The search for effective and safe weight loss treatment seems never-ending. But the newest anti-obesity medication, semaglutide, is still making waves more than a year after its 2021 approval by the U.S. Food and Drug Administration.
The injectable drug, initially only used as diabetes medication, is the first drug since Saxenda (2014) approved to treat chronic weight management in the 70% of American adults who are obese or overweight. Research continues to show the effectiveness of semaglutide injections for weight loss. It also highlights the value of treating obesity as a chronic metabolic disease instead of expecting people to rely solely on willpower and lifestyle changes to manage their condition. But semaglutide is not a miracle drug. And it’s not for everyone.
“It is important to remember that obesity is heterogenous, chronic and complex,” says Vijaya Surampudi, MD, physician nutrition specialist and assistant director of the UCLA Weight Management Program (RFO). “There is no cure for obesity. It requires lifelong treatment that’s not one size fits all.”
Here’s what you need to know about semaglutide:
What is semaglutide?
Semaglutide belongs to a class of medications known as glucagon-like peptide-1 receptor agonists, or GLP-1 RAs. It mimics the GLP-1 hormone, released in the gut in response to eating.
One role of GLP-1 is to prompt the body to produce more insulin, which reduces blood sugar (glucose). For that reason, health care providers have used semaglutide for more than 15 years to treat Type 2 diabetes.
But GLP-1 in higher amounts also interacts with the parts of the brain that suppress your appetite and signal you to feel full. When used in conjunction with diet and exercise, it can cause significant weight loss — and a reduced risk of cancer, diabetes and heart disease — in people who are obese or overweight.
Semaglutide injections for weight loss
Currently, semaglutide is only approved for weight loss under the brand name Wegovy. The typical dose for weight loss is 2.4 milligrams, administered weekly as subcutaneous (under the skin) self-injections.
But as interest in semaglutide for weight loss continues to grow, health care professionals are finding ways to manage the demand. Many prescribe other brands of semaglutide, such as Ozempic and Rybelsus, off-label (using a drug that is FDA-approved for a different reason).
“Many people use semaglutide off-label to help manage weight,” Dr. Surampudi says. “The demand has become so high, that now there is a shortage for people who need this medication to help manage their diabetes.”
How effective is semaglutide for weight loss in non-diabetics?
There have been several anti-obesity medications that help suppress appetite and achieve weight loss. But semaglutide performs on a new level.
An early study of 2,000 obese adults compared people using semaglutide plus a diet and exercise program with people who made the same lifestyle changes without semaglutide. After 68 weeks, half of the participants using semaglutide lost 15% of their body weight, and nearly a third lost 20%. Participants who incorporated only lifestyle changes lost about 2.4% of their weight.
Since then, additional studies have shown similar results. But they’ve also revealed that participants tend to regain the weight lost when they stop taking semaglutide.
“The fundamentals of obesity management will always be changes to diet and exercise,” Dr. Surampudi says. “But having anti-obesity medications is another tool in the toolbox — depending on the person’s clinical history.”
What are the side effects of semaglutide injections?
The side effects of semaglutide are typically mild — especially when compared to the complications associated with overweight and obesity.
People taking semaglutide for weight loss may experience:
- Dizziness
- Fatigue
- Gastrointestinal issues, such as diarrhea, constipation and gassiness
- Headache
- Stomach issues, including nausea, vomiting, pain or distension (bloat)
Gastrointestinal issues are the most common complaint among people just starting semaglutide. But you may be able to reduce the side effects by beginning on a lower dose and then slowly increasing the amount you take.
Who should (and should not) take semaglutide for weight loss?
The FDA recommends Wegovy for weight loss if you meet one of the following criteria:
- Have a body mass index (BMI) of 27kg/m2 or greater and at least one weight-related condition, such as high blood pressure, Type 2 diabetes or high cholesterol
- Have a BMI of 30kg/m2 or greater
Avoid semaglutide if you have:
- History of medullary thyroid cancer
- History of gallbladder disease
- History of pancreatitis
- Multiple endocrine neoplasia syndrome type 2 (MEN2)
If you’re considering semaglutide for weight loss, your first step should be consulting your primary care physician (PCP). They know your personal and family medical history and can guide you in the best treatment for your condition. If you have diabetes and already take a different medication, talk to your physician about acceptable (and safe) combinations of diabetes medication.
