OZEMPIC, TRULICITY, MOUNJARO, ZEPBOUND: THE SEMAGLUTIDES. YES! THEY WORK!

You’re tired of being overweight, and you’ve been a victim of the tyranny of the last ten, fifteen, or twenty pounds as long as you can remember. You’ve tried everything. You’ve been dieting as long as you can remember and nothing happens. You exercise to exhaustion, lose some pounds and gain them back. No matter what you do, your tummy is still there and slowly expanding, your thunder thighs painfully stretch the seams of your designer jeans. And yet, you know you’re not alone. 42% of Americans are either overweight or obese. There are well over 60,000 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 them everywhere. Those articles and TV ads for the new semaglutide peptides (Wegovy, Trulicity, Mounjaro, Ozempic, Zepbound). Maybe a friend or two has cheerfully lost some weight. Why not you?

These look good enough. A simple weekly injection, originally FDA approved for Type 2 (adult onset) diabetes, and there was a marvelous side effect: users of the semaglutides lost weight.

In a head-to-head competition of diet/exercise versus semaglutide, after 16 months, overweight patients following diet/exercise alone lost 2% of their weight, but semaglutide users lost 20%. Think about doing the math on yourself. Let’s say you weigh 160 lbs. After 64 once-a-week injections (16 months, 4 weeks a month) you weigh 128. Maybe not enough to open an account at Brandy Melville (that was meant to be a joke). But then…three months later, off the semaglutides, you’ve regained ten pounds. Don’t hyperventilate. Call for a refill. They’re FDA approved for lifetime use.

How do Semaglutides work?

They are peptides, short chains of amino acids (a “long chain” is a protein), called GLP-1 RA “Glucagon Like Protein Receptor Agonist”, that is stored in the lining of your small intestine and is released when food arrives to increase your insulin, lower your blood glucose, and reduce your hunger.  Like insulin itself (also a peptide), GLP- 1 RA medications are self-administered by injection and were originally FDA approved for Type 2 Diabetes. However, it was quickly noticed that patients also lost weight quickly and with relatively few side effects.

Not surprisingly, with a big winner on their hands, Big Pharma priced the semaglutides very high (they average $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. Zepbound is approved for obesity with medically related conditions. Like its siblings, it usually gets denied as well.  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.

More Details on How Semaglutides Work

Once injected, the semaglutide increases the amount of insulin from your pancreas and decreases 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. This is the first part of the semaglutide weight loss effect.

Studies show the semaglutides work fairly fast: with no change in eating habits, semaglutide patients lose 2% of their weight in 4 weeks. But a second astonishing effect of the semaglutides is to silence the “food noise” in your head. Semaglutides suppress your appetite to the extent that they change the signal to your brain when you feel full.

 “I really don’t think about food anymore”, which makes calorie restriction much easier than ever before.  To everyone’s delight, weight loss begins with dreaded belly fat which had slowly accumulated because the tummy is “lipophilic”, it “loves fat”.

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 products (all of them), average $1,300 for a one month supply, the compounding pharmacies prepare a single vial and you’re given a supply of insulin syringes for at home self administration for a much more reasonable amount of about $300 a month.

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. You’ll be working with our nutritionist Tam Dickson-Meyer and/or one of our Nurse Practitioners so you get the maximum benefit from your semaglutide program.

You can expect your out of pocket costs to average $300 a month which seems a reasonable price for the health benefits and the positive sense of yourself that comes from weight loss. Visits with Nurse Practitioners and our Nutritionist can be submitted to your health insurance. Although your semaglutide from the compounder is not covered, if you’ve got a Health Savings Accounts (HSA), you’ll likely be eligible for reimbursement.

For most people, 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”. Others note nausea during the first 2-3 days after each injection.

The not particularly surprising 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 fat person you once were. Ever again.

If you are a WholeHealth Chicago patient, ask your practitioner about semaglutides. If new to us, call or request an appointment online with a WholeHealth Chicago practitioner near your home. After your initial appointment, in a few days the semaglutides will be sent directly to your home from the pharmacy. If you need help learning self injection, we’ll teach that to you.

Be well,

David Edelberg, MD