Doctor Explains Why Baby Steps, Personalized Care Are Key When Using Semaglutide for Weight Loss
by REBEKAH PIERCE
Weight-loss medications are all the rage in the fight against obesity, but that doesn’t mean they are the answer for everyone. Amid the novelty and excitement, it can be easy to forget that the basics of a healthy diet and lifestyle are still just as important as ever.
With more people turning to these treatments than ever before, understanding how to use them safely could make all the difference.
Dr. Gabriela Lopez Cohen is a board-certified family medicine practitioner in Haines City who works for BayCare Medical Group.
It was during her residency, she says, that her attention first became drawn to the medical advancements in weight loss management.
“At the beginning,” she says, “it was challenging because [semaglutide] was not FDA approved.”
Fast forward to 2024, and the FDA has approved semaglutide for weight loss under the brand name Wegovy®. Similar drugs, such as Ozempic, can be used for treating other diseases (mainly type 2 diabetes) but aren’t FDA-approved for weight loss.
What Is Semaglutide?
Semaglutide is a type of glucagon-like peptide-1 receptor agonist (GLP-1 RA) that mimics the effect of GLP-1, a naturally occurring hormone that regulates blood sugar and appetite. According to Lopez Cohen, the drugs are particularly effective because they work for a longer period of time in our bodies compared to their naturally occurring counterparts. “With that, we can achieve weight loss,” she explains.
Semaglutide produces several effects throughout the body. In the stomach, it delays gastric emptying, so the patient feels fuller for longer and with less food. It also takes more time to digest that food and decreases bowel motility. Semaglutide even works in the brain (decreasing appetite) and in the pancreas (increasing insulin secretion).
Besides weight loss, semaglutide has other clinical applications. It has been used for diabetes for several years but is currently being researched as a treatment for addiction disorders, Alzheimer’s disease, Parkinson’s, and even cardiovascular risk reduction.
Who Is a Good Candidate for Semaglutide?
Lopez Cohen emphasizes that despite the draw, not every patient is a good candidate for semaglutide. In fact, there are even some people who should avoid it.
The main contraindication to using these medications is a family history or personal history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 (MEN 2). Semaglutide is also not a good fit for patients who are pregnant or breastfeeding or those who are allergic to the drug.
Otherwise, there are two specific sets of criteria physicians use to evaluate patients’ suitability for the treatment as a weight loss drug. By itself, obesity with a BMI greater than 30 is an indication. If a person is not obese but is overweight with a BMI over 27, they may still qualify if they have one or more comorbidities related to weight, such as high blood pressure or high cholesterol.
“Access to the medication is a challenge,” Lopez Cohen admits. “Not all patients qualify based on the criteria, and if it’s not covered [by insurance] it could be an uphill battle.” This is an expensive medication, so if insurance doesn’t chip in to cover its several hundred-dollar price tag, it’s “usually a no,” she says.
Does Semaglutide Cause Any Side Effects?
Like all medications, semaglutide does carry with it some potential side effects, but according to Lopez Cohen, many of these, like nausea, vomiting, constipation, and diarrhea, are preventable with the proper eating habits.
She explains it this way: “Your stomach is the same size, but can’t handle the same amount of food because it’s working slower. If you provide the exact same amount of food and the same kind of food, your stomach won’t be able to handle it.”
Beyond these GI issues, Lopez Cohen says other side effects that are less common include gallbladder disease, pancreatitis, and gastroparesis (delayed gastric emptying). She emphasizes that these tend to be dose-dependent, which is why patients need to have a gradual dose increase and shouldn’t be started on the highest dose possible.
The same applies to muscle loss, another concern about semaglutide that has dominated the news of late.
“The rate of weight loss shouldn’t be more than one or two pounds per week or you’re probably losing muscle, and that’s not good,” she says. She cites the importance of proper protein intake (at least 90 to 100 grams per day, spread out over every meal) and resistance exercises to preserve muscle mass and improve strength.
Gaining Ground With Semaglutide
Semaglutide and other weight loss medications continue to gain ground as research progresses.
When treating a patient with semaglutide, Lopez Cohen sees patients as often as every three to four weeks, recognizing the importance of good medical supervision to ensure they’re establishing good long-term diet and exercise habits and are tolerating the medication well.
She’s optimistic about its applications but emphasizes the importance of personalized care. While semaglutide has been successful for some people in the short term, most of the time, it’s part of a long-term care plan.
“We need to be aware that obesity is a chronic disease,” she says. “Most of the time, it requires chronic management, just like diabetes or high blood pressure.”