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Semaglutide, the Holy Grail of Weight Loss?

I have been involved with weight loss for many years (most of my 26-year career in medicine) and have never seen a product to lose weight be pushed so strongly by the pharmaceutical industry. Semaglutide is the active ingredient in Ozempic, Wegovy and Rybelsus. It is being pushed as the next miracle drug to combat the battle against obesity. The advertisement says just 1 shot a week, no dieting or exercise needed, and the pounds just melt off. It seems like the perfect drug and the answer to the obesity epidemic. However, like any drug that has recently come out on the market, the studies are limited, and the safety profile has still not been 100% determined.

In our clinic, we are very selective in who we offer Semaglutide to. Most of the individuals we offer it to have failed other weight loss treatments first, have some form of blood sugar abnormalities upon evaluation, have a significant amount of weight to lose or have other medical issues that would benefit from losing weight. We believe that in these cases, knowing what we do about Semaglutide, the benefits of using it must outweigh the risk of taking this treatment. Currently, there are other safer alternatives to anyone who considers using Semaglutide. Also, no matter what treatment an individual decides to start, whether weight loss pills, injection or surgery, all must be coupled with a healthy diet and exercise plan in order to increase the chances of maintaining their results after they complete the program.

So, what is Semaglutide and how does it work? Semaglutide was a medication that was developed for patients with diabetes type 2. During its development, it was observed that patients were also experiencing weight loss, hence it is now sold as both a diabetic and weight loss drug. The weight loss effect is observed in diabetics, pre diabetics and nondiabetic individuals (so you do not have to be diabetic to obtain its benefit). It has several effects that are believed to be responsible for weight loss. One is the medicine’s ability to slow gastric emptying (essentially to slow how fast the stomach empties or processes food), which leads to patients getting fuller quicker from a meal and eating smaller portions. Secondly, it diminishes a person’s overall appetite by affecting areas in the brain associated with calorie intake, which in turn leads to less food consumption.

So why don’t we just place everyone on Semaglutide since it’s so effective or use it long-term? Well, there are several side effects that are known at this time and possibly others still unknown that may surface over time as the medication spends more time out in the market. One of the most concerning side effects to anyone who considers taking Semaglutide is the incidence of thyroid tumors or cancer. In studies done on rodents, it was found that a small percentage of rodents given Semaglutide later developed thyroid tumors, or medullary thyroid carcinoma. It is not known whether this same phenomenon will occur in people. The results reflected on the study were dependent on dosage (the higher the dose, the higher the risk of cancer) and length of treatment (the longer the rodents were on the medication, the higher the risk of cancer). The second concerning side effect is the possibility of gastrointestinal motility slowing down, to the point where intestinal blockage might develop in some individuals, resulting in hospitalization. Although these are the two most worrisome side effects, others side effects include pancreatitis (inflammation of the pancreas), hypoglycemia (excessively low blood sugar), nausea, vomiting, diarrhea, constipation, abdominal pain, etc...


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