Myths and Facts:
Semaglutide is the name for a peptide found in diabetic and weight loss medications . First developed for managing blood sugar in patients with type II diabetes, it has gained popularity for its remarkable ability for individuals to lose weight. The weight loss is consistent for both diabetics as well as people who are overweight or obese and do not have any form of diabetes.
Insurance should cover my weight loss medicine:
Since the FDA approval of semaglutide (Wegovy®) for weight loss, demand has been so strong that the manufacturer has had difficulty keeping up with manufacturing the drug. This has led people (and their doctors) to use another form of semaglutide called Ozempic® which is only FDA-approved for diabetes but is the same drug. Most people do not have weight loss coverage in their healthcare policies, and getting Ozempic® may fool your insurance company into thinking you have diabetes and paying for the drug.
This has led to a shortage of Ozempic® and has harmed diabetics who need this medication for their health. The use of Ozempic ® for weight loss is also harming insurers who wind up paying for a mediation that isn’t covered by the policy, and it is not clear who has to pay the insurance company back, the doctor who wrote the non covered medicine, the patient who took it, or the pharmacy who filled it.
You can contact your healthcare company or your benefits manager to see if you have weight loss coverage. The use of Ozempic® for weight loss is not FDA approved (without diabetes) and although your insurance may assume that you have diabetes if your doctor uses this to save you money (and bill your health insurance) this is not appropriate. The insurers have not been able to manage this work around the rules, but they will, and someone will have to pay the money back.
If you do have weight loss medication health care insurance coverage, the appropriate drug is Wegovy®, and based on your policy, it may cost you nothing.
Bottom line: You may have weight loss coverage, and if you do, great. If you do not, avoid the temptation of tricking your insurance carrier into covering a drug that they think you are using for another medical purpose. You can just pay for it.
Semaglutide causes you to lose muscle mass:
Weight loss at 68 weeks in the largest clinical trial was around 15-17% of body weight, and they didn’t assess for “where did the weight loss come from”.Since then, numerous studies have evaluated this question. It is essentially all fat loss. There can be some loss of muscle mass in inactive individuals, but even then, it is not significant and it is exactly what would happen if an inactive person lost weight with any method. When you are lighter, you require a less robust musculoskeletal system to carry your body around.
An analysis of 140 participants in the primary weight loss study (the one that the FDA evaluated to approve the drug) found that:
- Fat mass reduced
- Visceral fat (the harmful fat in your organs) reduced
- Lean body mass as a percentage of weight improved.
Bottom line: Semaglutide targets fat loss, not muscle or bone loss.
Semaglutide causes a “hollow face”
The term “Ozempic Face” has popped up as people noted their faces were not as full after they lost a large amount of weight. Your facial appearance consists of your skull which changes very little, fat pockets that shrink as we age, and muscles that sag as we age.
When people have large weight loss, for any reason, the face may look saggier due to the fat loss that occurs everywhere, including the face! We see the same thing after bariatric weight loss surgery after people make lifestyle changes and lose weight, and it can occur with semaglutide.
The loss of facial fat will occur over time, no matter what. It may become more apparent after a substantial weight loss as well. This is treated with nonsurgical facial fillers (such as Magic Lift™) or with a minor surgical fat transfer procedure.
Bottom line: Weight loss can lead to a less full appearing face.
Semaglutide causes pancreatitis:
In the larger clinical studies of semaglutide vs placebo, pancreatitis did occur, but less often in the semaglutide patients than the placebo patients.
There is a recommendation by the FDA not to use semaglutide if you develop pancreatitis while on the drug. But a prior history of pancreatitis doesn’t prevent you from using semaglutide.
Bottom line: Semaglutide doesn’t cause pancreatitis.
Semaglutide causes cancer:
This one is worth paying attention to. In rodent (think rats) studies, semaglutide can cause medullary thyroid cancer, but this has not been found to be true in humans. Medullary thyroid cancer is a very rare type of thyroid cancer, most thyroid cancers are a different type. If you have a personal or family history of medullary thyroid cancer (not thyroid cancer, but medullary type) then semaglutide is best avoided because of evidence from animal studies.
MEN is a rare condition called Multiple Endocrine Neoplasia.MEN type 2 is a contraindication to semaglutide as determined by the FDA. The reason for this and the link is not clear, but for now, if you or a known family member had MEN2, do not use semaglutide.
Bottom Line: Semaglutide may have a link to individuals predisposed to certain genetic risk cancers (medullary thyroid cancer and MEN2) but we just don’t know yet.
Semaglutide will make my blood sugar go too low.
Semaglutide, by itself, doesn’t lower blood sugar below a normal level. It does lower abnormally high blood sugar to normal levels, however.
If you are on blood sugar-lowering agents (such as other diabetes medications that can cause low blood sugar, insulin for example), semaglutide can magnify the effect of the other drug.
Do not use semaglutide along with other diabetic medications if you are not a diabetic (metformin is an exception, as it generally doesn’t cause low blood sugar by itself either). If you are a diabetic, your doctor will work with you to monitor your sugar and adjust the dosage of the other medications.
Bottom line: Many diabetic medications lead to low blood sugar, and semaglutide doesn’t work that way.
I will gain the weight back if I stop the semaglutide:
This is a concern. The manufacturer would like you to be on their drug forever, so they had to do a study that would help determine what would happen when people stopped semaglutide (or placebo).
The study took place over about 2 ½ years. Individuals were given semaglutide shots or placebo (fake) shots. At 68 weeks, the people on the semaglutide lost about 17% of their body weight. Those on placebo lost about 2% of body weight.
There is a catch. At the start of the study, the participants were directed to perform 150 minutes a week of light exercise, as well as to cut their daily food intake by 500 kcals (or about 20% less food).
At the 68 week point, they asked a group to stop the drug (or placebo), stop the exercise, and resume prior, higher calorie eating habits. They then followed the participants for another year.
Individuals who were on a placebo and lost a small amount of weight gained it all back. Those who were on semaglutide were still thinner than baseline after being off of the medication for a year, and even after they were instructed to resume their old lifestyle habits.
We have found that those individuals who are more effective with lifestyle intervention tend to stay at their lower weight (the more effective individuals lost more weight than the less effective individuals) after coming off of the medication, which was also found in the clinical study.
We are also seeing that the use of metformin after stopping the semaglutide is effective for longer term weight loss. Previous blogs reviewed this topic.
We are also seeing that the use of metformin after stopping the semaglutide is effective for longer term weight loss. Previous blogs reviewed this topic.
Bottom line: Most people keep weight off after discontinuation of semaglutide, but some effort is needed.
Dr. Charles Mok
