Medical Weight Loss

Semaglutide is an injectable medication approved by the FDA for weight loss in patients with a BMI over 30 or a BMI over 27 and weight related co-morbidities such as high blood pressure or elevated lipids.   This medicine is similar to the glucagon made in the human pancreas which helps regulate blood sugar. This medication works by slowing down GI motility and improves regulation of the hypothalamus and hindbrain which are the major control centers for appetite. 

You’re a candidate is BMI over 30 or a BMI over 27 and weight related co-morbidities.

Do not consider this treatment if:

• You have any known allergy to Semaglutide
• You or a family member have a history of medullary thyroid carcinoma
• You or a family member have a history of multiple endocrine neoplasia type 2(MEN2)
• You are pregnant or breast feeding
• For patients who have a BMI of 40 or greater as well as those with a BMI of 35 and co-morbidities, surgery may be a more appropriate clinical course

This medication has been shown in multiple large studies to help patients effectively loss weight. A March 2021 study published in The New England Journal of Medicine followed almost 2000 patients. The patients using once a week Semaglutide lost an average of 15% their total body weight over a 16 month period. Several other important health metrics also showed significant improvement including, waist circumference, BMI, blood pressure, glucose levels, fasting lipid levels and multiple physical/mental functioning scores. Please keep in mind that using this medication for weight loss in patients who have a BMI under 27 with no comorbidities is currently considered off label but expected to have similar results.

Of note, most of our patients require about half the dose of the patients in the above referenced studies for effective weight loss. Stopping eating when full, maintain appropriate hydration and only using gradual dose escalation all significantly decrease side effects. Also, we will provide supportive medication specifically tailored for the known side effects at the beginning of the program and for the days immediately after any necessary dose adjustments. Any side effects not improving or lasting longer than two weeks should be reported back to your provider.

As with any mediation, there can be a risk of serious side effects with Semaglutide (9% with Semaglutide versus 6% in Placebo group).   Severe side effects are rare, but many patients do experience mild to moderate GI (gastrointestinal) side effects.  There are most common when starting Semaglutide and when increasing the dose of the medication.  The most common side effect is nausea which in large studies was almost always mild to moderate and transient.  Up to 40% of patients experience some nausea with up to 20% experiencing short term vomiting.  No anti-nausea medications were given in these studies.  Other common side effects include temporary diarrhea or constipation which occurred in approximately 25% of patients.  All of the above-mentioned side effects were noted to resolved after anywhere from couple days to a couple weeks with the constipation lasting up to a month.  Other side effects that were seen in studies included fatigue, headache and sore throat.   None of these affected the weight loss associate with treatment and occurred almost exclusively after starting the medication or after dose adjustments.  These side effects were noted to be mild to moderate in 98% of the patients. 

Other potential side effects include allergic reaction.  This is extremely rare but still possible.   If you notice hives, rash, swelling of lips or face or any change in your airway within the first hour after treatment please report it to a provider immediately.  The incidence of thyroid tumors in rodents was noted to increase during early animal testing of the medication.  This has not been seen in humans as we have significantly different thyroid cells as compared to rodents but there may still be a risk.  Although risk of pancreatic, liver and kidney issues was noted in very small numbers of patients, these were not significantly different than the placebo group and were almost exclusively seen in patients with pre-existing disease.   There are several drugs that if taken with Semaglutide, can raise the risk of low blood sugar so please ensure that we have an accurate list of all of the medications you currently tak

Without diet or activity changes studies shows that a majority of patients gained back about 2/3 of weight they lost within 12 months of stopping semaglutide.   Tapering down with better nutritional and activity habits is the best way to fully stop the medication while maintaining results.   After tapering office if weight is creeping back up there are options for long term maintenance which include reduced dosing, increasing time between dosing and seasonal cycling of medication.