SEMAGLUTIDE FOR WEIGHT LOSS

Providers who prescribe Ozempic or other forms of semaglutide have different opinions on who makes a good candidate. 

Some must adhere strictly to on-label, FDA-approved indications, to comply with state licensing laws, offering Ozempic only to people who have Type 2 diabetes; and Wegovy only to chronically obese patients or those who are overweight with co-existing health conditions.

Others prescribe compound semaglutide to healthy people who aren't technically overweight, but have put on pounds and are having trouble returning to their baseline weight, despite routine exercise and healthy eating.

The main contraindication for semaglutide is a personal or family history of certain thyroid cancers (more on this below).

Pregnancy is another disqualifying factor. “The medication must be stopped at least 6 weeks prior to planned pregnancy, as the active ingredient has the potential for fetal harm,” cautions Dr. Jennifer Bourgeois, a clinical pharmacist in McKinney, Texas.

Most doctors also refuse to offer the drug to patients with a history of pancreatitis, active pancreatitis, or gallstones, which can trigger pancreatitis.

According to Dr. Giese, “people with obesity or who are overweight with another medical problem should contact their primary care doctor to obtain a prescription for Wegovy, Zepbound, or Ozempic.”

She says that people who have seen their weight drift up and haven’t successfully lost unwanted pounds with diet and exercise alone may be good candidates for a more comprehensive program, like the one she offers her patients. It includes “custom semaglutide dosing, weekly nutritional coach follow-up, dietary and behavior counseling as desired, weight maintenance, and eventual weaning off of the medication.”

With interest in the new drug surging, all manner of medical providers have begun prescribing semaglutide. 

Endocrinologists and doctors who specialize in diabetes treatment and weight loss medicine have the most experience with GLP-1 receptor agonists, but “all medical doctors and advanced practice providers, such as physician assistants and nurse practitioners, can prescribe semaglutide medications at their discretion,” says Dr. Thais Aliabadi, a board-certified OB-GYN in Los Angeles who specializes in medically assisted weight loss.

A number of plastic surgeons also prescribe the drug, often as a way to help patients reach their goal weight before surgery.

It’s also possible to get the prescription drug online via telehealth sites, some of which offer quick virtual consultations.

Many physicians worry that not all semaglutide prescribers are equally qualified to “oversee the use of a powerful drug with multiple potential side effects,” cautions Dr. Evan Garfein, a board-certified plastic surgeon in New York City. “Any doctor who prescribes it must be careful about drug interactions for individual patients and other medical or surgical issues that can be affected by the possibility of hypoglycemic states.”

According to the Mayo Clinic, semaglutide does not cause hypoglycemia (low blood sugar) on its own. But low blood sugar can occur if patients combine semaglutide with other medications, such as insulin or sulfonylureas. 

If you choose to get a prescription online, follow up with your primary care provider to ensure that you’re a good candidate, and reach back out to them if you experience unwanted side effects.

Pros

• Semaglutide, the active ingredient in Ozempic and Wegovy, induces and accelerates success of weight loss. When used as an obesity medicine, the drug has been shown to cause significant weight loss of up to 100 pounds in some patients.
• Wegovy’s safety and efficacy were studied in four 68-week randomized, double-blind, placebo-controlled clinical trials. According to the FDA, “individuals who received Wegovy lost an average of 12.4% of their initial body weight compared to individuals who received placebo.”
• Semaglutide has been shown to curb food cravings. 
• The drug can also (indirectly) reduce the risk of major cardiovascular events (heart attack, stroke) in adults with Type 2 diabetes and established cardiovascular disease.  “Staying closer to your low weight as an adult decreases cardiometabolic risk factors for the rest of your life,” explains Dr. Giese.

Cons

• Both brand-name and compounded forms of semaglutide can be expensive, and insurance doesn’t always cover it.
• While semaglutide does come in pills (Rybelsus), the most common and effective forms of the medication must be injected at home once a week.
• Like all medications, this one has risks, side effects, and contraindications (more on that below). 
• Weight regain can occur after you stop taking semaglutide if you don’t maintain lifestyle changes, like regular exercise and a healthy diet with reasonable portions. 

Related: Why I Decided to Take Ozempic After Losing 100 Pounds Naturally

• Average Cost:
• $694

• Range:
• $150 - $1,501

Patient reviewers on RealSelf say semaglutide costs $694 per month, on average. 

SingleCare, an online prescription discount site, reports that Wegovy costs $1,750 per month, on average, while Ozempic costs $1,205 for four 1 mg doses and $1,368 for four 0.5 mg doses, without insurance coverage.

Some doctors offer compounded semaglutide as part of weight-management programs, which typically include the drug itself, as well as monitoring, coaching, and lab work. 

“In our office, the total all-in cost per month is around $600,” says Dr. Jonathan Kaplan, a board-certified plastic surgeon in San Francisco who prescribes semaglutide to patients as part of a comprehensive weight management program, which includes drug monitoring, coaching, and scale and lab work, along with the monthly cost of the semaglutide injections and shipping. 

Board-certified plastic surgeon Dr. David Shafer offers a similarly comprehensive weight management program, which includes semaglutide, for $510 to $610 per month. 

Dr. Giese says her customized elective weight loss program costs about $600 per month. Her plan features semaglutide compounded with vitamin B12.

For patients with Type 2 diabetes, some insurance companies (including Medicare) will cover Ozempic. Every plan is different, however, so you’ll need to consult your insurer for specifics. “Some insurance plans have great coverage with little out-of-pocket expense,” says Dr. Kaplan. “However, I've also seen some plans ‘cover it,’ but the patient still has a $900 copay.”

The manufacturer of Ozempic also offers savings of up to $150 per month, for up to 3 months, for "commercially insured patients with coverage."

Weight loss medications, including Wegovy, are covered by some insurance plans for qualified patients. Ask your insurer how to qualify.

If your plan includes coverage, keep in mind that “the medications usually require prior authorization, which means the provider has to seek special approval for insurance to cover the medication,” explains Dr. Bourgeois. “For instance, if a patient is seeking medication for weight loss, the provider may need to submit information proving the patient is clinically obese.”

The medication will also have to be in stock and available at the pharmacy, notes Dr. Giese—which can sometimes be a challenge, given that demand may exceed supply.

“Medicare doesn’t cover anti-obesity medications at this time,” notes Dr. Aliabadi.

The semaglutide before and after pictures in our gallery were shared by the prescribing doctors, with their patients' permission.

Ozempic and other branded GLP-1 medications are FDA approved and considered safe, provided you’re a good candidate and are being monitored by a physician and dietician throughout your treatment. 

Several studies have proven both Ozempic and Wegovy to be safe and effective drugs for managing the chronic medical conditions of Type 2 diabetes and obesity, respectively.

Recent and ongoing studies have also shown cardiovascular benefits of semaglutide and its ability to lower the risk of heart disease, heart attack, and stroke in patients with diabetes and obesity.

The most common side effects of semaglutide are gastrointestinal, including: 

• nausea
• vomiting
• diarrhea
• constipation
• bloating
• belly pain 

Some Ozempic patients note that they feel more tired and experience insomnia. “Many people have decreased energy and feel a little foggy,” adds Dr. Jennifer Levine, a board-certified plastic surgeon in New York City. 

These symptoms can be minimized by slowly introducing the drug, gradually upping the dosage, and making sure you’re still eating enough to give your body the energy it needs to get through the day.

Semaglutide carries a small risk of gallbladder problems and pancreatitis, and a theoretical risk of a specific type of thyroid tumor. “Thyroid cancer has been seen only in lab rats, not humans, but if you have a history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2, you shouldn't take these medications,” says Dr. Kaplan.

Related: Experts Set the Record Straight on Ozempic Myths and Rumors

Many providers prescribe or source semaglutide from compounding pharmacies, where it’s more readily available than brand name forms. The active ingredient from accredited compounding pharmacies in the U.S. is nearly identical to that found in Wegovy and Ozempic.

“Regulations restrict compounding pharmacies from making replications of patented therapeutics, so some compounding pharmacies are combining semaglutide with other ingredients, such as L-carnitine and B-6,” explains Dr. Bourgeois. 

Compounded drugs are not FDA approved, but their active ingredient is. The FDA also allows for duplication of branded drugs that are backordered or otherwise unattainable for various reasons (provided they’re on the FDA’s official drug shortage list). When drug manufacturers like Novo Nordisk can’t meet the demand for their product, compounding is permitted to help patients avoid gaps in treatment.

The providers we spoke with urge patients considering compounded semaglutide to procure it through a reputable provider who can vet the drug supplier, explain all of the potential risks, and monitor your weight-loss journey. 

You’ve no doubt heard of “Ozempic face,” the buzzy term for losing facial fullness as a consequence of the drug’s efficacy. 

Fat helps support the skin, and dramatic weight loss can contribute to deflation and laxity—on the face and body. (Enter: “Ozempic butt.”) While fillers and fat grafting can help restore facial volume, a surgical facelift or tuck may be needed to tailor loose, hanging skin. 

Semaglutide can also spark short-term hair loss in some patients. Talk to your doctor about supplementing your diet with the basic nutrients needed for healthy hair as well as ways to stem shedding and jumpstart new growth.

Both Ozempic and Wegovy are once-weekly injections that can be delivered into the lower abdomen, thigh, or upper arm. These branded forms of semaglutide come in pre-filled, self-injectable pens. Compounded versions of the medication are typically dispensed in a sterile vial and administered via syringe.

Since Ozempic is not approved to treat obesity, there is no formal Ozempic dose for weight loss, but the typical starting dose is .25 milligrams once a week, while the maximum high dose is 2 milligrams. 

“The .25 mg dose is just so our body can get used to the medication,” says Dr. Aliabadi. “The therapeutic doses start at 0.5 mg once a week.” 

Dr. Giese recommends finding a provider who will tailor your dosage and adjust it as needed, paying attention to what’s working best for your body. That’s one of the big benefits of working with a prescribing provider, rather than going with a more hands-off telehealth option.

“My goal is to get people to appetite suppression and weight loss as quickly as possible, while avoiding side effects,” says Dr. Giese. “There really is no norm here, and individuals vary vastly. Some people take the same small dose for a month and much longer with success. With others, we slowly amp up the dose, as soon as one week. I have men over 200 pounds who are taking doses lower than my 120 pound female patients.”

Dr. Aliabadi typically recommends that her patients titrate their weekly dose up gradually, spending two to four weeks at each dose. If side effects are mild, the dosage can gradually increase to .5 mg, then 1 mg, then 1.7 mg, with a maximum dose of 2.4 mg at the 17-week mark.

A 2022 study of adults with obesity found that Wegovy was safe and effective for over 104 weeks.

How long your treatment takes will depend on how much weight you have to lose. Some patients take semaglutide for just a few months, whereas others—particularly those with chronic obesity—may stay on it indefinitely.

“Semaglutide injections are approved for long-term treatment of obesity, so they can be used as long as it’s beneficial for the patient,” says Dr. Bourgeois.

Dr. Aliabadi shares that most of her patients use the medication for about one to two years. 

Dr. Giese recommends that her patients “stay on medication until their target weight is attained and maintained for a period of time, then wean off.” She also continues to monitor their results, to prevent rebound weight gain. “If someone gains 3-5 pounds after stopping the medication, I recommend they restart.”

Patients typically see some weight loss in the first month of semaglutide use, with significant results within four to six months. 

“Most of my patients lose a half to two pounds a week,” notes Dr. Giese. “Over time, I see people losing about one pound a week. The weight loss is steady and slow, not rapid.” She also notes that it’s possible to experience weight loss plateaus that require “additional intervention and analysis.”

One key to steady, sustained, and lasting weight loss is adopting healthy lifestyle choices and behaviors, including regular exercise and a healthy, balanced diet. 

Related: I’ve Been Taking Ozempic for Weight Loss for 3 Months—Here’s What It’s Really Like

Because the drug delays gastric emptying and keeps food in your stomach for longer, it’s important to eat a clean diet with reasonable portions of lean protein and veggies.

Dr. Aliabadi advises patients to focus on soluble fiber and healthy fats, while avoiding grease, carb-rich foods, spicy foods, and carbonated beverages. 

Steer clear of foods that make you feel full or bloated, which could exacerbate semaglutide’s GI side effects. Eating small portions more frequently can also help. 

Semaglutide lowers one's thirst drive in a similar way to how it lowers hunger, but it’s critical to stay hydrated, to help minimize side effects like nausea and constipation. If you’re aware of being thirsty, you are already dehydrated.   

Working with a dietician can help you maximize your results and minimize the unwanted side effects that can come with being hungry or not getting all the nutrients you need.

Recent research suggests that many patients gain weight back after they stop taking semaglutide. However, it’s possible to avoid a rebound effect by maintaining the lifestyle modifications that have been adopted during the course of treatment, says Dr. Giese. She also says it’s worth considering restarting the medication if you regain 3-5 pounds. 

Dr. Kaplan agrees that lifestyle changes are essential to long-term results. “The idea is to use the medication, in combination with behavioral changes, like exercise and a healthy diet, to get to an ideal weight, and then get off the medication and continue the healthy lifestyle.”. 

Most patients are deeply motivated to do this because they love the way they look and feel, and realize that their new habits can help keep them in this happy place, even after they stop injections.