Semaglutide is everywhere. And as a doctor, and an advisor for the BiohackrHealth Medical Weight Loss Program, who offers semaglutide, it is important to understand the good and bad of it.
The basic facts:
- FDA approved it in 2017 for the management of Type 2 Diabetes
- It was quickly found to cause weight loss. I blogged about it first in 2021, after I read about a British study of 2000 patients who had been on it for a year. The results were impressive, with a significant number of people losing 20% of their body weight.
- It is thought to work in 3 ways. First, it helps with insulin resistance. Second, it works in the brain to decrease appetite. There are many personal accounts of how it made them want to drink less/exhibit less addictive behaviors. Third, it slows gastric emptying, which means your stomach slows in its release. That makes you feel full longer.
- Negatives: It can cause GI issues like nausea, diarrhea, and constipation. There are cases of pancreatitis (which can be severe), kidney injury, and a possible risk of increased thyroid cancer (seen in animal studies, not humans).
- It is unclear if you can stop it. In the British study, when people get off the medicine, their weight came back.
- It is currently indicated for BMI 30 or above, or BMI 27 with an additional issue like high blood pressure or diabetes.
- Cost varies, but seems to be $1000-$2000/month. (If you can find it).
- Dosage varies. The different brands have different dosages. It is usually given as an injection once a week, though oral forms are coming out.
- It is good to do this with some kind of health monitoring. Basic labs, your weight, body scan to see body composition, blood pressure, micronutrients are all things to consider.
My thoughts?
It is a clear gamechanger. I don’t think we will see gastric bypass surgery for most patients in the future. There are people who cannot tolerate it- it clearly is not for everyone. If you have significant weight or medical problems, it seems a good choice.
BUT.
For those where you have that pesky menopause weight or extra baby weight or 10 pounds you keep meaning to lose…. Is it for you? Jury is out for me on that. This is something that needs to be maintained. How long can you be on it? Are there long term side effects? Can you wean off it? Do lower dosing or less frequent dosing? Does it affect people differently?
We are going to be learning a ton about this in the coming years, as we have large numbers of patients who take it. Again, for those who have a BMI of 27 and higher with any other medical issue, or those BMI 30 or higher, it is a great thing to consider. We know the risks of high blood pressure, high BMI affects on healing/infections/blood clots/ joints, diabetes.
I want to bring science to this so will have a series of looking at the original scientific papers. So though semaglutide is not a plastic surgical thing, the effects of the weight loss (droopy breasts, hanging tummies, laxity in the face and neck and volume loss) are things I treat daily as a plastic surgeon.
More to come.