Ozempic and Wegovy for weight loss: Q&A

semaglutideWe posted a video on TikTok last week on Ozempic and Wegovy and how these medications can achieve up to 15% weight loss when combined with diet and exercise. The video currently has 1.6 million views and over 3,000 comments/questions. So we thought this would be a good opportunity to answer some of the most commonly asked questions below.

 

What medications are we talking about and how do they work?

Ozempic, Wegovy, generic semaglutide, Rybelsus, Saxenda (iraglutide and approved in kids 12-17), Mounjaro (tirzepatide) are all Glucagon Like Peptide-1 (GLP-1) receptor agonists. The active ingredient in this class of drugs all end in “tide.” This will make it easier to spot these drugs in the future.

GLP-1 drugs stimulate the pancreas in type 2 diabetes to produce insulin. After initially producing too much insulin in patients with type 2 diabetes because of too much food intake and stimulating the pancreas to produce more and more insulin leading to insulin resistance, the pancreas gets “burned out.” GLP-1 drugs enhance insulin secretion in this scenario.

In addition to producing insulin, these medications suppress appetite and make you feel full by slowing the movement of food from the stomach to the intestines. Based on the studies of the various medications above, some result in a 15% weight loss (semaglutide that we have in the office) or up to 25 pounds in other studies.

These medications are all injections except for Rybelsus which is an oral tablet. However, Rybelsus didn’t result in as much weight loss in studies.

Ozempic was approved for type 2 diabetes in 2017 and found to have a side benefit of weight loss. Therefore, the manufacturer took the same medication and got approval specific for weight loss under the name Wegovy. So using this drug for weight loss is not off label. It is a legitimate, FDA-approved use.

 

Can the office just send the medication to me?

These medications are real medications and patients need to be monitored while on them. For that reason, all patients that are deemed candidates (more on this in a minute), must join our 6-month weight management program to get a health assessment, including bloodwork and an EKG, followed by weekly coaching sessions.

 

Who’s a candidate?

While some may believe this medication is being unfairly taken away from type 2 diabetics, this really isn’t an accurate assessment of the situation. Wegovy (semaglutide) is specifically approved for weight loss as long as you fit the criteria for obesity, which is to have a BMI of greater than 30 or greater than 27 if you have other comorbid conditions like type 2 diabetes or high blood pressure (calculate your BMI here). If you’re a candidate and a California resident, you can purchase a month’s supply of semaglutide  injections (the active ingredient found in Wegovy and Ozempic) from our office.

We can teach you how to give yourself the weekly injections in person or virtually once you’ve joined the weight management program. The initial consult (a cost of $100 that will go towards the cost of the program) and subsequent sessions can all be done virtually. Again, you must be a California resident because we can not ship these medications to other states.

 

How much does it cost? Will insurance cover it?

Our 6-month weight management program is $1199 and each month’s supply of injectable semaglutide is $400 per month. Insurance does not cover our program and it is difficult to get coverage in general. Sometimes, even with insurance, your out of pocket cost may still be more expensive than the “all in” cost of our program with medication.

 

What are the side effects?

Side effects include burping, bloated feeling, diarrhea and most severe, but rare, pancreatitis. This is why we continue to monitor patients on semaglutide in our weight management program rather than distributing the medication unmonitored. Based on study results, it’s unclear if someone who previously had pancreatitis can take this medication.

Many comments in our TikTok post asked about risks of cancer. Studies on lab rats showed an increase in thyroid cancer but is not necessarily the case in humans. If you have a history of medullary thyroid cancer or Multiple Endocrine Neoplasia (MEN) type 2, you should not take these medications.

 

Do you have to take it forever? What happens when you stop?

Based on current recommendations, you can continue to take the medication as long as it’s beneficial.

Many asked if you will gain the weight back if you stop the medication. A better way to look at it is, if you stop the medication but continue with other behavioral changes like a healthy diet and exercise, you would not gain the weight back.

But even more important, if you lose weight with the medication in combination with diet and exercise, then stop the medication and conscientiously continue the diet and exercise, not only will you keep the weight off, you’ll no longer have type 2 diabetes and won’t need the medication! Why?

Type 2 diabetes is caused by obesity and is reversible. So try this: Consider using the medication to jump start your weight loss journey but don’t stop there. Use this opportunity to start life anew with a healthy diet and exercise, reverse type 2 diabetes and stay off diabetes medications for good. (This advice does not apply to type 1 diabetes which is a very different disease and generally not curable in the same way type 2 diabetes is).

 

Is there a shortage of this medication?

Currently, we have a robust supply of semaglutide in our office for patients that meet the criteria for obesity. We obtain this generic, less expensive version of Ozempic and Wegovy from a compounding pharmacy.

Never heard of a compounding pharmacy? That’s ok, chances are you’ve used medication from a compounding pharmacy before.

 

Examples of what a compounding pharmacy offers:

  • Allergic to a dye or certain ingredient in a medication? A compounding pharmacy would recreate that medication without the dye or allergen
  • A child, or elderly parent that can’t swallow the pill form of a medication? A compounding pharmacy can recreate the medication in liquid form
  • Ever received botox or filler at a doctor’s office? The topical numbing cream placed on the skin prior to treatment was made at a compounding pharmacy
  • On bioidentical hormone replacement therapy (BHRT)? From a compounding pharmacy.
  • Medications that are in short supply, including medication for COVID, can be produced by compounding pharmacies too

This last example is why we’re able to get semaglutide. It’s on the FDA’s shortage list, and as such, the FDA allows a compounding pharmacy to duplicate a commercially sold drug that’s currently unavailable or in short supply.

So what if semaglutide is removed from the shortage list? Then the compounding pharmacy we work with could no longer manufacture semaglutide. That’s why we’re actively stockpiling semaglutide for our patients in our 6-month weight management program, so they’ll have access to the medication during their program, and if supplies last, well after their 6-month program.

But we’re also hoping they won’t need the medication forever. Because our primary goal here is not for our patients to become medication-dependent for the rest of their lives.

We want our program to coach patients to a healthier lifestyle with diet and exercise. That way, if accessing medication becomes a problem, they would’ve at least had 6 months to strive for their goal weight with medication and then maintain it with newly developed behavioral changes learned in the  6-month program.

 

Quality standards of compounding pharmacies

In regards to the quality of medications produced by a compounding pharmacy, the facility we get semaglutide from is considered an “outsourcing facility,” as defined in The Drug Quality and Security Act, of 2013. That law created a new section, 503B, in the Federal Food, Drug, and Cosmetic Act. As such, an outsourcing facility is overseen and inspected by the FDA, along with state regulators.

Under the law, outsourcing compounding pharmacies must comply with section 503B and current good manufacturing practice (CGMP) requirements. In other words, they have very high standards to keep.

And we’ve had a great experience with this compounding pharmacy providing our semaglutide. A relationship that predates this particular drug. So for now, we have a robust supply of semaglutide and will maintain at least a 6 month availability while supplies last.

As an aside, we’re hearing the shortage of the brand name drugs are actually a shortage of parts for the pen (think epipen) to administer the brand name versions. We don’t have a shortage in this sense either since we’re sending 4 prefilled syringes (not a pen) to patients as part of their medication regimen.

Also, patients that take these medications for type 2 diabetes or obesity do have other medication options as well as starting a healthy diet and exercise regimen to reverse and cure themselves of type 2 diabetes. Of course that’s easier said than done, but still true. Sometimes when we have medications to treat disease, we can lose sight of non-medicinal, behavioral-based cures.

 

If you’re serious about joining this program and want to be seen as soon as possible to get started, then you can pay the consult fee online here and be prioritized for the next earliest appointment. But before you do… 1) are you a California resident, 2) is your BMI > 27 with obesity related issues (type 2 diabetes, high blood pressure, etc) or a BMI > 30 and 3) don’t have any thyroid or pancreatic issues. If you can answer affirmatively to all three questions, then pay the consult fee here and our office will follow up with you ASAP to get you on the schedule for an in-person or virtual consult. Once we confirm you’re a candidate during your consult, then you can move forward with paying for the 6-month weight management program and the semaglutide (or appropriate medication) monthly subscription.

 

More questions? Email us at [email protected] or call/text us at (415) 923-3005 or book online here.

 

What if I have excess skin after the weight loss?

A year ago, we started the weight management program because we were seeing patients coming in for tummy tucks and mommy makeovers that had more weight to lose and were not candidates for surgery.

Rather than turning them away completely, we decided a weight management program would help them lose weight and if after the weight loss they did have too much leftover skin, we could help them with a body contouring procedure (like this before and after photo). Or maybe they’d lose the weight and not feel like they needed any surgery anymore.

body contouring after weight loss

Either way, we could help them achieve their goals. If you do feel you’re ready for a tummy tuck or other body contouring procedure, check current pricing on all of our services here.

Questions? Call/text (415) 923-3005 or email [email protected]. Or book a consultation online here so you can lock in a procedure with a deposit in 2022 before prices increase in 2023.

 

If you’re serious about joining this program and want to be seen as soon as possible to get started, then you can pay the consult fee online here and be prioritized for the next earliest appointment. But before you do… 1) are you a California resident, 2) is your BMI > 27 with obesity related issues (type 2 diabetes, high blood pressure, etc) or a BMI > 30 and 3) don’t have any thyroid or pancreatic issues. If you can answer affirmatively to all three questions, then pay the consult fee here and our office will follow up with you ASAP to get you on the schedule for an in-person or virtual consult. Once we confirm you’re a candidate during your consult, then you can move forward with paying for the 6-month weight management program and the semaglutide (or appropriate medication) monthly subscription.

 

 

“Dr. Kaplan is a true professional. He gave me extremely helpful and direct honest advice…I strongly recommend him.”– David S.

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