Receptor Agonist, and that means it stimulates the production of insulin (glucose dependent) to lower blood sugar. It also inhibits glucagon which is responsible for storing sugar and carbohydrates. Because of these qualities, Semaglutide is an excellent treatment for type 2 Diabetes. These same properties of controlling insulin and inhibition of glucagon make this an amazing medicine for weight loss.
How do I take it?
According to recommendations, Semaglutide is dosed low in the first 1-2 months, then there is a progressive increase in dose until the patient is taking maximum dose for weight loss. The medicine is given in a subcutaneous injection right under the skin once weekly with dose escalations every 4 weeks. In my opinion, it is this rapid dose escalation that causes the majority of the side effects and likely the source of concerns that people have voiced in social media posts.
What are the side effects?
The most common side effects reported by my patients are nausea, constipation and dry mouth. Less common is acid reflux, abdominal pain, vomiting.
In my practice, I’ve found that the best way to prevent these side effects are:
1. Start at the lowest dose of Semaglutide but don’t be in a rush to get to the top dose.
2. Let patients know what possible side effects they may experience.
3. Give patients instructions on what to do if they have any side effects.
Start at the lowest dose of Semaglutide but don’t be in a rush to get to the top dose.
I start my patients at 0.25 mg once weekly for 4 weeks, and then if they tolerate that dose well, then I advise them to increase to the 0.5 mg dose. Once my patients are at 0.5 mg dose I leave them at this dose for as long as they can tolerate it and as long as it works for them. We only increase it to the next dose if the patient is feeling hungry or if their weight is not coming off.
Give patients instructions on what to do if they have any side effects.
Most patients are willing to try a medicine if they know what to expect. I advise patients what to do if they are nauseated, how to prevent it, and when to contact me. Patients are encouraged to report any changes as they happen so they can be supported while on their weight loss journey.
When and How to Stop Semaglutide
It’s true that once your endocrine system is on Semaglutide, you absolutely cannot stop this medicine abruptly. Imagine the shock your body goes through when the insulin levels fall, and glucagon goes up. Yikes! Patients all need to be told that once they get on the Semaglutide train, they’ve got to ride it and can’t just get off without a plan. The consequence of stopping the medicine abruptly includes rapid weight gain and an increase in blood sugar. In my practice, I’ve found that the best way to come off is a nice and slow wean down dose just like we started. And patients can stay on this medicine long term for prevention of weight gain and as diabetes treatment. So if you don't want to stop, you don't have to as long as you're being monitored by a medical professional.
I advise my patients not to be afraid of Semaglutide. If you have questions about this medicine, I encourage you to schedule an appointment with your doctor to discuss your options and to see if this medicine is right for you. If you would like to see us for weight management, we are offering weight management services at Lilies MediSpa, our onsite spa and wellness center.