Semaglutide is an injectable prescription medication that is FDA-approved for chronic weight management alongside diet and exercise. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists that regulate blood sugar and appetite.
Specifically, semaglutide works by activating areas of the brain involved in food intake control. It increases feelings of fullness and satisfaction from smaller food portions to promote weight loss. Semaglutide also slows stomach emptying and suppresses the release of glucagon after eating.
The brand names for semaglutide are Ozempic and Wegovy. Wegovy is a higher dose formulation specifically for weight management. Ozempic is typically prescribed for diabetes at a lower dose than Wegovy.
In 2021, the FDA approved Wegovy for chronic weight management in adults living with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related medical problem. These problems include high blood pressure, type 2 diabetes, and high cholesterol.
The certified medical weight loss providers at Balance Hormone Institute conduct comprehensive health evaluations to determine if semaglutide is appropriate for each patient’s needs and health status.
We begin with an in-depth review of the patient’s detailed medical history, family history, and any previous attempts at losing weight. The provider performs a complete physical examination and calculates BMI.
There is an open discussion surrounding the patient’s weight loss goals and expectations for semaglutide therapy. Realistic targets are established considering the patient’s starting weight and overall health.
Required laboratory testing checks for proper organ function and ensures semaglutide can be used safely. For example, thyroid function is evaluated since semaglutide is not suitable for people with certain types of thyroid cancer.
Our clinic also screens for multiple endocrine neoplasia syndrome type 2, pregnancy in women of childbearing age, and inadequate glucose control in diabetics. Any contraindications or precautions uncovered during the exam are reviewed with the patient.
In general, semaglutide is appropriate for patients meeting the following criteria:
Based on the complete initial weight loss consultation, our medical team decides if the patient is a good fit for a medically supervised injectable weight loss program with semaglutide.
If appropriate, a start date for the first injection is scheduled. The patient is also set up with follow up appointments to monitor progress and tolerance.
While taking semaglutide, patients must be ready to make certain healthy lifestyle changes for the best chance of long-term weight loss success. Our certified weight management counselors provide customized recommendations based on the patient’s individual needs.
However, there are some general guidelines we suggest patients follow. These include:
Nutrition
Physical Activity
Behavior Modification
Patients who actively participate in our medically supervised weight management program increase their chances of losing significant weight and keeping it off long-term. Small, sustainable adjustments to eating patterns, activity levels, and thoughts/behaviors compounds over time. There are also tremendous physical and mental health benefits to adopting a balanced, fulfilling lifestyle.
Semaglutide is administered once weekly via subcutaneous injection with a pre-filled, disposable pen device. Patients receive in-depth instructions on proper injection technique during the initial clinic visit.
To start, semaglutide therapy is initiated at the lowest 0.25 mg dose. This helps minimize temporary GI side effects like nausea, vomiting or diarrhea that sometimes occur when beginning treatment.
Over the course of 5 weeks, the dosage slowly titrates up from 0.25 mg to 0.5 mg, then finally 1 mg. The 1 mg maintenance dose leads to the greatest appetite suppression and weight loss.
Patients are advised to inject semaglutide on the same day of the week and time of day each dose. However, the physical location on the body should be changed weekly to allow proper healing and reduce injection site reactions.
Common sites include the thighs, stomach, or upper arms with enough fat padding underneath the skin. Proper hand washing and skin cleaning is imperative prior to injections.
Before injecting, the pen should be visually inspected and allowed to reach room temperature for 15-30 minutes. After choosing an appropriate injection site with sufficient fatty tissue, a pinch of skin is grasped to elevate the area. With a quick, dart-like motion of the pen touching the skin at 90 degrees, the needle is inserted fully into the tissue.
Once activated, holding the position for 5-10 seconds allows full dose delivery. Letting go of the pinched skin before removing the needle prevents medication leakage into the subcutaneous layer.
Managing expectations about the pace, efficiency, and side effects of medical weight loss treatment is an important part of patient education. Our clinicians always set realistic weight loss goals based on the medical evidence.
On average, participants in the Wegovy clinical trials lost between 5% and 15% of their baseline body weight over a 68 week period. However, there was individual variability in weight loss responses. Following the lifestyle recommendations boosts semaglutide efficacy.
Temporary GI complaints like nausea, vomiting, diarrhea or constipation are common initially. Staying on the lowest effective dose for 4 weeks reduces these issues. About 1 in 10 patients stops treatment because of intolerable nausea or other GI side effects.
Monitoring blood sugar and heart rate is critical for patients with type 2 diabetes or cardiovascular diseases. Semaglutide causes thyroid tumors in rodents so caution is urged for those at higher risk like people with multiple endocrine neoplasia syndrome type 2.
Women who become pregnant must stop semaglutide therapy right away since the drug's effect in human pregnancy is unknown. Discontinuing the medication may lead to weight regain so pregnant patients should discuss alternative obesity treatment options with their healthcare provider.
In clinical studies, semaglutide showed excellent safety over 2 years of weekly treatment. The most concerning side effects like diabetic retinopathy, pancreatitis, and suicidal behavior were very rare.
Still, medical supervision is essential when using semaglutide for weight loss to detect problems early. Patients should inform their provider about any unusual symptoms or health changes that occur during therapy.
For individuals struggling with severe obesity and related medical complications like diabetes, semaglutide represents an exciting new advancement for chronic weight management. When combined with nutritional counseling, physical activity, and behavior changes, semaglutide unlocks life-changing weight loss and metabolic improvements.
Mount Sinai, New York offers excellent weight loss infrastructure through specialized obesity clinics, dietitians, personal trainers and bariatric surgeons. Here is a sampling of resources patients can utilize alongside semaglutide pharmacotherapy:
EmbodyGPS Weight Loss Clinic: Multi-faceted medical weight loss solutions including prescription medications, medically tailored meal replacements, health coaching and transition support into maintenance
Mount Sinai Nutrition Counseling: Outpatient consultations for personalized diet planning, grocery shopping guidance, cooking demos, accountability
Mount Sinai Rehab and Sports Physical Therapy: Custom exercise programs to improve mobility, flexibility, strength and cardiovascular endurance in overweight/obese patients trying to get active
Mount Sinai Bariatric Surgery Center: For those who do not achieve sufficient weight loss on medications alone, surgical options like gastric bypass and gastric sleeve
Mount Sinai Behavioral Health Psychology: Specialized therapy and counseling for eating disorders, emotional eating, self-esteem, body image and motivation
Leveraging the collective knowledge from local weight management experts leads to optimal outcomes. No matter what point patients are at in their journey, our supportive Mount Sinai obesity treatment community provides the tools they need to feel healthy and confident in their bodies long-term.
