Slimming Down with Semaglutide (Wegovy): Is This the Holy Grail of Weight Loss?

May 29, 2024

By: Michael Fouts, RD, Daniel Feldman, RD, Christle Guevarra, DO

In the constant quest for effective weight loss solutions, the pharmaceutical world has introduced a new player: semaglutide, the drug marketed by the brand name Wegovy.

Marketed as a revolutionary treatment for obesity, Wegovy has garnered attention for its potential to help individuals shed those stubborn pounds. But is this truly the holy grail of weight loss we've all been waiting for?

In this article, we'll dive into what Wegovy is, how it works, its pros and cons, and what you need to consider before embarking on a weight loss journey with Wegovy. At the end there is a personal story of Dr. Christle Guevarra’s use of Wegovy, and how it impacted her life.

Understanding The Basics

Semaglutide is the generic drug that is used in different formulations as different brand names, based on different doses and therapeutic targets (e.g., what it’s used to treat), and the delivery method (injectible, pill):

Wegovy:

Dose = 2.4mg
Therapeutic target = obesity
Delivery method: injectible (once per week)

Ozempic

Dose: 0.5mg
Therapeutic target: type 2 diabetes and cardiovascular disease
Delivery method: injectible (once per week)

Rybelsus:

Dose: 7-14mg (similar dose as Ozempic once in the bloodstream)
Therapeutic target: type 2 diabetes and cardiovascular disease
Delivery method: daily oral medication

How Does Semaglutide Affect Weight Loss?

Semaglutide belongs to a class of drugs called GLP-1 receptor agonists, which mimic the effects of a hormone called glucagon-like peptide-1 (GLP-1) in the body:

Reduction of concentration of sugar in your blood: GLP-1 increases the production of insulin (the hormone that brings blood sugars down), and inhibits glucagon (the hormone that increases blood sugar release from the liver).
Reduced appetite: GLP-1 helps reduce appetite by targeting the brain's hunger center; the exact mechanism is complex and not yet well understood.
Increase feelings of fullness: GLP-1 slows down gastric emptying (slows down food moving from your stomach into your intestines to be digested), making you feel “full” longer than you normally would.

The unique actions described above earned semaglutide, since it does the same thing as GLP-1, the spotlight as a potential game-changer in the world of weight loss: helping people adhere to a reduced-calorie diet.

It’s important to understand that with any drug there will be some pros and cons. Let’s review some of them for Wegovy.

The Pros of Wegovy for Weight Loss:

Appetite Suppression: By reducing appetite and increasing fullness, Wegovy can make it easier to make healthier food choices and avoid overeating.
Steady Weight Loss: Individuals taking Wegovy experience steady and sustainable weight loss over time, as long as they continue to use it.
Improved Blood Sugar Control: For individuals with type 2 diabetes, Wegovy offers the added advantage of better blood sugar control. By facilitating both weight loss and blood sugar control, it can greatly benefit individuals with type 2 diabetes.
Potential Cardiovascular Benefits: Wegovy can improve heart health by reducing the risk of cardiovascular events. As individuals with obesity are often at higher risk for heart-related issues, the cardiovascular benefits are crucial.

The Cons of Wegovy for Weight Loss:

Side Effects: nausea, vomiting, diarrhea, abdominal discomfort, and acid reflux. While these side effects often subside over time, they can be challenging to manage initially. Compared to other semaglutide formulations (e.g., Ozempic), side effects tend to be seen more with Wegovy due to its higher dose.
Long-Term Safety: Researchers are still studying long-term safety. Since Wegovy is relatively new, unforeseen risks might only become apparent after prolonged use.
Injection: Patients administer Weogvy via injections. This aspect might be a hurdle if you fear needles or struggle with self-administration.
Cost: Wegovy can be expensive if you don't have insurance coverage. In the US, without insurance Wegovy can cost around $1350 USD per month
Muscle Loss: despite people taking Wegovy experiencing significant weight loss, much of the weight loss tends to be muscle; highly recommended to do concurrent resistance training and a high-protein diet (120g or more) to minimize losses in muscle mass.

Is Weight Loss Permanent?

If Wegovy is discontinued, weight regain is possible — especially if you haven’t made any long-term lifestyle (diet and exercise) changes.

Is Wegovy Right for You?

Deciding whether Wegovy, or other semaglutide formulations, is right for you requires careful consideration. You need to consider your individual health circumstances, preferences, and the potential impact on your lifestyle. You should have open and honest discussions with your healthcare team, particularly your doctor and registered dietitian, and ensure they monitor and support you along the way. If you do take Wegovy, it’s highly recommended to engage in resistance training and eat a high-protein diet to minimize losses in muscle mass as noted above.

Any formulation of semaglutide is not a standalone solution for weight loss, and shouldn’t be used to replace a balanced diet, regular physical activity, and sustainable lifestyle changes. You’re a good candidate for Wegovy if you have these foundational practices in place, but still struggle with weight management —- especially hunger and cravings. Dr. Guevarra is one such example.

Patient Perspective: When the Doctor Becomes the Patient

Dr. Christle Guevarra, Sports Medicine

For as long as I can remember my weight has always fluctuated between being overweight and obese. Growing up, my next-door neighbor’s mom used me as an example of the “Clean Plate Club” to encourage her own daughter to eat more food. I loved sports and being active, but I also really, really loved food, too.

As a physician who specializes in sports medicine it may be surprising to hear that I- like many, have struggled my entire life to achieve and maintain a “healthy weight” - by BMI standards - and that’s not for lack of trying. I even had the advantage of medical training on my side to help me understand and access resources for weight management. I have been able to study the many different factors that influence someone’s weight like genetics, environment, lifestyle and so on. Yet there I was, still struggling to gain control over my own weight loss journey. This led me to spend the next nearly 20 years working on and making the necessary lifestyle changes, primarily diet and exercise, that all of the latest research suggested, and still I wasn’t seeing the desired effects.

I even tried different medications for obesity. All of which failed spectacularly well.

This led to many bouts of hopelessness, giving up on dieting altogether, along with my hopes of ever being happy with my body. These feelings peaked during my medical training, especially during my residency/fellowship. The grueling work and study schedules made prioritizing healthy lifestyle choices extremely challenging.

My biggest struggle? I never truly felt full when I ate. Even after eating ridiculous amounts of chicken breast and broccoli. Losing the first 20-25 lbs was fairly easy, it was losing weight beyond the initial drop that was extremely challenging from a hunger perspective.

After witnessing my husband's experience with consistent hunger post-bodybuilding show, I realized maybe it wasn’t necessarily me that was the issue, instead it was my constant hunger. This realization led me to finally “give in” to trying Wegovy, as it was a weight loss medication that was supposed to help suppress hunger for those who struggled with always feeling hungry.

Wegovy was recommended to me before by my primary care physician, but my initial response was no because I was too busy dealing with COVID-19 and navigating my ever-evolving sports medicine fellowship experience. The medication also was not covered by my insurance - this meant it would be quite expensive.

My “Eureka” moment on Wegovy:

I went to San Diego with my husband for a weekend getaway and we ended up at a nice restaurant. For the first time in as long as I can remember I was able to sit and have a conversation with my husband without my never ending hunger distracting me. Further, when the food came I was able to calmly eat, taking the time to actually enjoy my food and drink. Most shockingly, part way through the latter part of the meal I looked up at my husband with a confused look on my face and said, “I’m…full.” There were a few bites left on the plate and still some wine in my glass. I didn’t feel the need to force myself to finish either.

This personal story isn’t meant to suggest that everyone should take semaglutide in one of its forms (Wegovy, Ozempic, or Rybelsus). Rather, the point is to shed light on the fact that we all have varying degrees of hunger, and Wegovy can be effective for those that struggle with altered hunger cues as a big barrier for weight management. In particular, those that have built the other necessary habits (diet, exercise, sleep, etc.) that work in conjunction with this medication to benefit your health and well-being.

References:

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Mike is a Registered Dietitian and the owner of Leverage Nutrition, a nutrition company that helps people leverage nutrition to maximize their results, performance, and health. More specifically, Leverage Nutrition helps people with fat loss, building muscle, weight management, and sports nutrition. Outside of work Mike enjoys playing hockey, playing squash (the racquet sport), traveling, hanging out with friends and family, reading, and watching movie and tv series, as well as cooking.

Website: www.leveragenutrition.ca

IG: @leveragenutrition.ca

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Dan is a registered dietitian and personal trainer with a master's degree in Human Nutrition. He's also a competitive powerlifter, having competed in several local USAPL meets. Dan has a strong passion for making nutrition research more understandable and accessible for health practitioners. Towards this end, he regularly summarizes complex nutrition topics and research findings on his Instagram page. He also runs a successful, insurance-based private practice, helping individuals improve their health via nutrition. And he's a mentor for other dietitians who need help with running an insurance-based private practice.

Website: danfeldmanrd.com

IG: @powerlifterdietitian

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Christle completed her Family Medicine residency at Crozer Health in PA, where she was awarded “Resident of the Year.” She then completed her Sports Medicine fellowship at the University of Nevada Las Vegas. Currently, she maintains a telemedicine private medical practice, serves as a traveling Team Physician for US Figure Skating, and is a project manager for RP Strength. As a firm advocate of Exercise Is Medicine, Christle believes in “practicing what you preach.” A former competitive powerlifter, she now enjoys lifting while also training for Brazilian Jiu Jitsu.

IG: @dr.christle

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