Rapid Weight Loss and Semaglutide
Is it a magic shot?
According to the NIH about 42% of adults in the United States have obesity (link). Obesity is defined as having a body mass index of greater than 30. BMI itself is a rather rudimentary tool to gauge body composition by dividing body mass in kg by the square of height in m resulting in a unit of kg/m^2. Even myself, weighing in at 90kg and 1.88m tall. This results in a BMI just over 25 and in the “overweight” category by NIH and CDC definition, despite being <10% body fat.
Now it would be naive to assume a significant amount of adults fall in the same category as myself. Even though it’s rudimentary, BMI is a rough value indicating what we see with our own eyes; an obesity epidemic in America.
The natural response to a market approximately 88 million people large is to serve that market with a product. Semaglutide was originally approved in 2017 and one of the first brands to market it was Ozempic, with a relatively lower dose of semaglutide at 1.0mg per week.
Another naive assumption is thinking only obese people will use semaglutide, which is currently listed at a shortage nationwide. The interesting fact about semaglutide was it wasn’t always focused on bodyweight and obesity. Rather, it started as a drug to manage type II diabetes.
In 2012, a team of researchers at Novo Nordisk (behind Ozempic) developed semaglutide as a once-weekly injection diabetes therapy, whose clinical trials concluded in 2017 along with its approval.
Numerous studies during and after the release of Ozempic found semaglutide to be extremely effective at reducing weight in the patients being treated for diabetes. In 2021, the FDA approved the use of semaglutide specifically for weight loss.
On July 7th, 2022, a paper titled “An inter-organ neural circuit for appetite suppression” was published in the major publisher Cell. This paper outlined the specific mechanism that GLP-1 acts to create satiety in our bodies. Semaglutide, after all, was used because it is one of the most effective GLP-1 agonists.
GLP-1, or glucagon-like peptide 1, is a small protein naturally produced in the human body. It can suppress appetite through at least two mechanisms through parallel pathways in our body. Parallel pathways are just pathways in the body that operate independently of one another to accomplish a common goal. GLP-1 acts on at least two pathways in the body and the brain. In one pathway, it acts on receptors in the body, specifically the enteric nervous system. GLP-1 binds to neurons that causes gut distension, and a feeling of fullness. In the second pathway, GLP-1 follows a pathway from the gut to the hypothalamus suppressing appetite and activating satiety in the brain. These two pathways show a parallel action between the brain and body in pursuit of a common goal - satiety.
A GLP-1 agonist therefore binds to GLP-1 receptors thus stimulating further release of GLP-1 in the body. Semaglutide itself is known as an incretin mimetic. Incretins are natural to the human body, and are gut hormones that are secreted from enteroendocrine cells into the blood within minutes after eating. Mimetic simply means semaglutide acts like incretins such as GLP-1.
All this explanation to understand one simple thing: subcutaneous semaglutide injections can lead to massive weight loss. Brands like Wegovy and Ozempic create once-per-week shots for patients to inject under their skin to create long lasting effects of satiety, often off of much smaller meals than normal. As a result they experience drastic weight loss in short periods of time.
Fun fact: Yerba Mate actually stimulates the release of GLP-1 (and thus minor appetite suppression), as well being a significant source of caffeine.
The question remains, is semaglutide a magic shot? Like anything in this world, there are drawbacks. Some patients experience nausea, vomiting, GI issues, stomach pain, thyroid tumors and cancer, pancreas inflammation, kidney failure, and gallbladder issues. Everyone’s response is different, but the fact remains these potential side effects should be taken account into a future patient’s risk profile prior to using semaglutide. Additionally, reports of “Ozempic Face”, or a gaunt look from massive weight loss in the face are now coming out. But skin sagging should be expected if someone were to lose a massive amount of weight.
Up until recently, nothing really existed that is producing results similar to semaglutide. Celebrities, athletes, and Elon Musk are even using it to produce satiety and lose weight quickly. It may seem like ‘magic’ to those that just aren’t able to regulate themselves when it comes to nutrition. I always stand by nutrition and exercise fundamentals when it comes to weight management. Those that look for the magic pill or the magic shot are those that are considered “majoring in the minors” rather than the majors. Many look for the easy way out, regardless of if around body weight or other topics.
As of now, no major reports including large amounts of people are experiencing major side effects. Time will tell with a large enough market using these injections to produce results what the long term damage could look like. I think the pharmacological side of semaglutide is extremely interesting and merited this write up. I hope you enjoyed, and if you have any questions don’t hesitate to reach out.