Updated 3/12/24
First Let’s Talk about Ozempic.
In 2017, the U.S. Food and Drug Administration (FDA) approved a medication called Ozempic® to improve blood sugar control (along with diet and exercise) in adults with type 2 diabetes. Ozempic is what’s called a “GLP-1 RA”, which stands for glucagon-like peptide receptor agonist. It acts like the hormone GLP-1 that’s naturally produced by the body, and is below normal in people with type 2 diabetes. It helps the pancreas release insulin and it makes people feel full faster (inducing satiety) so they tend to eat less. Ozempic has also been shown to reduce the risk of major adverse cardiovascular events such as heart attacks and strokes in adults with type 2.
Since many people on Ozempic were experiencing significant weight loss, its makers (Novo Nordisk) decided to use the same active ingredient (semaglutide) in higher doses for a weight loss medication. The FDA required Novo Nordisk to call high-dose semiglutide by a completely different name because of the primary indication of weight loss, compared to Ozempic where the primary indication is type 2 diabetes. However, most folks with type 2 diabetes have weight issues, and a high percentage of people who are overweight have type 2 diabetes, so it really works for both populations. This new medication is called Wegovy, and it was just approved by the FDA in June 2021.
How Does Wegovy Help with Diabetes and Weight Loss?
Glucagon and insulin are like fire and ice – the exact opposite of each other. The more glucagon the body secretes, the less effective natural or self-administered insulin becomes. I’m sure we have all heard of “insulin resistance”. Essentially, both natural and self-administered insulin (even with increasing doses) becomes ineffective at moving sugar (glucose) into each cell/organ for energy. This is like “starving” the body at a cellular level. GLP-1 agonists, such as Wegovy, inhibit the release of glucagon, which in turn helps preserve the effects of insulin.
But Why Does It Help People Lose Weight?
“Insulin resistance” causes sugar (glucose) to be converted into fat storage. By decreasing insulin resistance, the body can more efficiently use sugar and get it into the cells/organs where it needs to be for energy and decreased overall fat storage. In addition, as mentioned above, Wegovy induces satiety and reduces caloric intake.
How Much Weight Can You Expect to Lose?
Semiglutide has been shown to be one of the most powerful tools for weight management in people with and without diabetes. In several year-long studies in different populations (including people with type 2 diabetes) who were starting with a baseline weight of 231 lbs, the average weight loss ranged between 15-17%. So someone weighing 200 lbs and taking the higher dose of semiglutide (Wegovy), would lose 30-35 lbs.
How Do You Know If You’re a Candidate for This Medication?
Wegovy is designed to work alongside a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of 30 kg/m2 or greater (defined as obese) or 27kg/m2 or greater (defined as overweight) in the presence of at least one weight-related comorbid condition like hypertension/high blood pressure, high cholesterol, or type 2 diabetes. Wegovy also helps people with portion control. However, nothing can replace the importance of being conscious of diet and physical activity!
Who Should NOT Use This Medication?
- Anyone who has a personal or family history of medullary thyroid carcinoma (i.e. thyroid cancer)
- Anyone who has a history of or active Multiple Endocrine Neoplasia Syndrome type 2 (a very rare condition)
- Anyone with a history of repeated pancreatitis
Please DO NOT GOOGLE – discuss with your physician if Wegovy is an option for you.
What Are the Dosing and Titration Recommendations?
To avoid nausea, Wegovy doses should be increased slowly over time in the following manner:
- Week 1-4 weekly dose = 0.25mg
- Week 5-8 weekly dose = 0.5mg
- Week 9-12 weekly dose = 1mg
- Week 13-16 weekly dose = 1.7mg
- Week 17 and onward weekly dose = 2.4mg
How Do You Administer Wegovy, and Are There Side Effects?
Before starting Wegovy, your physician or pharmacist should review proper injection technique. Administer Wegovy once weekly on the same day each week, without regard to time of day or meals.
Wegovy injections should be done subcutaneously in the abdomen, thigh, or upper arm. If a dose is missed and the next dose is MORE than 48 hours away, administer the missed dose as soon as possible.
As a pharmacist, listing side effects is a double-edged sword. Yes, we want patients to know the potential side effects, but the placebo effect can be very potent! Use common sense. If there are new onset “symptoms” such as abdominal pain, nausea, diarrhea, or anything else “new” since starting this therapy, let your physician know right away!
You can request a Wegovy™ Savings Card and WeGoTogether™ support here.
Editor’s Note: On March 8th, 2024, the FDA approved Wegovy to reduce cardiovascular risk in people with obesity.
Additional Resources:
TCOYD Podcast #2 – Weight Loss: Not One Size Fits All (Featuring Obesity Specialist Jennie Luna MD)
What about use in people with T1D?
Absolutely, if you fit the main criteria, which is being overweight.
By “civilian standards I am not overweight. But job standards, ballet dancer, trying to return I am – about 15-20 lbs. Thanks
No, it’s really not meant for people who are not overweight, no matter the profession.
what about heart disease can I take this Medication?
Absolutely. It’ll help protect your heart as well.
I’m on week 4 of Ozempic as a type 1 diabetic and would love to see a video on this topic, there’s a lot of T1Ds taking it but there’s a lot more stuff from random bloggers than from reputable sources about this topic. (By the way, it’s going wonderfully for me so far and doing exactly what it’s supposed to do)
Does Medicare Part D cover this? I am 74 and BMI is 34. What is average monthly cost?
It’s different for the different types of Medicare plans and supplementals. You can try checking the Wegovy website here: https://www.wegovy.com/ and inquiring with their customer service here: https://www.novonordisk-us.com/contact-us.html
How long should you take the drug?
For sure as long as you need to get to your weight goal. If you want to wean yourself off of it when you get to your goal, you have to make permanent lifestyle changes so you don’t gain all the weight back. Wegovy is not a permanent fix for being overweight if you don’t make any changes yourself.
Don’t forget that Wegovy has been proven to protect people from heart attacks and strokes. If you have type 2 diabetes you can stay on it long-term, but if you’re taking it solely for weight loss, you may not need to take it forever.