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Semaglutide Frenzy

  • sdougher3
  • May 15
  • 3 min read

Obesity is complex, chronic and often with relapses and progression to metabolic syndrome which puts you at higher risk for cardiovascular disease, stroke, and diabetes. However, obesity is also influenced by genetics, metabolism, sociocultural, and environmental factors. The risk of cardiovascular disease, metabolic disease such as diabetes, osteoarthritis, sleep apnea, and malignancy are increased. An average weight loss of 10-15% can alleviate the complications associated with obesity.



Over the last few years the use of Semaglutide has been on the rise. Semaglutide is a glucagon-like peptide agonist and it works by increasing insulin release, blocking glucagon secretion, slowing gastric emptying, and blood glucose control. The medication was developed by Novo Nordisk in 2012, and was released 5 years later to treat diabetes. During the semaglutide clinical trials in 2015 patients noticed they were also losing weight.


Other medication alternatives that are FDA approved include: naltrexone-bupropion combination, phentermine-topiramate combination, orlistat, setmelanotide, and liraglutide. Naltrexone-bupropion reduces energy consumption and pro-opiomelanocortin neurons regulate food intake. Phentermine is an appetite suppressant and topiramate is an anticonvulsant whose mechanism of action is not fully understood in weight loss. Orlistat decreases fat absorption by decreasing pancreatic and gastric lipase. Setmalanotide is a melanocortin 4 receptor agonist. Liraglutide is a glucagon like peptide agonist that works like semaglutide and helps reduce hunger and increase satiety. Semaglutide has proven to be more effective at weight loss than liraglutide.

Naturally the next step was to study the efficacy of how well semaglutide would work for weight loss, hence the Semaglutide Treatment Effect in People (STEP) trials 1-5. All the STEP trials included diet and exercise but at different intensities with the use of semaglutide weekly injection versus placebo. Typically weight management is recommended using lifestyle changes such as reducing caloric intake, increasing physical activity and exercise, and behavioral modifications.


Semaglutide is approved for weight management for patients with BMI equal to or greater than 30 or for those with BMI equal to or greater than 27 and at lease 1 weight associated comorbidity such as high blood pressure, or dyslipidemia.


The side effects of semaglutide typically include nausea, abdominal pain, diarrhea, constipation, gastric reflux, fatigue, muscle atrophy. The effects are more noticeable with rapid dose increases. The more serious side effects include gallbladder disease and biliary tract disease including cholelithiasis -gall stones, and cholecystitis-inflammation of the gallbladder. Another serious complication can be pancreatitis-inflammation of the pancreas. Medullary thyroid cancer has been reported in humans with the use of liraglutide which has been in use longer. There is an increased risk of diabetic retinopathy for those that have diabetes and have a history of diabetic retinopathy and a rapid reduction in the A1c. Acute kidney injury may occur secondary to nausea, vomiting, and diarrhea. Bowel obstruction may occur with the slowing of the gastric tract and constipation. Low blood glucose or hypoglycemia can also be an issue. Because of these side effects, we always encourage hydration, smaller portion sizes and eating until you feel full rather than cleaning off your plate. We also review history to ensure you don't have the contraindications of pancreatitis or thyroid cancer before we start you on GLP -1 agonist like semaglutide or tirzepatide.


Here at Optimal Hormones Medical we help you manage your weight goals with nutrition counseling, exercise and increasing activity in addition to safely prescribing semaglutide.

We monitor your weight and implement a plan to come off of the semaglutide also-as it is meant to be a short term booster to help you get to a healthy weight. The key is to learn to eat cleaner or healthier- more lean proteins and more fresh fruits and vegetables, while your stomach size is reduced with less intake while you are on the semaglutide and also when you wean off of it. We want you to feel and look your best. My mottos to live by are "movement is medicine" and "nutritious eating equals a vibrant and healthy life!"


By Satinder Dhillon-Dougher AGCNP-BC


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