What is the Scoop with Semaglutide (Ozempic and Wegovy)?
Lots of questions about the new injectable medications that help treat obesity and assist with weight reduction swirling around online, in the media, on Tik Tok and in our office! Lots of opinions and hard to know what actually accurate information is. So here is the scoop on semaglutide once weekly injection.
Semaglutide is in a class of drugs used for diabetes called GLP1 receptor agonists. GLP1 is an incretin hormone released by the gastrointestinal tract that sends a satiety signal to the brain (done eating!), slows how fast your stomach empties so you feel full longer and increases insulin release by the pancreas. The diabetes version is marketed as Ozempic and the anti-obesity version is marketed as Wegovy (FDA approved in 2021). The difference is the dosing for Wegovy goes up to 2.4 mg and Ozempic up to 2 mg. The STEP trials researching semaglutide 2.4 mg demonstrated great effectiveness with an average of 15-20% body weight loss over 68 mos.
Sounds great so what’s the catch?
Side effects- Like all medications, semaglutide has some side effects. They are mainly gastrointestinal such as nausea, vomiting, diarrhea, constipation, stomach upset. Semaglutide starts with a low dose and titrates up slowly as your body can get used to the medication and the side effects often resolve with time. Some more rare but serious side effects can be pancreatitis, gallstone formation, kidney injury. It is also not recommended for people with a family history of medullary thyroid cancer or Multiple Endocrine Neoplasia Syndrome.
Cost- semaglutide is expensive both as Ozempic (approx. $800/month) and Wegovy (approx. $1300/mos) if you don’t have insurance coverage. As ridiculous and unfair as it is, Medicare, Medicaid in many states and a lot of commercial insurers don’t cover medications to treat obesity and so Wegovy is inaccessible to many people but check your insurance! I’m finding more companies are opting to cover treatments for obesity than in the past. Ozempic is on many insurance formularies and if you have diabetes, it is usually covered. For those who are willing to pay out of pocket for Ozempic, you can upload your prescription to a Canadian mail order pharmacy for $350-400/month. We’ve had patients using Mark’s Marine online pharmacy with good success.
Availability- Wegovy had a manufacturing issue and was unavailable most of 2022 but now back in pharmacies. There has been a bit of a shortage of Ozempic and the supply at this point seems hit and miss. Ozempic can be prescribed ‘off label’ for obesity if you don’t have diabetes but whether it gets covered is a vague ‘sometimes’ but more plans are asking for a ‘prior authorization’ which gets denied without a diabetes diagnosis.
How long should you stay on it? During the STEP Trials for Wegovy, a later phase of the study called STEP 4 looked at stopping the medication in half the group who had been losing weight. The half that stopped medication started to have weight recurrence within a few months. The group that stayed on it continued to maintain or lose weight. This occurs because of metabolic adaptation. From an evolutionary standpoint, our bodies are ‘hard wired’ not to starve. When your body senses the loss of stored energy that was in your fat cells and is now gone, it feels it needs that energy back. The body will slow metabolism and increase hunger signaling to make you put that weight back on. We always think losing weight is the hard part, but actually keeping it off long term is the hardest part because of metabolic adaptation. So yes, people who stay on the medication long term do better keeping their weight off.
Our patients have been seeing good weight reduction results and most people are tolerating semaglutide well. Stay tuned for the scoop on tirzepetide (Mounjaro) with average 22% body weight loss, on the fast track to be approved to treat obesity by the FDA this year.