Latest weight-loss craze has a solid medical foundation

Elon Musk did it. Amy Schumer did it. And a growing number of other celebrities are doing it, too, whether they admit it or not.

Semaglutide, marketed under the brand names Ozempic and Wegovy, is the latest craze for weight loss, and it is not confined to Hollywood. The drug is now being prescribed by local doctors as well as at weight-loss clinics like the one recently opened by Dr. Paul Graham of Diabetes and Endocrine Associates of the Treasure Coast.

“Semaglutide mimics a natural hormone called glucagon-like peptide-1 (GLP-1) that helps to regulate insulin secretion,” said Dr. Graham. “When you eat your food, your small bowel makes this hormone that stimulates your panaceas to make insulin and keep your blood sugar from shooting up. This is true for everyone whether you are a diabetic or not.

“Semaglutide also suppresses the appetite and delays gastric intake so that when you eat, it slows the passage from the stomach to the small bowels and tells you to stop eating because you are full,” Dr. Graham continued. “Diabetics have less GLP-1 and that’s why they have elevated blood sugars. The drug does many things for diabetics, but for non-diabetics it suppresses appetite, regulates insulin and delays gastric intake which expedites weight loss.”

Semaglutide was first developed by researchers at Novo Nordisk in 2012 as a weekly diabetes therapy but it wasn’t until 2017 that it was approved by the FDA as a treatment for type 2 diabetes. It is marketed as Ozempic, an injectable GLP-1 that patients take once a week.

While Ozempic was not labeled as a weight-loss drug, studies sponsored by Novo Nordisk found that even non-diabetic patients can lose weight by taking semaglutide. Those studies helped lead to the FDA approving semaglutide for weight loss in 2021 under the brand name Wegovy, which can be given in higher doses than ozempic – up to 2.4 milligrams of semaglutide in Wegovy compared with 0.5 milligrams to 2 milligrams of semaglutide in Ozempic.

“Ozempic and Wegovy are the same drug marketed under different names for diabetics (Ozempic) and non-diabetics (Wegovy),” Dr. Graham said.

“Since 60 percent of our clients are diabetic and 50 percent of diabetics are overweight, we already had years of experience using GLP-1s to help them control their sugar and lose weight. When they marketed Wegovy for non-diabetics we decided to open a weight-loss clinic to help them lose weight as well. Our patients see a dietitian for a healthy diet program and we start them on Wegovy if its covered by insurance. If it’s not covered, we have alternative medications to help with weight loss.”

Semaglutide works by targeting the areas of the brain that regulate appetite and food intake.

The medication dose must be increased gradually over 16-to-20 weeks to 2.4mg weekly to reduce gastrointestinal side effects.

While semaglutide is being called a game-changer for obesity, some people taking it suffer side effects. The most common include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion, dizziness, abdominal distension, belching, flatulence, gastroenteritis and gastroesophageal reflux disease. It can also cause hypoglycemia (low blood sugar) in patients with type 2 diabetes.

“The average person loses 2-to-3 pounds a week and most patients will lose about 15-to-20 pounds in the first three months, Dr. Graham confirmed. “Because semaglutide delays gastric intake, the most common side effect is gastrointestinal. If you overeat you get that reflex or upset stomach.

“Because your appetite is suppressed, you simply can’t eat as much as you used to. These side effects are triggered by what you eat, so I tell my patients that they aren’t really side effects but punishment for overeating. Cut everything in half and if you go out to eat split an entrée or box up half of it to go home. You also need to increase your exercise to at least a half hour every other day.”

Wegovy is the first new FDA-approved drug for chronic weight management in obese adults since 2014. The drug is prescribed for patients with a body mass index (BMI) of 30 or above, and for patients who have at least one weight-related ailment and a BMI of 27 or higher.

According to the FDA, 69 percent of American adults are obese or overweight, conditions that can lead to serious health issues such as heart disease, stroke, diabetes and certain types of cancer. Losing just 5 percent to 10 percent of body weight through diet and exercise has been associated with a reduced risk of cardiovascular disease and better health in general.

WeightWatchers is jumping on board the semaglutide band wagon by acquiring the telehealth platform Sequence, which will give calorie-counting members access to drugs like Wegovy. While some WeightWatchers fans question the compatibility of the new weight-loss drugs with the company’s healthy eating platform, WeightWatchers CEO Sima Sistani defended the move citing the “responsibility of the company to support those interested in exploring medications that are right for them.”

“We need to think of obesity as a disease that can increase the risk for diabetes, hypertension, heart disease, female infertility, arthritis and certain types of cancers like colon cancer,” Dr. Graham said.

“More and more children are developing diabetes as teens only because of their weight.

Diabetes used to be called the disease of aging, but these kids are being diagnosed at age 15 instead of 50. While diabetes is genetic, if you have the gene and you become obese, it triggers the diabetes to manifest.

“The problem with obesity is that appetite is a strong driver and some people eat for the pleasure of food and not to satisfy hunger. Semaglutide works on the part of the brain that suppresses hunger by stimulating your natural GLP-1 receptors and helps your body make more insulin. It’s very safe because you only make insulin if your sugar is high, but if your sugar is low, it turns off. It auto-regulates.”

When a patient reaches their desired weight the semaglutide dosage is reduced until they are weaned off it completely. If they find themselves regaining weight, they can be put back on the medication. Although its primary function is treating chronic obesity, there is no harm in going on and off the medication if the dosage is monitored by a physician.

Dr. Paul Graham graduated from the University of Rochester School of Medicine and Dentistry in Rochester, N.Y., and did his residency in Internal Medicine and fellowship in Endocrinology at Wilford Hall USAF Medical Center, Lackland Air Force Base in San Antonio. He moved to Florida in 1989 and joined the Doctors Clinic until it closed in 2001.

He then cofounded Diabetes and Endocrine Associates of the Treasure Coast, specializing in diabetes, and has now added weight loss within the practice. His office is located at 2835 20th St., Vero Beach: 772-299-3003.


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