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Ozempic (Semaglutide) is a GLP-1 receptor agonist, originally made as a diabetes medication and approved by the FDA in 2017. It is now widely used – currently, it is the number one injectable prescribed in the U.S. Several large-scale studies have been done to analyze effectiveness for weight loss. The results have been overwhelmingly positive, specifically one published in March 2021 in the New England Journal of Medicine (Once-Weekly Semaglutide in Adults with Overweight or Obesity | NEJM ) – an average of 14.9% overall body mass reduction was achieved in this trial. As of June 2021, it was officially approved by the FDA for weight loss. One of the main reasons it was approved for weight loss is that it does NOT tend to cause hypoglycemia due to its indirect effect on insulin. So, it has benefits of weight loss without some of the negative side effects that would be a concern for patients without baseline elevated glucose levels.
The pharmaceutical manufacturer that makes this medication rebranded it under the name Wegovy for weight loss patients, but it is the same exact medication as Ozempic (the generic drug name is semaglutide).
Dr. Story has been prescribing semaglutide for two years (at first off-label for weight loss patients who were not diabetic, as well as for patients with diabetes). She is very comfortable with the medication, including its side effect profile and contraindications.
Primary contraindications include patients with multiple endocrine neoplasia type 2 (MEN type 2) – however, most patients know if they or their family has a history of that condition. Medullary thyroid cancer is another contraindication. Dr. Story has deployed a conservative protocol starting at a very low dose with full disclosure of side effects (primarily nausea, constipation).
Other contraindications include patients with a history of pancreatitis; also, patients who are pregnant or thinking of becoming pregnant are not approved for this program.
Semaglutide is a GLP 1 receptor agonist. This medication keeps food in the stomach longer by slowing gastric motility. This results in patients physically feeling not as hungry because the stomach is full longer. Also, it stimulates a hormone called incretin that tells the brain that you feel full; additionally, there is an indirect action on the pancreas with insulin and glucagon. Overall, Dr. Story believes that it is an eloquently designed drug well-suited for weight loss success.
Further, there are other drugs in the pipeline coming out, and trials will begin to be publicized. Dr. Story stays on top of the latest in this field of treatment. For now, she believes that semaglutide is a very good option.
The NEJM showed an average of 14.9% body weight loss, but in practice Dr. Story has seen higher results achieved.
The main side effect early on that Dr. Story watches for is nausea. It does improve over time (usually it is the worst the day after the injection, each time, but will decrease in severity over time). The nausea typically doesn’t last the entire week and is most pronounced the day after injection – patients will notice it most after a dosage increase. Most people know about it in advance, tolerate it well, and decide that it is worth it.
If you have a history of acid reflux you might find it gets a little worse, or that you can’t eat at night (which we don’t recommend anyway).
Constipation can occur; the best thing to do drink a lot of water and take a capful of Miralax a day (for constipation). Usually this does get better over time.
The long-term approach for this medication is unknown at this time; anecdotally, Dr. Story has patients who basically are on lower doses than they were previously and are now just trying to maintain a certain weight (dosage is individual).
Overall, Dr. Story has found semaglutide to be very effective for patients and very well tolerated. The titration of dosage is patient-dependent, but usually starts at .25 mg/week for 2 weeks, then moving up to .5mg/weeks for 3 weeks, and then (assuming patients are tolerating it well) moving to 1mg/week. If patients want an aggressive approach to weight loss and Dr. Story concurs upon consultation, patients can go to 1.5 mg/week and then to 2mg/week – all dosages/protocols are individualized based on consultation between doctor and patient.
It is important to note that this medication is not permanently changing the patient's hormones. When the injections stop, weight can creep back up as the patient's "threshold for feeling full" returns to previous levels. When treating chronic obesity, semaglutide is considered a long-term medication similar to other treatments of chronic conditions. Just like diet and exercise, this medication as a treatment for weight gain requires ongoing application.
However, not everyone stays on Ozempic/semaglutide forever. Oftentimes, non-obese patients can be "brought back to their baseline" with a short course of semaglutide and then wean off of the medication and maintain their target weight on their own.
The program consists of monthly telehealth visits with one of our providers, either Dr. Story or her physician assistant, Mary Capstick. Baseline labs will be drawn within the first month of the program and once yearly thereafter.
For more information on availability and pricing, please contact 
courtney@elizabethstorymd.com
***This is for information purposes only and does not constitute direct, individualized medical advice. For full information on the medication see the pharmacy website at www.wegovy.com***