Does Semaglutide Work For Weight Loss?

Semaglutide was developed in 2012 as a treatment for type 2 diabetes. It is a member class of drugs called GLP 1 agonists. In 2021 a research paper was published in the New England Journal of Medicine showing that a once weekly injection of Semaglutide could produce significant weight loss in test subjects. 50% of those tested lost over 15% of their body weight and 30% of those tested lost over 20% of their body weight compared to a 2% reduction in the control group, Subjects treated with Semaglutide also showed improvements in their liver function tests, improvement in their fasting insulin levels, and reduction of their visceral fat.

Since that paper was published, there has been a dramatic increase in the interest in and the usage of Semaglutide and other GLP 1 agonists. They are commonly marketed under the brand names Ozempic, Wegovy, and Mounjaro. Let us examine what these drugs are, how they work, and the practicality and safety of using them.

How does Semaglutide work?

After consuming food, cells lining the small intestine secrete a hormone called GLP 1, short for glucagon like peptide. GLP 1 travels to the liver where it acts to decrease the effects of glucagon secretion. Glucagon is a hormone released by the alpha cells of the pancreas whose function is to cause the liver to release glucose into the bloodstream by breaking down glycogen and synthesizing new glucose molecules. Its purpose is to increase your blood sugar and works in the opposite way that insulin works. Therefore, in a fed state, glucagon levels are decreased, and insulin levels are increased. GLP 1 has a very short half- life; in other words, it only stays in your system for several minutes before it is broken down by a chemical called DPP4 (dipeptidyl pepsidase IV).

What if we could make an agonist to GLP 1 that does not break down so rapidly?? An agonist is a substance that mimics a hormone or a neurotransmitter. How would that work in a human body?

GLP 1 agonists are analogs of GLP that are not readily broken down by DPP4. Since they remain in circulation significantly longer, GLP 1 agonists produce the effect of making your internal sensing mechanisms act as if you have just eaten. Glucagon levels decrease and insulin levels increase, reducing circulating blood sugar levels and reducing the release of glucose from the liver. Additionally, there are two other very powerful actions that GLP 1 agonists produce with respect to appetite. One is delayed gastric emptying, so after you eat you feel fuller for a longer period of time. The other is they inhibit the hunger centers in the brain so you significantly reduce the desire to consume calories.

Health benefits of Semaglutide

There are many other health benefits related to Semaglutide. It is associated with increased insulin sensitivity. It has been shown to be an effective treatment for NAFLD (non-alcoholic fatty liver disease). Recent studies have shown Semaglutide reduces the risk of heart attacks, strokes, or heart related deaths in patients with cardiovascular disease by 20% and improves the symptoms of those patients who have congestive heart failure.

Most patients tolerate treatment very well. Semaglutide is administered by a once weekly injection. Side effects of administration of Semaglutide are mostly related to the intestinal tract. The biggest side effect is nausea. Patients also sometimes complain of abdominal pain, diarrhea and bloating. There are rare instances of pancreatitis. It is contraindicated in patients with a history of thyroid cancer or multiple endocrine neoplasia type 2.

There is another benefit to Semaglutide which is becoming more apparent for patients who are considering plastic surgery. Many people want to lose weight prior to having a cosmetic procedure. Often, this is very difficult. With the availability of GLP 1 agonists, this goal is much more obtainable. Specifically, with respect to abdominoplasties, breast lifts, and facelifts, significant weight loss after the procedure could possibly compromise the results, but significant weight loss before the procedure could improve the results and reduce the surgical risks.

Semaglutide, and more recently Tirzepatide (a newer and more effective GLP 1 agonist) are soaring in popularity and providing a powerful mechanism for improving health, enhancing appearance, and combating the obesity epidemic that is so prevalent today. Metabolic dysfunction is a precursor to so many chronic diseases that limit healthspan and lifespan. We now can make earlier interventions to mitigate the effects of poor blood sugar regulation and obesity. If you are considering starting any of these GLP 1 agonists, please do so under the care and direction of a qualified medical practitioner.

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