Person holding injectable weight loss drug

For years people have whispered about others having had “work” done via plastic surgery to improve their appearance. Now they speculate about the source of sudden or extreme weight loss.

Many assume that it’s the prescription drug semaglutide, the new pound-paring tool used by everyone from reality starlets to TikTok influencers. Semaglutide is available under various brand names to treat type 2 diabetes and address long-term weight management.

But while semaglutide is the latest buzz, the drug may not be right for everyone.

“Semaglutide has become the topic of the day in weight loss, but there’s a lot of misinformation out there,” says Dr. Mythili Vedala, MD, primary care physician and obesity medicine specialist at Memorial Hermann Medical Group (MHMG) Sterling Ridge. “The high demand also has led to some unavailability of the drug.”

What is semaglutide, and how does it work?

Semaglutide mimics the chemical glucagon-like peptide-1 (GLP-1), produced in the small intestine that targets gut hormone receptors.

Developed in 2012, the medication originally was designed to help those with type 2 diabetes by unleashing more insulin into the bloodstream.

Insulin converts sugar from food into blood glucose to fuel cells.

But if that journey is interrupted, it may lead to diabetes. Uncontrolled or poorly controlled diabetes may lead to complications such as blindness, heart disease, kidney disease, limb amputation—or even death.

To help those with type 2 diabetes, physicians may prescribe single-use semaglutide syringes for injecting into the thigh or belly.

But for some people, semaglutide’s contribution to weight loss, rather than treating type 2 diabetes, has become the goal. For them, semaglutide is strictly a drug for losing pounds. “The original intent was to treat diabetes,” Dr. Vedala says. “Losing weight became a side benefit.”

People on the drug often feel fuller faster and longer, so they’re satisfied with smaller portions. That perk has led to high demand – and lower availability -- for those who truly need semaglutide to treat their diabetes or obesity.

Dr. Vedala helps separate myths from the facts about semaglutide:

MYTH: The U.S. Food and Drug Administration has approved various drug brands with semaglutide as an active ingredient, so these are right for anyone.

FACT: The FDA has approved semaglutide to treat specific life-threatening ailments like diabetes and obesity and was never intended to help people who have a healthy body mass index (BMI) and just want to drop a clothing size or two.

“When possible, we recommend lifestyle changes as the first weight management approach,” Dr. Vedala says.

To lose weight, start with exercise and a diet rich in vegetables, fruits and lean protein, versus fast food. If drugs are needed, she says, semaglutide is the first or second drug of choice after metformin, the chief medication for treating type 2 diabetes.

Semaglutide may be prescribed to treat type 2 diabetes in people with hemoglobin a1c levels of 6.5 or higher, or to treat the precursor known as pre-diabetes in people with hemoglobin a1c levels of 5.7-6.5.

A brand with semaglutide that the FDA endorsed in 2021 targets the clinically obese—those with a BMI of 30 or higher. It’s also prescribed for those who have a BMI of 27, if they also have comorbidities that spike cardiovascular disease. These include type 2 diabetes, high blood pressure, high cholesterol or sleep apnea.

MYTH: If you don’t fall into diabetes or prediabetes categories, it’s still safe to take semaglutide.

FACT: If as a result of taking semaglutide you consume extremely low-calorie levels. Without the supervision of a weight management specialist, you could put your life at risk. “If you’re consuming as few as 300 to 500 calories daily, you risk hypoglycemia, electrolyte abnormalities and unsafe heart rhythms,” Dr. Vedala says. “You could become dizzy or weak, have heart palpitations or pass out.”

Severe hypoglycemia also can cause coma or death.

Also of concern is the risk of thyroid cancer. “If you have a personal or family history of thyroid cancer (either medullary or neuroendocrine), semaglutide won’t be prescribed,” Dr. Vedala says.

Additionally, if you’ve had pancreatitis – a swelling of the lower part of the stomach—you should not use semaglutide. Doctors take blood samples to monitor blood sugar and electrolytes to avoid such dangers.

MYTH: The more you take semaglutide, the more weight you’ll lose.

FACT: Semaglutide consumption should be slow and steady It’s important to set proper and realistic weight loss goals, (~ 4-6 pounds monthly).

And not everyone loses weight by taking medications with semaglutide. “It depends on the person,” Dr. Vedala says. “It’s not effective for everyone.”

After two doses over eight weeks, there should be a drop in weight. “If there isn't a significant change, we discontinue the medication,” she says.

Also concerning are semaglutide’s potential side effects, which can be mild, moderate or severe.

Since the medicine targets the gastrointestinal tract, it can lead to discomfort, such as bloating, nausea, vomiting, constipation or diarrhea.

Physicians start patients at the lowest dose of semaglutide for weekly injections done at home. The dose may increase monthly, giving the gastrointestinal tract time to adjust.

After two doses, most patients adjust. For some, anti-nausea medications may be needed to mitigate that side effect. “If patients still have nausea and diarrhea after four to six weeks, then semaglutide may not be appropriate for them,” Dr. Vedala says.

MYTH: Weight-loss injections are the best way to lose weight.

FACT: Improving your lifestyle, diet and exercise is the best way to manage your weight.

Strive for a diet rich in vegetables, fruit, plants and lean protein, and get moving – ideally, exercising 30 minutes five times weekly.

MYTH: Semaglutide is a one-and-done. You can stop taking it once you reach your weight loss goal.

FACT: If you stop taking the semaglutide, you may regain the weight without proper lifestyle choices or adjustments. “Obesity and diabetes are chronic conditions—like hypertension. Weight management is a lifetime journey,” Dr. Vedala says. “Lifestyle measures, including physical activity and healthy eating, are vital.”

As with drugs for hypertension or high cholesterol, if you experience good results with no side effects, semaglutide may be prescribed until you reach your goal. Then your doctor may wean you off the drug to see how you function without it.

MYTH: You can bypass your physician and buy a generic version of semaglutide at a compound pharmacy.

FACT: While the price sometimes is lower, there may be safety concerns, Dr. Vedala says. “There is no FDA-approved generic.”

“It’s important to know where the medicine comes from. The risk with compounded drugs is they may be diluted with vitamins or something else and sold as generics,” she says. “You also may be allergic to an additive, and your symptoms could last a week or two.”

Only a clinician or nurse practitioner in weight management or diabetes should prescribe the drug, Dr. Vedala says. “Clear guidelines need to be followed before these medications are dispensed.”

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