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What's So Special about Semaglutide?

By: Stephen Hsieh, MD


What's So Special about Semaglutide? 

Semaglutide has taken the weight loss community by storm lately. This medication was developed by Novo Nordisk under the name Ozempic for the treatment of diabetes and was recently branded under the name Wegovy with an FDA indication for the treatment of obesity. So, how does a medication for diabetes help weight loss? Here is the reason why semaglutide may be right for you in your weight loss journey.

Seventy-five years ago scientists thought that diabetes was a simple disease to understand and thought it was due to a lack of insulin. But over the past 20 years, we have found that diabetes is more complicated. It is not as simple as a lack of insulin but involves coordination between up to 8 organ systems balancing each other. Researchers realized that diabetes was difficult to manage because addressing the lack of insulin was only one of the eight factors which contributed to diabetes, otherwise known as the ominous octet [1] .

Scientists looked for medications that would address the other factors and focused on a natural hormone called Glucagon Like Peptide-1 or GLP-1 which up until now has been poorly understood. Early attempts to increase the levels of GLP-1 in the body resulted in a brand new class of very easily tolerated medications called Dipeptidyl peptidase 4 (DPP-4) inhibitors which had significant improvement in diabetes management when used in combination with older medication treatments.[2] This success led to pharmaceutical companies desiring to create a synthetic GLP-1 which was more potent than DPP-4 inhibitors and did not have to depend on working with other diabetic medications as much to treat diabetes. This is how sematlutide was developed as well as its cousins exenatide, liraglutide, dulaglutide, and lixisenatide.

When the pharmaceutical companies submitted their clinical trials to the FDA for approval to release to market, they noticed that these medications did NOT increase weight in the study patients like older diabetic medications. In fact, diabetic patients generally lost weight during the trial. Some patients lost a very small amount, but some lost a significant amount of weight. This prompted pharmaceutical companies to ask why this happened and if this response could be replicated in patients who were NOT diabetic. Fortunately for us, studies have shown that this class of medication can result in weight loss in patients WITHOUT diabetes. The FDA approved two of these medications to be released under the names Saxenda and Wegovy specifically for use in the treatment of obesity. [3][4] 

So, how does this magic work? Researchers think that these medications work by reinforcing a weight loss strategy that clinics have been preaching for decades. Slow down your eating, eat less, and eat less carbs. How GLP-1 agonists work is by a mechanism called "delayed gastric emptying." When taking these medications, the stomach slows down how quickly it digests your food and sends it to the small intestine. What this means is that your stomach fills up with food faster and empties slower resulting in a natural sense that you have eaten enough. [5] 

However, there are down sides to this medication. First of all, the medication is not a pill but an injection that is administered either once a day or once a week. If you hate needles, then you need to really consider if semaglutide is right for you. 

Secondly, these medications create the sense of fullness naturally. This means that it is still possible to overeat while on these medications. If you overeat or eat a meal overly rich in carbohydrates, you will probably feel a sense of nausea which is your body's signal to your brain that you have overdone it. So, these medications cannot replace your dedication to eating properly. It only helps your willpower to be more effective.

Thirdly, these medications cannot be used in people who have had thyroid tumors or pancreatitis. You will need to consult with your healthcare provider to see if these medications are right for you.

Lastly, these medications have become exceedingly hard to obtain. As it turns out, these medications have worked so well for diabetes and weight loss that the pharmaceutical companies have had a difficult time producing them which has resulted in nation-wide shortages most of the time. Consider yourself lucky if you are able to obtain a consistent supply of these medications.

I hope that this blog has been helpful in answering a lot of your questions. If you are in the area, please come see us to discuss ways in which we can assist you in your weight management needs

Works Cited:

[1] "From the Triumvirate to the Ominous Octet: A New Paradigm for the Treatment of Type 2 Diabetes Mellitus" by Ralph DeFronzo,, April 1, 2009.

[2] "Pleiotropic Mechanisms for the Glucose-Lowering Action of DPP-4 Inhibitors" by Bilal Omar et al,, June 14, 2014.

[3] "Weight Loss and Maintenance Related to the Mechanism of Action of Glucagon-Like Peptide 1 Receptor Agonists" by Jamyas Ard et al,, May 11, 2021.

[4] "Efficacy of GLP-1 RA Approved for Weight Management in Patients With or Without Diabetes: A Narrative Review" by Mojca Jensterte et al,, May 3, 2022.

[5] "Relationships Between Gastric Emptying, Postprandial Glycemia, and Incretin Hormones" by Chinmay S. Marathe,, April 13, 2013.
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