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Updated: Oct 2, 2023


Low Dosing, A Low Carb Diet, Intermittent Fasting, and An Exercise Regimen Facilitate Getting Off the Medication Without Weight Regain.

Paul Kolodzik, MD, FASAM, FACEP

Medical Director, Metabolic MD

What is Semaglutide (Ozempic/Wegovy)?

Ozempic (semaglutide) has received much attention recently for its effectiveness as a weight loss medication. Ozempic is an FDA-approve medication originally prescribed to diabetics for the purpose of controlling blood glucose. This medication (exact same medication) has also been branded as Wegovy when used for weight loss. Generic Compounded Semaglutide is also availble through providers such as Metabolic MD who arrange to have the medication supplied to our patients through licensed pharmacies. All three formulations (Ozempic, Wegovy, Compounded Generic Semaglutide) are once-weekly injectable medications. When treatment is initiated, they are started as a low dose, and the dose is gradually increased until a therapeutically effective dose is reached. These drugs belong to a class of medications called the “GLP-1 Agonists”. They mimic the body’s natural GLP-1 gastrointestinal hormones.

The best dose for Semaglutide is the lowest dose that is needed to achieve effective weight loss. Unfortunately, many patients are treated with higher than necessary dosing, and not as part of a comprehensive weight and health improvement program. They become dependent on the medication. Medication dependence can occur because of the high risk of weight regain when discontinuing the medication. Lower dosing and lifestyle changes while under treatment minimizes this risk.

In the initial studies on diabetics this medication was found to be very effective at lowering blood sugar with the added benefit of achieving weight loss. After seeing the weight loss this medicine achieved in patients with Type II diabetes, the manufacturer of Ozempic performed studies seeking FDA approval for the treatment of obesity in nondiabetics. In 2021, semaglutide was approved for weight loss with the brand name Wegovy, and became available to patients as a once-weekly injection to treat elevated Body Mass Index (BMI). The Compounded Generic version, which has the advantage of lower cost, came on the market in 2021 as well.

Of The Three Types of Semaglutide, Which Is the Right One for Me?

The type of semaglutide prescribed to a patient is dependent on both that person’s medical conditions and also on insurance coverage considerations.

For diabetics, Ozempic is usually the most appropriate medication, and is usually covered by insurance. Out of pocket costs are often low. For patients who are not diabetic, however, insurance coverage for Ozempic is rare.

Wegovy can be prescribed for obesity or for overweight individuals who are not diabetic. However, insurance coverage for Wegovy is very limited. In our experience, only 5-10% of private health insurances cover Wegovy. Medicaid and Medicare do not cover Wegovy, and only very generous privately insurances provide coverage for this medication.

The cost for the two branded medications (Ozempic and Wegovy) without insurance coverage can be well over $1,000 dollars per month.

Semaglutide, the generic compounded version of Wegovy and Ozempic, is often prescribed to patients who are not diabetic, and who do not have insurance coverage for Wegovy. Metabolic MD has been providing this medication to our patients for several years. It has been shown to be safe and effective in our patients, and has the advantage of lower cost. Generic Compounded Semaglutide is available at about one third the out-of-pocket cost of the brand name medications.

When & How Should These Medications be Prescribed for Weight Loss?

Metabolic MD only prescribes semaglutide with a focus on using lower doses and only as part of a comprehensive weight loss and metabolic health program. We use these medications in two instances:

· For a patient who wants to get a “jump start” on their weight loss program, but only with the understanding that other lifestyle changes be implemented simultaneously (low carb diet, intermittent fasting, exercise routine emphasizing strength training)

· Temporarily (usually a period of months) for a patient who stalls or plateaus during their weight loss effort, despite participation in a comprehensive program (as outlined above).

One of the goals when using these mediations, is that their use be temporary. We do not believe semaglutide should be prescribe to patients in a manner that commits them to lifetime dependence. This is why we only use them as part of a comprehensive program as outlined above. We do not want to commit our patients to lifetime dependence on semaglutide. Therefore, we use limited (not maximum) dosing so we can eventually titrate our patients off the medication without significant weight regain. Weight regains upon medication discontinuation is very common (often up to 60% of the weight lost), and can only be avoided with the institution of diet and exercise lifestyle changes while under treatment.

How does Semaglutide (Ozempic/Wegovy) work?

Semaglutide (Ozempic/Wegovy) is effective for several reasons. First, it acts on the hypothalamus in the brain, which regulates our sensation of hunger. With this action on the hypothalamus the drug alters the food-reward system and prolongs our sense of fullness (satiety). Semaglutide also slows down the motility of the gastrointestinal tract. Put more simply, it keeps food in your stomach for longer than usual, keeping you full longer. Finally, it lowers blood glucose. When blood glucose is lowered, fatty acids are used by the body as an energy source. When fat is burned, weight is lost.

How Much Weight Can I Lose?

According to medical studies, the average weight loss when using Semaglutide (Ozempic/Wegovy) is about 15% of initial body weight. At Metabolic MD we commonly see patients lose 20%, or even 25% of their initial weight, assuming patients are compliant with other aspects of our weight loss program. Individual weight loss varies depending on your diet and exercise regimen.

We believe a comprehensive program utilizing the following components best achieves optimal weight loss and health improvement:

· A focused low carb diet (best guided by the use of a continuous glucose monitor)

· Intermittent fasting

· An exercise regimen with a focus on strength training.

Semaglutide (Ozempic/Wegovy) can help you lose weight, but that weight loss is likely not to permanent after medication discontinuation, without lifestyle changes. Weight regain after stopping the medication is common, unless diet and exercise lifestyle changes have been ingrained. In our practice, we help our patients address the root causes of weight gain with a comprehensive program. We look to help our patients implement healthy lifestyle changes that will last a lifetime, and prevent weight regain when the medication is discontinued.

How Fast Does Semaglutide (Ozempic/Wegovy) Work?

The short answer is that many of our patients begin to lose weight in the first month. The first dose is small, but then the dose is titrated up over the following months. These lower doses are primarily used to gently introduce the medication to the body without risking developing significant side effects (mostly nausea).

All studies done on weight loss with this medication, Semaglutide (Ozempic/Wegovy), have shown effectiveness only when it is used in combination with an effective diet and exercise plan. At Metabolic MD, we believe the most effective dietary approach is a low carb diet, and the best exercise plan includes strength training. Our Semaglutide prescribing always is accompanied by detailed guidance related to your diet and an appropriate associated exercise regimen. We have proven that an extremely effective approach to weight loss is a continuous glucose monitor guided low carb diet in conjunction with semaglutide.

Who is Eligible for Weight Loss Treatment with Semaglutide (Ozempic/Wegovy)?

There are two qualifications for treatment with Semaglutide (Ozempic/Wegovy):

1. A Body Mass Index (BMI) over 30 (without any weight-related

complications or other conditions), OR

2. A BMI over 27 with weight-related complications such as

hypertension, high cholesterol, diabetes, obstructive sleep

apnea, fatty liver disease, etc.

Does Semaglutide (Ozempic/Wegovy) have side effects?

Some people can have mild to moderate side effects, however most of these are manageable by proper dosing. Significant side effects may occur, but in our experience are very rare.

The most common side effects are: nausea, diarrhea, vomiting, constipation, mild stomach pain, mild headache, fatigue, feeling bloated, belching, gas, stomach flu, and heartburn. We see some mild nausea in many patients, however based on our dosing regimens, we have found that other side effects are very rare.

How Should Dosing Be Approached?

Semaglutide (Ozempic/Wegovy) is taken as a once weekly injection “escalating” dose. This means you start the medication at a low dose, and increase the dosage gradually over a period of months. Progression on this regimen assumes side-effects are minimal. We have not had any patients need to discontinue treatment due to side effects.

We weigh several factors when deciding how and when to increase the dose for our patients. The first is whether you experienced significant side effects during your week of treatment during initiation or as the dose is increased. How fast dosing is increased for our patients is individualized and tailored to the needs of each patient. The individualized approach allows us to maximize the benefits of the medication while keeping side effects to a minimum. It also allows for lower dosing regimens that facilitate eventual medication discontinuation.

Metabolic MD also has a philosophy of utilizing the lowest dose necessary to achieve effective weight loss. This is for two reasons. Avoiding high doses helps to avoid wight regain when patients are titrated back down and off the medication. Also, higher doses of medication can result in significant muscle loss. Lower dosing (in conjunction with the strength training guidance we provide) helps avoid muscle loss. This is especially important for older patients and in women at risk for osteoporosis.

How Do You Administer Semaglutide (Ozempic/Wegovy)?

This medication is a taken as a once-weekly subcutaneous injection. This injection is self-administered at home with a VERY SMALL (31 gauge) needle into the abdominal area. If the brand names medicines are utilized, they are provided as an injectable pen. If a generic is provided, it must be drawn up into an insulin syringe form a vial. It is then injected in a manner similar to an insulin injection. The injection cannot be said to be 100% painless, but causes very minimal discomfort for most patients. We walk all our patients through the injection process either in office or by telemedicine.

Who Should Not Use Semaglutide (Ozempic/Wegovy)?

There are some situations where Ozempic is “contraindicated,” meaning an individual with a condition should not use this medicine. The major contraindications to treatment are:

· patients with a personal or family history of medullary thyroid carcinoma

· patients with a personal or family history of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)

· diabetic retinopathy, a type of damage to the eye from diabetes

· a history of recurrent low blood sugar

· recurrent disease of the gallbladder (patients who have had their gallbladder removed are not included in this group)

· decreased kidney function

· pancreatitis

· Inflammatory bowel disease

· patients on any medications that lower blood sugar

· patients on the blood thinner coumadin (also called warfarin)

I Have Heard Semaglutide (Ozempic/Wegovy) Is in Short Supply, and Medication Availability is subject to “Supply Chain” Issues?

Due to the demand for Semaglutide (Ozempic/Wegovy) at times these medications have been in short supply. This has been especially true of Wegovy.

Regarding less expensive Compounded Generic Semaglutide, Metabolic MD, through our relationship with multiple licensed compounding pharmacies, has not had our patients experience any interruption in timely delivery of their medication. However, any patient choosing to pursue treatment with Semaglutide (generic or brand name), should be aware of the potential risk of a supply chain issue, and potential medication unavailability. This is one reason our programs emphasize a comprehensive approach. We believe patients should not become solely dependent on this medication to achieve their weight loss and metabolic health goals.

Is Semaglutide (Ozempic/Wegovy) Covered by Insurance?

As mentioned above Ozempic is covered by most private insurances for those diagnosed with Type 2 Diabetes.

Wegovy is the brand name approved for weight loss in nondiabetics. It can be prescribed to patients with excess weight meeting the high BMI criteria as outlined above. At this time, insurance coverage for Wegovy is very limited, meaning it’s cost may not be covered by most insurances, including Medicaid, Medicare, and a majority of private insurances.

Metabolic MD offers Generic Compounded Semaglutide at a lower cost to our patients in comparison to the out-of-pocket cost of the brand name medications. The monthly cost is usually about one third the out-of-pocket cost for the brand name medications.

“Begin With The End In Mind”

Remember, the best weight loss program for Ozempic includes a plan for eventually stopping the medication. Low dosing, a low carb diet, Intermittent fasting, and an exercise regimen facilitate getting off the medication without weight regain.

How Can I Learn More?

If you have an interest in being prescribed Semaglutide (Ozempic/Wegovy) as part of a comprehensive weight loss and metabolic health program please contact Metabolic MD at this link for a complimentary phone consultation.

Our initial goal is to work with patients and guide them in the process of determining if they are eligible for insurance coverage of Ozempic or Wegovy. If not, we offer our patients the option of compounded generic semaglutide.

Complete our short patient inquiry form and a member of the MetabolicMD team will be in touch with you to arrange your no cost phone consultation.

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