You’re tired of being overweight, and now you’re teetering toward actual ‘obesity’. You’ve tried everything. You’ve been dieting as long as you can remember and nothing happens. You starve yourself, exercise to exhaustion, lose some pounds and gain them back. No matter what you do, your ‘tummy’ is still there. You know you’re not alone. There are well over 50,000 book titles on Amazon when you insert ‘diet’ in the search engine. Diet pills, prescription or not, give no lasting benefit.
And now you see articles and TV ads for the new semaglutide peptides (Wegovy, Trulicity, Mounjaro, Ozempic). These look good. Really simple, once weekly injections, originally FDA approved for Type 2 (adult onset) diabetes, had a marvelous additional benefit: users of the semaglutides lost weight.
And then, when the FDA approved one of them for obesity (Wegovy), everyone wanted it. Not surprisingly, Big Pharma priced the semaglutides quite high (Wegovy et. al are $1,300 a month without insurance). The insurance companies, fully aware that 70% of Americans are overweight and 42% are obese, took one look at these prices and pressed the denial button every time a doctor wrote the prescription for a semaglutide when prescribed for obesity. The meds are covered for diabetes only after other therapies have been shown to fail.
Nevertheless, there are national shortages of weight loss peptides, reminding you there are no shortages of rich overweight people for whom $15,000 a year to become and remain svelte is considered a good investment.
How do semaglutides work?
The last two Health Tips have been about peptides, short strands of amino acids either injected (insulin) beneath your skin or sprayed into your mouth. Semaglutide, once injected, works by increasing the amount of insulin produced by your pancreas and decreasing the amount of a second hormone (glucagon) which raises blood sugar. This combination lowers your blood sugar, reduces your hunger and increases your energy levels. The end result is that you lose weight.
Studies show that semaglutides work fairly fast: with no change in eating habits, patients lose 2% of their weight in 4 weeks, significantly more with calorie restrictions, and (to everyone’s delight) weight loss begins with dreaded belly fat, which had accumulated because of excess insulin (the tummy is “lipophilic”, it “loves fat”). Patients familiar with using glucose monitors notice immediately that semaglutides slow gastric emptying and reduce that sugar peak occurring after eating.
Mostly Good News, Some Bad News about the Semaglutides
Good news first. Although there are several brands of the semaglutides, the basic semaglutide molecule is in the public domain and cannot be owned by any one company, like “thyroid” or “insulin”. Therefore, semaglutide is available generically, by prescription, from peptide compounding pharmacies. Unlike the brand name product which sells four, pre-filled syringes for $1,300, the compounding pharmacies prepare a single vial and you’re given a supply of insulin syringes for at-home self administration.
You start at a very low dose, then slowly increase it over three months and maintain until you reach a weight you’re satisfied with. To get started you’ll need to request an appointment with one of our nurse practitioners. Your semaglutide package will include:
- an initial consultation with a nurse practitioner,
- baseline labs,
- 12 weeks’ worth of the semaglutide peptide,
- and a follow up consultation.
To really see a difference with semaglutide, you’ll need to be on it for at least 12 weeks. You can expect your out-of-pocket costs to average less than $265 a month which seems a reasonable price for the health benefits and the positive sense of yourself that comes from weight loss. Although your semaglutide is not covered, if you’ve got a Health Savings Account (HSA), you’ll likely be eligible for reimbursement.
Side effects from the semaglutides are really pretty minimal. Some patients have reported “fatigue”, but I think it’s because they’re eating less and their bodies are adjusting to life without “Dunkin”.
The bad news with the semaglutides is that if you’re not careful, you can gain your weight back again. One study showed that the substantial weight loss obtained by semaglutides was maintained when patients remained on the 2.4 mg dose for two years. If you do start adding pounds, simply
do three or four months of semaglutides again. You do not want to be the obese person you once were. Ever again.
If you are interested in semaglutides, book an appointment with one of our nurse practitioners or call us at (773)296-6700.
David Edelberg, MD